STATE OF CALIFORNIA ADULT SUBACUTE SCH ALLOCATION OF INDIRECT EXPENSES ADULT SUBACUTE Provider Name: SETON MEDICAL CENTER Fiscal Period Ended: JUNE 30, 2008 Provider No: LTC70037G COST CENTER COL 1.00 2.00 3.00 3.01 4.00 4.01 4.03 4.04 4.05 4.06 4.07 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 19.02 19.03 21.00 21.01 22.00 23.00 24.00 101.00 AUDITED CAP RELATED (COL 1) ALLOCATED EXPENSES Old Cap Rel Costs - Bldg and Fixtures Old Cap Rel Costs - Movable Equipment New Cap Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) $ Employee Benefits Non-Patient Telephones Data Processing Purchasing/Receiving Patient Admitting Patient Business Office Administrative and General Maintenance and Repairs Operation of Plant Laundry and Linen Service Housekeeping Dietary Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records and Library Social Service Nursing School Clinical Pastoral Education Intern and Res Service - Salary and Fringes Intern and Res - Other Program Paramedical Ed Program $ 245,950 220,674 0 0 0 8,732 198 12,947 7,441 462 0 24,978 9,520 12,042 9,200 4,013 51,332 20,230 15,811 187,566 3,449 15,815 2,423 0 0 0 0 This is trial version www.adultpdf.com TOTAL ALLOCATED INDIRECT EXPENSES $ AUDITED SAL & EMP BENEFITS (COL 2) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 1,791,244 7,973 24,320 75,568 77 0 249,438 112,802 7,100 23,298 136,906 374,586 149,517 580,760 51,350 16,895 88,551 100,615 0 0 0 0 852,781 $ 3,790,999 (To Adult Subacute Sch 1) 1.00 2.00 3.00 3.01 4.00 4.01 4.03 4.04 4.05 4.06 4.07 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 19.02 19.03 21.00 21.01 22.00 23.00 24.00 25.00 26.00 27.00 28.00 29.00 31.00 31.01 32.00 33.00 34.00 35.00 36.00 36.01 36.02 Nursery Medicare Certified Nursing Facility Distinct Part Nursing Facility Other Long Term Care Subacute Care Unit II Transitional Care Unit Nursing School Clinical Pastoral Education Intern and Res Service - Salary and Fringes Intern and Res - Other Program Paramedical Ed Program INPATIENT ROUTINE COST CENTERS Adults and Pediatrics (Gen Routine) Intensive Care Unit Coronary Care Unit Neonatal Intensive Care Unit Surgical Intensive Care Subprovider Subprovider Psych Administrative and General Maintenance and Repairs Operation of Plant Laundry and Linen Service Housekeeping Dietary Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records and Library Social Service Employee Benefits Non-Patient Telephones Data Processing Purchasing/Receiving Patient Admitting Patient Business Office GENERAL SERVICE COST CENTER Old Cap Rel Costs - Bldg and Fixtures Old Cap Rel Costs - Movable Equipment New Cap Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com 31,063,276 7,164,651 6,280,183 0 0 569,399 12,111,585 6,462,288 0 0 5,821,852 223,990 5,960,225 235,710 0 0 0 42,397,236 913,175 5,742,357 2,202,391 1,660,196 4,878,222 0 20,619,332 3,759,864 3,780,037 1,561,107 3,057,978 2,883,233 1,827,951 4,803,473 1,397,214 3,644,295 2,621,955 579,884 0 0 0 37,500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NET EXP FOR OLD CAPITAL COST ALLOC BLDG & (From Sch 10) FIXTURES 0.00 1.