STATE OF CALIFORNIA COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST_part3 pptx

STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO TRIAL BALANCE EXPENSES GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipmen 3.00 New Cap Rel Costs-Bldg & Fixtures 3.01 New Cap Bldg. Memorial 3.02 New Cap Bldg. - Midtown 3.03 New Cap Bldg. Infusion 4.00 New Cap Rel Costs-Movable Equipme 4.01 New Equip Memorial 4.02 New Equip - Midtown 4.03 New Equip Infusion 4.07 4.08 5.00 Employee Benefits 6.01 Communication 6.02 Data Processing 6.03 Purchasing 6.04 Admitting 6.05 Business Office 6.06 6.07 6.08 6.00 Administrative and General 7.00 Maintenance and Repairs 8.00 Operation of Plant 9.00 Laundry and Linen Service 10.00 Housekeeping 11.00 Dietary 12.00 Cafeteria 13.00 Maintenance of Personnel 14.00 Nursing Administration 15.00 Central Services & Supply 16.00 Pharmacy 17.00 Medical Records and Library 18.00 Social Service 19.00 19.02 19.03 20.00 21.00 Nursing School 22.00 Intern & Res Service-Salary & Fringes 23.00 Intern & Res Other Program 24.00 Paramedical Ed Program INPATIENT ROUTINE COST CENTER 25.00 Adults & Pediatrics (Gen Routine) 26.00 Intensive Care Unit 27.00 Coronary Care Unit 28.00 29.00 30.00 Neonatal Intensive Care Unit 30.01 Pediatric ICU 32.00 33.00 Nursery 34.00 Medicare Certified Nursing Facility 35.00 Distinct Part Nursing Facility 36.00 Adult Subacute Care Unit 36.01 Subacute Care Unit II 36.02 Transitional Care Unit SCHEDULE 8.3 Fiscal Period Ended: DECEMBER 31, 2007 POST NON- INT & RES STEP-DOWN TOTAL ALLOC ALLOC ALLOC PHYSICIAN NURSING SALARY & INT & RES PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT (Adj 15) 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 0 0 000 0000 0 0 0 0 0 000000 0000000 0 0 0 0 0 2,784,126 0 217,738 104,460,666 0 104,460,666 000000067,48120,989,878 20,989,878 000000027,12010,294,182 10,294,182 000000000 0 000000000 0 0000000025,023,717 25,023,717 00000001,6997,870,973 7,870,973 000000000 0 000000004,581,333 4,581,333 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,838,639 9,838,639 0 0 0 0 0 0 0 447,018 6,321,774 6,321,774 0 0 0 0 0 0 0 0 0 0 000000000 0 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO TRIAL BALANCE EXPENSES ANCILLARY COST CENTERS 37.00 Operating Room 37.01 Lithotripsy 39.00 Delivery Room and Labor Room 40.00 Anesthesiology 41.00 Radiology - Diagnostic 41.01 Ultrasound 41.02 Gamma Knife 42.01 CT Scan 43.00 Radioisotope 44.00 Laboratory 44.01 Pathology 47.00 Blood Storing, Processing & Tra 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 59.00 Cath Lab Invasive 59.01 O/P Pediatric Treatment 60.01 Heart Fail Clinic 60.02 Sleep Center 60.03 Peds Audiology 60.04 Development OP Clinic 60.05 Infusion 60.00 Clinic 60.06 Cancer Risk Assess Clinic 61.00 Emergency 62.00 Observation Beds 64.00 Home Program Dialysis 83.00 Kidney Acquisition 85.00 Heart Acquistion 85.01 Pancreas Acquisition 88.00 Interest Expense 90.00 Other Capital Related Costs NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop & Canteen 97.00 Research 98.00 Physicians' Private Office 99.00 Nonpaid Workers 100.00 Beauty Clinic 100.01 Grants 100.02 Dialysis Contract Services 100.03 Home Infusion 100.04 Long Term Care Pharmacy 