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,296,815 110,084 110,743 0 0 4,190 236,124 245,950 0 0 0 0 0 108,254 5,270 39,177 82,673 72,169 0 0 277,076 115,756 154,622 64,429 31,931 160,588 138,666 54,603 121,356 72,224 187,358 5,856 0 0 0 0 0 0 0 0 128,277 0 0 0 0 0 0 632 869 632 3,949 2,922 0 0 1,744 1,751 6,667 5,443 9,444 4,870 4,192 9,109 1,053 1,540 1,053 0 0 0 0 OLD NEW CAPITAL NEW CAP MOVABLE BLDG & REL COSTS EQUIP FIXTURES BLDG 2.00 3.00 3.01 1,163,540 98,770 99,361 0 0 3,760 211,857 220,674 0 0 0 0 97,129 4,728 35,151 74,176 78,724 0 0 255,989 103,860 138,732 57,808 28,649 144,084 124,415 48,991 108,884 64,802 168,103 5,254 0 0 0 0 NEW CAP REL COSTS MVB 4.00 0 0 0 0 134,989 0 0 0 0 0 665 914 665 4,155 3,075 0 0 1,835 1,842 7,016 5,728 9,938 5,125 4,412 9,585 1,108 1,621 1,108 0 0 0 0 NEW CAP REL COSTS EQUIP 4.01 COMPUTATION OF COST ALLOCATION (W/S B) ALLOC COST 4.03 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.05 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.06 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.07 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 37.00 38.00 39.00 40.00 41.00 41.01 41.02 42.00 43.00 44.00 44.01 46.00 47.00 48.00 49.00 50.00 51.00 52.00 53.00 54.00 55.00 56.00 57.00 58.00 59.00 59.01 59.02 59.03 60.00 60.01 60.02 60.03 60.04 61.00 62.00 71.00 85.00 86.00 96.00 97.00 98.00 99.00 99.01 99.02 99.03 99.04 100.00 100.01 100.02 100.04 100.05 100.07 TOTAL NONREIMBURSABLE COST CENTERS Gift, Flower, Coffee Shop and Canteen Research Physicians' Private Office Nonpaid Workers Satelite Clinic - Airport HIV Serviceis Women Service Line Community Health Education Marketing SF Heart Institute MD Office Building Mission Servicies Auxillary Group Foundation Clinic Wound Care Out-Patient Psychiatry Diabetes Treatment Center OB/GYN Clinic Emergency Observation Beds Home Health Agency Radiology - Therapeutic Radioisotope Laboratory Pathological Lab Whole Blood Blood Storing and Processing Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Gastro Intestinal Services Cardiac Cath Lab CT/MRI ANCILLARY COST CENTERS Operating Room Recovery Room Delivery Room and Labor Room Anesthesiology Radiology - Diagnostic Radiology - P O B TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com 278,609,141 213,432 0 0 0 781,507 635,121 2,994,547 105,880 91,807 8,069,310 1,118,132 142,425 6,529,583 1,164,303 2,077,814 1,699,278 8,219,868 1,652,619 536,586 4,298,321 2,875,053 479,862 205,737 1,371,483 68,665 18,683,105 7,797,109 836,705 2,897,500 1,184,007 2,217,970 162,680 0 1,350,693 371,887 239,997 1,540,437 6,875,131 4,860,028 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NET EXP FOR OLD CAPITAL COST ALLOC BLDG & (From Sch 10) FIXTURES 0.00 1.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,821,852 13,266 0 0 0 6,862 109,370 2,470 26,277 19,817 130,633 58,098 53,139 198,154 0 140,990 80,349 190,250 6,423 0 148,968 30,010 133,835 1,464 74,713 6,112 0 10,028 26,423 163,259 41,098 0 178,850 78,684 17,567 178,831 0 0 223,990 1,474 0 0 0 737 737 0 0 0 4,962 0 0 4,554 0 0 15,578 0 0 0 0 0 0 0 0 11,800 0 0 OLD NEW CAPITAL NEW CAP MOVABLE BLDG & REL COSTS EQUIP FIXTURES BLDG 2.00 3.00 3.01 5,960,225 11,903 0 0 0 6,157 98,130 2,216 23,576 17,781 117,208 52,127 47,678 273,392 141,293 126,500 72,091 184,669 5,763 26,991 133,659 139,996 120,081 1,313 67,034 5,484 0 8,997 136,860 23,708 146,481 36,875 0 160,469 70,597 15,761 70,499 160,453 117,044 0 NEW CAP REL COSTS MVB 4.00 235,710 1,551 0 0 0 776 776 0 0 0 5,222 0 0 4,793 0 0 16,393 0 0 0 0 0 0 0 0 12,418 0 0 NEW CAP REL COSTS EQUIP 4.01 COMPUTATION OF COST ALLOCATION (W/S B) ALLOC COST 4.03 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.05 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.06 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.07 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 1.00 2.00 3.00 3.01 4.00 4.01 4.03 4.04 