100.05 Spa OP Lab 100.06 Foundation 100.08 SHSSR Home Office 100.09 Other Related Organization 100.10 SCP TOTAL SCHEDULE 8.3 Fiscal Period Ended: DECEMBER 31, 2007 POST NON- INT & RES STEP-DOWN TOTAL ALLOC ALLOC ALLOC PHYSICIAN NURSING SALARY & INT & RES PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT (Adj 15) 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) 00000497,507 0 9,347 51,301,416 0 51,301,416 00000000285,221 285,221 0000000014,868,516 14,868,516 000000004,600,752 4,600,752 0000000018,502,870 18,502,870 000000002,687,148 2,687,148 000000001,075,020 1,075,020 000000003,774,503 3,774,503 000000004,058,266 4,058,266 0000000017,229,864 17,229,864 000000001,372,240 1,372,240 000000006,308,423 6,308,423 0000000011,782,174 11,782,174 000000004,797,291 4,797,291 00000000914,453 914,453 00000000751,535 751,535 000000001,664,553 1,664,553 000000002,511,765 2,511,765 0000000087,731,244 87,731,244 0000000034,831,693 34,831,693 0000000010,636,709 10,636,709 0000000010,308,074 10,308,074 000000001,265,926 1,265,926 00000000581,812 581,812 000000001,965,342 1,965,342 00000000493,343 493,343 000000003,750,957 3,750,957 0000000010,077,275 10,077,275 00000000813,599 813,599 00000000428,642 428,642 00000002,97419,710,216 19,710,216 000000000 0 0000000061,900 61,900 000000001,700,018 1,700,018 00000000373,760 373,760 0000000049,055 49,055 000000000 0 000000000 0 000000000 0 000000002,011,870 2,011,870 000000000 0 000000000 0 0000000027,990 27,990 000000003,361,925 3,361,925 00000000361,314 361,314 000000000 0 00000000731,436 731,436 0000000024,020 24,020 000000006,570 6,570 000000000 0 0000000012,621 12,621 000000022,94286,760 86,760 0 0 0 0 0 3,281,633 0 796,320 529,271,242 0 529,271,242 This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 9 Provider Name: Fiscal Period Ended: SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007 OLD BLDG OLD MOVBLE NEW BLDG NEW CAP BLDG NEW BLDG NEW MOV. NEW EQUIP. NEW EQUIP. NEW EQUIP. STAT STAT & FIXTURES EQUIP & FIXTURES MEMORIAL MIDTOWN INFUSION EQUIP. MEMORIAL MIDTOWN INFUSION (SQ FT) (SQ FT) (SQ FT) (SQ FT) (SQ FT) (SQ FT) ($ VALUE) (SQ FT) (SQ FT) (SQ FT) 1.00 2.00 3.00 3.01 3.02 3.03 4.00 4.01 4.02 4.03 4.07 4.08 (Adj ) (Adj ) (Adj 16) (Adj ) (Adj 23) (Adj ) (Adj 17) (Adj ) (Adj 18) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 3.01 New Cap Bldg. Memorial 3.02 New Cap Bldg. - Midtown 3.03 New Cap Bldg. Infusion 4.00 New Cap Rel Costs-Movable Equipment 4.01 New Equip Memorial 4.02 New Equip - Midtown 4.03 New Equip Infusion 4.07 4.08 5.00 Employee Benefits 9,086 11,173 441 6.01 Communication 6.02 Data Processing 1,353 6.03 Purchasing 6.04 Admitting 587 1,828 6.05 Business Office 2,120 182 2,907 16,954 6.06 6.07 6.08 6.00 Administrative and General 18,572 11,368 1,316 286,878 77,940 4,844 4,835 7.00 Maintenance and Repairs 154,761 161,008 6,599 361,271 268,153 1,341 8.00 Operation of Plant 9.00 Laundry and Linen Service 9,233 3,668 653 10.00 Housekeeping 6,901 8,667 1,619 60,472 14,057 2,100 11.00 Dietary 10,776 7,916 2,265 24,124 10,589 9,282 12.00 Cafeteria 6,639 2,735 13.00 Maintenance of Personnel 14.00 Nursing Administration 3,138 2,087 882 38,473 19,162 15.00 Central Services & Supply 12,466 17,042 811 381,233 308,329 