4.05 4.06 4.07 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 19.02 19.03 21.00 21.01 22.00 23.00 24.00 25.00 26.00 27.00 28.00 29.00 31.00 31.01 32.00 33.00 34.00 35.00 36.00 36.01 36.02 Nursery Medicare Certified Nursing Facility Distinct Part Nursing Facility Other Long Term Care Subacute Care Unit II Transitional Care Unit Nursing School Clinical Pastoral Education Intern and Res Service - Salary and Fringes Intern and Res - Other Program Paramedical Ed Program INPATIENT ROUTINE COST CENTERS Adults and Pediatrics (Gen Routine) Intensive Care Unit Coronary Care Unit Neonatal Intensive Care Unit Surgical Intensive Care Subprovider Subprovider Psych Administrative and General Maintenance and Repairs Operation of Plant Laundry and Linen Service Housekeeping Dietary Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records and Library Social Service Employee Benefits Non-Patient Telephones Data Processing Purchasing/Receiving Patient Admitting Patient Business Office GENERAL SERVICE COST CENTER Old Cap Rel Costs - Bldg and Fixtures Old Cap Rel Costs - Movable Equipment New Cap Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com ALLOC COST 4.08 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,126,141 1,996,828 1,863,665 0 0 194,614 3,579,077 1,799,976 0 122,201 445,593 464,655 0 0 1,687,334 691,325 70,325 783,797 608,759 543,200 1,346,452 45,608 984,434 482,924 186,075 0 0 0 0 EMPLOYEE BENEFITS 5.00 84,690 10,586 10,586 0 0 1,764 22,937 16,762 0 26,466 9,704 20,290 0 0 86,454 32,641 882 3,529 9,704 21,173 7,940 17,644 9,704 22,937 38,816 4,411 0 0 0 0 0 0 0 0 0 0 0 2,922,224 498,020 903,532 0 760,336 760,336 0 0 0 0 0 0 0 0 0 195,003 42,591 37,715 0 0 2,400 102,613 76,465 0 21,525 0 0 58,924 753 3,153 13,009 43,843 210,340 187,654 27,538 12,297 1,072,650 28,563 150 0 0 0 0 459,150 84,064 85,201 0 0 7,797 92,700 111,541 0 0 0 0 0 0 0 0 0 0 0 0 0 936,018 171,371 173,689 0 0 15,894 188,977 227,386 0 0 0 0 0 0 0 0 0 0 0 0 0 NON PATS DATA PURCHASING ADMITTING CASHIERING PHONES PROCESSING RECEIVING COST ACCOUNTS 6.01 6.02 6.03 6.04 6.05 COMPUTATION OF COST ALLOCATION (W/S B) ALLOC COST 6.06 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 6.07 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 6.08 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,324,632 9,678,945 8,661,144 0 0 799,818 16,809,136 9,161,041 0 23,749,024 5,468,128 4,077,426 1,783,889 3,967,073 4,047,559 2,839,822 6,307,305 1,713,757 5,863,502 3,530,881 783,791 0 0 0 37,500 ACCUMULATE COST 4,130,371 901,928 807,085 0 0 74,531 1,566,352 853,667 0 509,545 379,953 166,231 369,670 377,170 264,628 587,743 159,696 546,388 329,024 73,037 0 0 0 3,494 ADMINISTRATIVE & GENERAL 6.00 Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 8.1 37.00 38.00 39.00 40.00 41.00 41.01 41.02 42.00 43.00 44.00 44.01 46.00 47.00 48.00 49.00 50.00 51.00 52.00 53.00 54.00 55.00 56.00 57.00 58.00 59.00 59.01 59.02 59.03 60.00 60.01 60.02 60.03 60.04 61.00 62.00 71.00 85.00 86.00 96.00 97.00 98.00 99.00 99.01 99.02 99.03 99.04 100.00 100.01 100.02 100.04 100.05 100.07 TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 4.08 NONREIMBURSABLE COST CENTERS Gift, Flower, Coffee Shop and Canteen Research Physicians' Private Office Nonpaid Workers Satelite Clinic - Airport HIV Serviceis Women Service Line Community Health Education Marketing SF Heart Institute MD Office Building Mission Servicies Auxillary Group Foundation Clinic Wound Care Out-Patient Psychiatry Diabetes Treatment Center OB/GYN Clinic Emergency Observation Beds Home Health Agency Radiology - Therapeutic Radioisotope Laboratory Pathological Lab Whole Blood Blood Storing and Processing Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Gastro Intestinal Services Cardiac Cath Lab CT/MRI ANCILLARY COST CENTERS Operating Room Recovery Room Delivery Room and Labor Room Anesthesiology Radiology - Diagnostic Radiology - P O B TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com 42,603,915 28,000 0 0 0 95,618 148,349 13,367 0 2,108,294 355,821 1,734,384 240,963 471,046 238,100 1,720,507 0 143,386 1,190,539 488,064 119,481 63,274 414,609 18,337 0 242,577 727,098 361,292 566,769 51,139 0 299,914 86,578 70,599 128,037 2,073,643 1,381,146 0 EMPLOYEE BENEFITS 5.00 1,047,157 1,764 0 0 0 5,293 22,055 36,170 7,058 7,058 81,161 10,586 882 59,107 22,055 12,351 14,115 45,874 0 0 16,762 20,290 0 14,997 2,647 0 3,529 40,581 28,230 2,647 0 22,937 10,586 4,411 30,877 63,518 0 5,844,447 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,744,864 17,221 0 0 0 912 872 12,505 831 37,526 1,255 17,679 47,980 9,936 23,334 110,242 279,742 225,457 6,300 38,080 7,428 11,398 349 4,800 881 2,547,818 11,676 34,530 8,017 48,128 668 0 52,525 5,675 406 7,386 14,342 21,781 0 2,821,577 0 0 0 0 0 0 0 90,482 18,957 47,091 66,404 34,912 69,445 42,417 215,359 3,579 5,139 119,801 37,600 8,505 3,708 66,055 1,018 386,442 313,625 15,326 55,286 17,118 128,866 81,092 0 14,091 1,918 309 3,540 133,037 0 0 5,781,755 0 0 0 0 0 0 0 184,455 38,646 95,999 135,371 71,171 141,570 86,470 439,028 7,295 10,477 244,226 76,651 17,339 7,558 134,659 2,075 787,796 639,351 31,243 112,706 34,896 262,704 165,314 0 28,726 3,911 629 7,217 271,207 29,727 0 NON PATS DATA PURCHASING ADMITTING CASHIERING PHONES PROCESSING RECEIVING COST ACCOUNTS 6.01 6.02 6.03 6.04 6.05 COMPUTATION OF COST ALLOCATION (W/S B) ALLOC COST 6.06 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 6.07 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 6.08 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 278,609,141 288,612 0 0 0 897,862 1,013,897 3,058,101 110,567 149,549 44,655 10,819,069 1,653,622 404,892 9,054,560 1,684,632 3,063,051 2,343,063 11,304,644 1,901,135 728,879 6,190,355 3,707,064 890,500 283,403 2,148,351 105,218 22,405,161 8,750,085 1,160,081 4,004,561 1,655,461 3,562,407 541,514 0 2,108,205 629,837 349,679 1,757,116 9,761,739 6,473,243 0 ACCUMULATE COST 23,749,024 26,894 0 0 0 83,667 94,480 284,968 10,303 13,936 4,161 1,008,170 154,092 37,730 843,745 156,982 285,429 218,337 1,053,418 177,156 67,920 576,845 345,441 82,981 26,409 200,193 9,805 2,087,815 815,373 108,102 373,163 154,263 331,961 50,461 0 196,452 58,691 32,585 163,736 909,643 603,206 0 ADMINISTRATIVE & GENERAL 6.00 Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 8.1 1.00 2.00 3.00 3.01 4.00 4.01 4.03 4.04 4.05 4.06 4.07 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 19.02 19.03 21.00 21.01 22.00 23.00 24.00 25.00 26.00 27.00 28.00 29.00 31.00 31.01 32.00 33.00 34.00 35.00 36.00 36.01 36.02 Nursery Medicare Certified Nursing Facility Distinct Part Nursing Facility Other Long Term Care Subacute Care Unit II Transitional Care Unit Nursing School Clinical Pastoral Education Intern and Res Service - Salary and Fringes Intern and Res - Other Program Paramedical Ed Program INPATIENT ROUTINE COST CENTERS Adults and Pediatrics (Gen Routine) Intensive Care Unit Coronary Care Unit Neonatal Intensive Care Unit Surgical Intensive Care Subprovider Subprovider Psych Administrative