23,174 16.00 Pharmacy 3,801 3,496 241 21,501 6,571 17.00 Medical Records and Library 7,585 3,594 1,865 1,994 18.00 Social Service 870 7,722 221 3,373 19.00 19.02 19.03 20.00 21.00 Nursing School 22.00 Intern & Res Service-Salary & Fringes 23.00 Intern & Res Other Program 24.00 Paramedical Ed Program 575 374 INPATIENT ROUTINE COST CENTERS 25.00 Adults & Pediatrics (Gen Routine) 67,874 60,191 66,891 158,216 26.00 Intensive Care Unit 13,048 6,716 210,226 123,915 27.00 Coronary Care Unit 7,434 54,798 28.00 29.00 30.00 Neonatal Intensive Care Unit 9,251 354,236 30.01 Pediatric ICU 6,938 51,647 32.00 33.00 Nursery 3,024 34.00 Medicare Certified Nursing Facility 35.00 Distinct Part Nursing Facility 21,578 13,308 21,578 36.00 Adult Subacute Care Unit 17,773 0 37,140 0 36.01 Subacute Care Unit II 36.02 Transitional Care Unit STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 9 Provider Name: Fiscal Period Ended: SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007 OLD BLDG OLD MOVBLE NEW BLDG NEW CAP BLDG NEW BLDG NEW MOV. NEW EQUIP. NEW EQUIP. NEW EQUIP. STAT STAT & FIXTURES EQUIP & FIXTURES MEMORIAL MIDTOWN INFUSION EQUIP. MEMORIAL MIDTOWN INFUSION (SQ FT) (SQ FT) (SQ FT) (SQ FT) (SQ FT) (SQ FT) ($ VALUE) (SQ FT) (SQ FT) (SQ FT) 1.00 2.00 3.00 3.01 3.02 3.03 4.00 4.01 4.02 4.03 4.07 4.08 (Adj ) (Adj ) (Adj 16) (Adj ) (Adj 23) (Adj ) (Adj 17) (Adj ) (Adj 18) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) ANCILLARY COST CENTERS 37.00 Operating Room 24,810 15,613 1,346,129 1,259,908 37.01 Lithotripsy 39.00 Delivery Room and Labor Room 16,203 182,549 40.00 Anesthesiology 218 131 182,457 157,180 41.00 Radiology - Diagnostic 9,584 4,894 2,046,447 782,865 41.01 Ultrasound 665 1,034 34,446 80,321 41.02 Gamma Knife 300 309,443 42.01 CT Scan 914 515 123,874 267,520 43.00 Radioisotope 3,645 2,415 306,144 1,709 44.00 Laboratory 4,403 8,404 903 257,587 44.01 Pathology 2,194 1,506 10,727 15,330 47.00 Blood Storing, Processing & Tra 1,087 49.00 Respiratory Therapy 3,898 1,995 141,741 244,093 50.00 Physical Therapy 7,288 2,250 3,849 1,185 51.00 Occupational Therapy 1,368 1,217 52.00 Speech Pathology 508 175 277 14,141 53.00 Electrocardiology 873 2,906 2,099 161,485 54.00 Electroencephalography 2,674 1,993 132,760 20,490 55.00 Medical Supplies Charged to Patients 4,747 785 56.00 Drugs Charged to Patients 141 253 800 16,326 57.00 Renal Dialysis 8,158 371 126,456 59.00 Cath Lab Invasive 7,265 710,004 59.01 O/P Pediatric Treatment 2,518 14,814 60.01 Heart Fail Clinic 38,428 60.02 Sleep Center 55,578 60.03 Peds Audiology 809 10,087 60.04 Development OP Clinic 5,227 6,923 60.05 Infusion 2,515 8,009 60.00 Clinic 2,326 3,392 60.06 Cancer Risk Assess Clinic 1,680 61.00 Emergency 7,215 4,279 168,340 48,663 62.00 Observation Beds 64.00 Home Program Dialysis 83.00 Kidney Acquisition 3,852 462 85.00 Heart Acquistion 1,285 85.01 Pancreas Acquisition 88.00 Interest Expense 90.00 Other Capital Related Costs NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop & Canteen 97.00 Research 2,875 2,118 2,694 98.00 Physicians' Private Office 99.00 Nonpaid Workers 100.00 Beauty Clinic 482 100.01 Grants 5,203 1,001 100.02 Dialysis Contract Services 587 100.03 Home Infusion 100.04 Long Term Care Pharmacy 1,835 