and General Maintenance and Repairs Operation of Plant Laundry and Linen Service Housekeeping Dietary Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records and Library Social Service Employee Benefits Non-Patient Telephones Data Processing Purchasing/Receiving Patient Admitting Patient Business Office GENERAL SERVICE COST CENTER Old Cap Rel Costs - Bldg and Fixtures Old Cap Rel Costs - Movable Equipment New Cap Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com 1,191,366 101,132 101,738 0 0 3,850 544,579 225,951 0 142,049 76,219 43,237 171,653 139,830 60,871 134,754 69,041 176,057 8,069 0 0 0 0 MAINT & REPAIRS 7.00 938,991 79,709 80,186 0 0 3,034 429,217 178,086 0 60,073 34,078 135,291 110,209 47,976 106,208 54,416 138,762 6,360 0 0 0 0 OPER PLANT 8.00 662,081 69,910 69,709 0 0 0 792,274 127,419 0 0 0 0 0 0 0 0 0 1,264,847 206,506 116,159 0 0 0 1,058,341 180,692 0 148,426 0 58,080 58,080 0 0 0 0 0 LAUNDRY & LINEN HOUSEKEEP 9.00 10.00 1,890,079 67,355 142,194 0 0 0 2,144,002 636,468 0 0 0 0 0 0 0 0 DIETARY 11.00 725,613 127,955 121,417 0 0 0 427,168 206,472 0 112,817 4,854 91,377 75,163 22,080 0 0 0 0 CAFE 12.00 0 0 0 0 0 0 0 0 0 0 0 0 0 MAINT OF PERSONNEL 13.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 0 0 0 0 0 2,374,966 432,373 412,395 0 0 0 1,477,195 713,680 0 NURSING ADMIN 14.00 637,956 148,396 134,837 0 0 10,399 219,726 310,467 0 6,882 0 0 0 0 CENTRAL SERVICE & SUPPLY 15.00 38,661 9,025 7,467 0 0 192 8,056 24,190 0 0 0 0 0 0 PHARMACY 16.00 691,577 126,617 128,330 0 0 11,743 139,625 168,004 0 0 0 0 0 MEDICAL RECORDS & LIBRARY 17.00 0 0 0 0 334,552 29,678 30,053 0 0 0 387,013 112,042 0 SOCIAL SERVICE 18.00 Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 8.2 37.00 38.00 39.00 40.00 41.00 41.01 41.02 42.00 43.00 44.00 44.01 46.00 47.00 48.00 49.00 50.00 51.00 52.00 53.00 54.00 55.00 56.00 57.00 58.00 59.00 59.01 59.02 59.03 60.00 60.01 60.02 60.03 60.04 61.00 62.00 71.00 85.00 86.00 96.00 97.00 98.00 99.00 99.01 99.02 99.03 99.04 100.00 100.01 100.02 100.04 100.05 100.07 TOTAL NONREIMBURSABLE COST CENTERS Gift, Flower, Coffee Shop and Canteen Research Physicians' Private Office Nonpaid Workers Satelite Clinic - Airport HIV Serviceis Women Service Line Community Health Education Marketing SF Heart Institute MD Office Building Mission Servicies Auxillary Group Foundation Clinic Wound Care Out-Patient Psychiatry Diabetes Treatment Center OB/GYN Clinic Emergency Observation Beds Home Health Agency Radiology - Therapeutic Radioisotope Laboratory Pathological Lab Whole Blood Blood Storing and Processing Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Gastro Intestinal Services Cardiac Cath Lab CT/MRI ANCILLARY COST CENTERS Operating Room Recovery Room Delivery Room and Labor Room Anesthesiology Radiology - Diagnostic Radiology - P O B TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com 5,977,673 15,953 0 0 0 8,187 100,477 1,883 2,269 24,140 18,206 120,011 53,374 48,818 292,605 144,672 129,525 73,815 200,718 5,901 27,637 136,855 183,134 122,953 1,345 68,638 5,615 0 9,212 140,133 24,274 149,984 37,757 0 164,307 72,285 16,138 72,185 194,431 119,843 0 MAINT & REPAIRS 7.00 4,599,429 12,574 0 0 0 6,453 79,192 1,484 1,789 19,026 14,349 94,588 42,067 38,477 230,621 114,025 102,087 58,179 158,199 4,651 21,782 107,864 144,340 96,907 1,060 54,098 4,425 0 7,261 110,448 19,132 118,212 29,758 0 129,501 56,973 12,720 56,893 153,244 94,456 0 OPER PLANT 8.00 2,086,413 0 0 0 0 0 0 0 53,859 0 66,473 0 14,650 0 0 0 19,252 0 0 0 31,151 20,160 0 12,098 0 147,375 0 0 4,414,057 0 0 0 0 77,440 0 0 258,132 0 225,866 0 0 135,519 0 0 0 0 0 0 0 45,173 167,786 0 0 45,173 367,838 0 0 LAUNDRY & LINEN HOUSEKEEP 9.00 10.00 4,880,098 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DIETARY 11.00 3,354,489 3,481 0 0 0 12,340 14,577 2,981 3,584 3,228 167,371 30,196 161,922 24,239 41,146 20,782 205,167 0 10,057 119,632 62,915 12,465 6,623 34,819 2,657 0 28,436 67,753 21,596 29,649 0 29,486 12,172 8,684 20,419 147,981 133,215 0 CAFE 12.