2,471 50 100.05 Spa OP Lab 100.06 Foundation 2,541 1,575 100.08 SHSSR Home Office 100.09 Other Related Organization 2,254 100.10 SCP TOTAL 0 0 420,785 430,292 45,870 4,986 6,510,155 5,775,619 63,757 12,844 0 0 COST TO BE ALLOCATED 0 0 3,624,811 2,058,835 81,184 85,371 9,048,996 7,634,577 56,100 12,844 0 0 UNIT COST MULTIPLIER - SCH 8 0.000000 0.000000 8.614402 4.784739 1.769871 17.122142 1.389982 1.321863 0.879903 1.000000 0.000000 0.000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 3.01 New Cap Bldg. Memorial 3.02 New Cap Bldg. - Midtown 3.03 New Cap Bldg. Infusion 4.00 New Cap Rel Costs-Movable Equipment 4.01 New Equip Memorial 4.02 New Equip - Midtown 4.03 New Equip Infusion 4.07 4.08 5.00 Employee Benefits 6.01 Communication 6.02 Data Processing 6.03 Purchasing 6.04 Admitting 6.05 Business Office 6.06 6.07 6.08 6.00 Administrative and General 7.00 Maintenance and Repairs 8.00 Operation of Plant 9.00 Laundry and Linen Service 10.00 Housekeeping 11.00 Dietary 12.00 Cafeteria 13.00 Maintenance of Personnel 14.00 Nursing Administration 15.00 Central Services & Supply 16.00 Pharmacy 17.00 Medical Records and Library 18.00 Social Service 19.00 19.02 19.03 20.00 21.00 Nursing School 22.00 Intern & Res Service-Salary & Fringes 23.00 Intern & Res Other Program 24.00 Paramedical Ed Program INPATIENT ROUTINE COST CENTERS 25.00 Adults & Pediatrics (Gen Routine) 26.00 Intensive Care Unit 27.00 Coronary Care Unit 28.00 29.00 30.00 Neonatal Intensive Care Unit 30.01 Pediatric ICU 32.00 33.00 Nursery 34.00 Medicare Certified Nursing Facility 35.00 Distinct Part Nursing Facility 36.00 Adult Subacute Care Unit 36.01 Subacute Care Unit II 36.02 Transitional Care Unit SCHEDULE 9.1 Fiscal Period Ended: DECEMBER 31, 2007 EMP BENE COMM DATA PROC. PURCHASING ADMITTING BUS OFFICE STAT STAT STAT ADM & GEN MAINT & (GROSS (NO. OF (NO. OF (PURCHASE (INPATIENT (GROSS (ACCUM REPAIRS SALARIES) PHONES) CPU'S) COST) REVENUE) REVENUE) COST) (SQ FT) 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 7.00 (Adj 23) (Adj ) (Adj ) (Adj 23) (Adj 23) (Adjs 24, 25) (Adj ) (Adj ) (Adj ) (Adj 19) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) 18,962 53 4 5,113,775 101 14,472 27,412 2,609,792 17 15,665 93,944 12,621,189 3 894,464 330,396 4,484,708 3 6,487 772,050 7,496,700 6,901 1,934,144 30 27,862 183,927 2,501,536 10,776 3,243,259 1 227 308,417 4,818,708 6,639 0 6,693,364 22 19,720 83,720 9,016,691 3,138 1,385,002 51 11,145 57,826 2,317,963 12,466 8,537,580 46 286,261 285,214 13,765,415 3,801 40,899 33 841 818 6,863,217 7,585 3,660,357 43 136 33,204 4,716,470 870 0 0 0 0 0 2,804,116 13 0 401,032 3 2,181 621,890 575 53,316,216 301 611,694 2,362,618 332,091,295 332,091,295 69,623,883 67,874 10,601,190 87 108,364 575,286 68,354,722 68,354,722 15,186,879 13,048 5,830,225 26 40,614 249,548 33,489,217 33,489,217 7,815,578 0 0 14,260,525 31 19,864 545,587 130,750,990 130,750,990 18,945,136 4,561,427 16 22,719 189,807 32,289,219 32,289,219 6,037,187 0 2,225,753 3,764 162,082 12,027,690 12,027,690 3,502,515 0 3,470,306 44,753 18,237,908 18,237,908 5,621,641 21,578 2,756,551 19 174,574 7,910,270 7,910,270 3,160,401 17,773 0 0 STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO ANCILLARY COST CENTERS 37.00 