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MAINT OF PERSONNEL 13.00 COMPUTATION OF COST ALLOCATION (W/S B) 7,116,713 0 0 0 0 38 0 0 393,358 110,496 54,915 0 7,207 320 0 31,080 2,177 62,881 621 10,531 0 0 147,672 78,995 57,675 0 81,768 0 475,013 191,354 0 NURSING ADMIN 14.00 2,177,348 0 0 0 0 35 1,688 0 24,957 2,802 11,689 14,569 5,508 646 23,524 215,005 0 22,030 429 16,309 16,227 8,145 2,771 0 50,818 14,606 3,714 5,730 2,998 0 160,466 212 173 10,038 20,437 73,156 0 CENTRAL SERVICE & SUPPLY 15.00 6,689,686 0 0 0 0 0 0 0 15,728 1,117 4,546 3,236 131 98 599 72 0 1,357 1,389 44 0 6,533,103 1,763 10,320 1,827 16,131 380 0 782 15 8,808 643 0 PHARMACY 16.00 4,249,886 0 0 0 0 0 0 0 136,285 28,554 70,929 100,019 52,585 104,599 63,889 324,376 5,390 7,741 180,446 56,634 12,811 5,584 99,493 1,533 582,063 472,385 23,084 83,273 25,783 194,099 122,142 0 21,224 2,890 465 5,332 200,381 0 0 MEDICAL RECORDS & LIBRARY 17.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 893,337 SOCIAL SERVICE 18.00 Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 8.2 1.00 2.00 3.00 3.01 4.00 4.01 4.03 4.04 4.05 4.06 4.07 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 19.02 19.03 21.00 21.01 22.00 23.00 24.00 25.00 26.00 27.00 28.00 29.00 31.00 31.01 32.00 33.00 34.00 35.00 36.00 36.01 36.02 Nursery Medicare Certified Nursing Facility Distinct Part Nursing Facility Other Long Term Care Subacute Care Unit II Transitional Care Unit Nursing School Clinical Pastoral Education Intern and Res Service - Salary and Fringes Intern and Res - Other Program Paramedical Ed Program INPATIENT ROUTINE COST CENTERS Adults and Pediatrics (Gen Routine) Intensive Care Unit Coronary Care Unit Neonatal Intensive Care Unit Surgical Intensive Care Subprovider Subprovider Psych Administrative and General Maintenance and Repairs Operation of Plant Laundry and Linen Service Housekeeping Dietary Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records and Library Social Service Employee Benefits Non-Patient Telephones Data Processing Purchasing/Receiving Patient Admitting Patient Business Office GENERAL SERVICE COST CENTER Old Cap Rel Costs - Bldg and Fixtures Old Cap Rel Costs - Movable Equipment New Cap Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com ALLOC COST 19.00 0 0 0 0 0 0 0 0 0 0 ALLOC COST 19.02 0 0 0 0 0 0 0 0 0 0 ALLOC COST 19.03 0 0 0 0 0 0 0 0 0 NONPHYSICIAN ANESTH 21.00 0 0 0 0 0 0 0 0 0 NURSING SCHOOL 21.01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 INT & RES SALARY & FRINGES 22.00 COMPUTATION OF COST ALLOCATION (W/S B) 40,994 0 0 0 0 0 0 0 INT & RES PROGRAM 23.00 0 0 0 0 0 0 0 PARAMED EDUCAT 24.00 59,246,686 11,979,529 10,812,714 0 0 903,567 26,002,684 12,898,180 0 25.00 (2,068,736) 26.00 POST STEP-DOWN SUBTOTAL ADJUSTMENT 57,177,950 11,979,529 10,812,714 0 0 903,567 26,002,684 12,898,180 0 27.00 TOTAL COST Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 8.3 37.00 38.00 39.00 40.00 41.00 41.01 41.02 42.00 43.00 44.00 44.01 46.00 47.00 48.00 49.00 50.00 51.00 52.00 53.00 54.00 55.00 56.00 57.00 58.00 59.00 59.01 59.02 59.03 60.00 60.01 60.02 60.03 60.04 61.00 62.00 71.00 85.00 86.00 96.00 97.00 98.00 99.00 99.01 99.02 99.03 99.04 100.00 100.01 100.02 100.04 100.05 100.07 TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 19.00 NONREIMBURSABLE COST CENTERS Gift, Flower, Coffee Shop and Canteen Research Physicians' Private Office Nonpaid Workers Satelite Clinic - Airport HIV Serviceis Women Service Line Community Health Education Marketing SF Heart Institute MD Office Building Mission Servicies Auxillary Group Foundation Clinic Wound Care Out-Patient Psychiatry Diabetes Treatment Center OB/GYN Clinic Emergency Observation Beds Home Health Agency Radiology - Therapeutic Radioisotope Laboratory Pathological Lab Whole Blood Blood Storing and Processing Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Gastro Intestinal Services Cardiac Cath Lab CT/MRI ANCILLARY COST CENTERS Operating Room Recovery Room Delivery Room and Labor Room Anesthesiology Radiology - Diagnostic Radiology - P O B TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com ALLOC COST 19.02 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALLOC COST 19.03 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NONPHYSICIAN ANESTH 21.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NURSING SCHOOL 21.01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 INT & RES SALARY & FRINGES 22.00 COMPUTATION OF COST ALLOCATION (W/S B) 40,994 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 INT & RES PROGRAM 23.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PARAMED EDUCAT 24.00 278,609,141 347,514 0 0 0 1,008,581 1,380,062 3,351,105 128,512 209,878 81,372 13,091,529 2,076,319 617,080 11,048,531 2,182,774 3,733,789 2,816,838 13,597,439 2,094,232 918,483 7,315,993 4,598,016 1,235,466 324,425 2,624,273 132,023 25,075,039 16,570,945 1,388,756 4,983,080 2,030,220 4,653,795 785,010 0 2,904,288 833,059 465,631 2,085,719 12,386,890 7,689,116 0 25.00 (2,068,736) 26.00 POST STEP-DOWN SUBTOTAL ADJUSTMENT 276,540,405 347,514 0 0 0 1,008,581 1,380,062 3,351,105 128,512 209,878 81,372 13,091,529 2,076,319 617,080 11,048,531 2,182,774 3,733,789 2,816,838 13,597,439 2,094,232 918,483 7,315,993 4,598,016 1,235,466 324,425 2,624,273 132,023 25,075,039 16,570,945 1,388,756 4,983,080 2,030,220 4,653,795 785,010 0 2,904,288 833,059 465,631 2,085,719 12,386,890 7,689,116 0 27.00 TOTAL COST Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 8.3 1.00 2.00 3.00 3.01 4.00 4.01 4.03 4.04 4.05 4.06 4.07 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 19.02 19.03 21.00 21.01 22.00 23.00 24.00 25.00 26.00 27.00 28.00 29.00 31.00 31.01 32.00 33.00 34.00 35.00 36.00 36.01 36.02 Nursery Medicare Certified Nursing Facility Distinct Part Nursing Facility Other Long Term Care Subacute Care Unit II Transitional Care Unit Nursing School Clinical Pastoral Education Intern and Res Service - Salary and Fringes Intern and Res - Other Program Paramedical Ed Program INPATIENT ROUTINE COST CENTERS Adults and Pediatrics (Gen Routine) Intensive Care Unit Coronary Care Unit Neonatal Intensive Care Unit Surgical Intensive Care Subprovider Subprovider Psych Administrative and General Maintenance and Repairs Operation of Plant Laundry and Linen Service Housekeeping Dietary Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records and Library Social Service Employee Benefits Non-Patient Telephones Data Processing Purchasing/Receiving Patient Admitting Patient Business Office GENERAL SERVICE COST CENTERS Old Cap Rel Costs - Bldg and Fixtures Old Cap Rel Costs - Movable Equipment New Cap Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com OLD BLDG OLD MOVBLE & FIXTURES EQUIP (SQ FT) (SQ FT) 1.00 2.00 NEW CAP 13,441 229 12,904 19,491 637 1,384 160 234 160 2,984 6,632 3,947 10,239 320 70,870 6,016 6,052 1,013 827 1,435 740 265 266 96 132 96 600 444 (SQ FT) 3.01 BLDG (COAST) 15,142 6,326 8,450 3,521 1,745 8,776 7,578 5,916 288 2,141 4,518 3,944 NEW CAP BLDG (SQ FT) 3.00 13,441 229 12,904 70,870 6,016 6,052 2,984 6,632 3,947 10,239 320 15,592 6,326 8,450 3,521 1,745 8,776 7,578 5,916 288 2,141 4,518 4,795 NEW CAP MOV EQUIP (SQ FT) 4.00 19,491 637 1,384 160 234 160 1,013 827 1,435 740 265 266 96 132 96 600 444 NEW CAP EQUIP (SQ FT) 4.01 STATISTICS FOR COST ALLOCATION (W/S B-1) 4.03 STAT 4.04 STAT 4.05 STAT 4.06 STAT 4.07 STAT 4.08 STAT Fiscal Period Ended: JUNE 30, 2008 SCHEDULE 37.00 38.00 39.00 40.00 41.00 41.01 41.02 42.00 43.00 44.00 44.01 46.00 47.00 48.00 49.00 50.00 51.00 52.00 53.00 54.00 55.00 56.00 57.00 58.00 59.00 59.01 59.02 59.03 60.00 60.01 60.02 60.03 60.04 61.00 62.00 71.00 85.00 86.00 96.00 97.00 98.00 99.00 99.01 99.02 99.03 99.04 100.00 100.01 100.02 100.04 100.05 100.07 TOTAL COST TO BE ALLOCATED UNIT COST MULTIPLIER - SCH NONREIMBURSABLE COST CENTERS Gift, Flower, Coffee Shop and Canteen Research Physicians' Private Office Nonpaid Workers Satelite Clinic - Airport HIV Serviceis Women Service Line Community Health Education Marketing SF Heart Institute MD Office Building Mission Servicies Auxillary Group Foundation Clinic Wound Care Out-Patient Psychiatry Diabetes Treatment Center OB/GYN Clinic Emergency Observation Beds Home Health Agency Radiology - Therapeutic Radioisotope Laboratory Pathological Lab Whole Blood Blood Storing and Processing Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Gastro Intestinal Services Cardiac Cath Lab CT/MRI ANCILLARY COST CENTERS Operating Room Recovery Room Delivery Room and Labor Room Anesthesiology Radiology - Diagnostic Radiology - P O B Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA This is trial version www.adultpdf.com 0 0.000000 0 0.000000 OLD BLDG OLD MOVBLE & FIXTURES EQUIP (SQ FT) (SQ FT) 1.00 2.00 NEW CAP 224 1,793 318,160 5,821,852 18.298504 34,034 223,990 6.581360 112 375 5,977 135 1,436 1,083 112 725 9,773 9,774 4,300 960 1,444 8,922 2,246 548 363,031 5,960,225 16.417951 135 1,436 1,083 375 5,977 725 7,129 9,774 4,300 960 4,294 9,773 548 8,336 1,444 8,922 2,246 1,644 8,141 8,527 7,314 80 4,083 334 8,141 1,640 7,314 80 4,083 334 2,367 351 692 7,705 4,391 11,248 351 7,705 4,391 10,397 3,175 2,904 16,652 8,606 3,175 2,904 10,829 754 NEW CAP MOV EQUIP (SQ FT) 4.00 7,139 (SQ FT) 3.01 BLDG (COAST) 7,139 NEW CAP BLDG (SQ FT) 3.00 34,034 235,710 6.925721 112 112 224 1,793 2,367 692 754 NEW CAP EQUIP (SQ FT) 4.01 STATISTICS FOR COST ALLOCATION (W/S B-1) 0 0.000000 4.03 STAT 0 0.000000 4.04 STAT 0 0.000000 4.05 STAT 0 0.000000 4.06 STAT 0 0.000000 4.07 STAT 0 0.000000 4.08 STAT Fiscal Period Ended: JUNE 30, 2008 SCHEDULE ... Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA. .. ANCILLARY COST CENTERS Operating Room Recovery Room Delivery Room and Labor Room Anesthesiology Radiology - Diagnostic Radiology - P O B Provider Name: SETON MEDICAL CENTER STATE OF CALIFORNIA. .. Rel Costs - Bldg and Fixtures New Cap Rel Costs - Bldg (Coastside) New Cap Rel Costs - Movable Equipment New Cap Rel Costs - Equip (Coastside) TRIAL BALANCE EXPENSES Provider Name: SETON MEDICAL