Operating Room 37.01 Lithotripsy 39.00 Delivery Room and Labor Room 40.00 Anesthesiology 41.00 Radiology - Diagnostic 41.01 Ultrasound 41.02 Gamma Knife 42.01 CT Scan 43.00 Radioisotope 44.00 Laboratory 44.01 Pathology 47.00 Blood Storing, Processing & Tra 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 59.00 Cath Lab Invasive 59.01 O/P Pediatric Treatment 60.01 Heart Fail Clinic 60.02 Sleep Center 60.03 Peds Audiology 60.04 Development OP Clinic 60.05 Infusion 60.00 Clinic 60.06 Cancer Risk Assess Clinic 61.00 Emergency 62.00 Observation Beds 64.00 Home Program Dialysis 83.00 Kidney Acquisition 85.00 Heart Acquistion 85.01 Pancreas Acquisition 88.00 Interest Expense 90.00 Other Capital Related Costs NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop & Canteen 97.00 Research 98.00 Physicians' Private Office 99.00 Nonpaid Workers 100.00 Beauty Clinic 100.01 Grants 100.02 Dialysis Contract Services 100.03 Home Infusion 100.04 Long Term Care Pharmacy 100.05 Spa OP Lab 100.06 Foundation 100.08 SHSSR Home Office 100.09 Other Related Organization 100.10 SCP TOTAL COST TO BE ALLOCATED UNIT COST MULTIPLIER - SCH 8 SCHEDULE 9.1 Fiscal Period Ended: DECEMBER 31, 2007 EMP BENE COMM DATA PROC. PURCHASING ADMITTING BUS OFFICE STAT STAT STAT ADM & GEN MAINT & (GROSS (NO. OF (NO. OF (PURCHASE (INPATIENT (GROSS (ACCUM REPAIRS SALARIES) PHONES) CPU'S) COST) REVENUE) REVENUE) COST) (SQ FT) 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 7.00 (Adj 23) (Adj ) (Adj ) (Adj 23) (Adj 23) (Adjs 24, 25) (Adj ) (Adj ) (Adj ) (Adj 19) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) 23,111,096 145 8,141 43,343,701 295,104,515 395,738,167 38,458,041 24,810 127,714 2,402,318 236,501 8,580,645 92 10,252 897,918 68,987,860 77,263,163 11,564,705 2,023,613 4 1,414 1,832,034 60,616,288 72,271,840 3,394,184 218 5,458,137 9,851 3,275,467 44,412,068 68,721,118 14,453,379 9,584 1,179,225 1 17,908 13,285,730 23,489,714 2,140,962 665 37,765 2,505 135,699 8,448,396 866,530 300 1,046,433 215,195 48,022,445 92,143,955 2,838,948 914 1,101,332 10 6,857 873,723 12,943,844 18,065,542 3,065,945 3,645 6,956,923 76 13,540 2,886,594 139,158,834 185,096,760 13,412,651 4,403 8 2,395 6,782 19,131,682 30,641,729 898,880 2,194 164,721 48 43,335 6,254,353 7,552,437 5,264,833 1,087 6,119,975 27 26,459 1,044,379 96,971,679 100,782,051 9,205,688 3,898 2,737,571 19 7,887 30,588 15,419,746 16,189,980 3,340,734 7,288 483,144 14,455 3,084,470 3,198,707 647,342 1,368 425,643 126 1,312,322 1,711,434 584,057 508 686,441 16 1,609 16,636 21,228,360 23,342,567 1,258,660 873 835,598 104 16,479 131,256 11,038,403 13,971,098 1,854,028 2,674 1,538,635 223,665,366 225,163,517 70,879,802 6,422 914,435 182,430,415 221,077,833 16,502,322 141 4,006,161 23 925,430 9,467,989 32,405,270 6,910,381 8,158 4,373,728 58 4,144 15,231,334 63,188,927 98,559,937 8,180,472 749,452 46,742 98,703 1,762,807 991,076 333,624 9,076 68 263,899 487,023 1,025,438 50,249 899 5,030,065 1,629,918 204,494 136,261 1,226,569 1,677,204 407,960 2,788,488 52 38,990 2,904,991 3,111,508 854,877 5,954,994 5,829,683 23,435,371 8,406,772 532,183 6 12,385 1,265,531 674,777 112,276 1,894 52 485,177 209,913 1,680 9,791,503 80 15,593 1,246,010 32,768,097 102,328,771 14,875,372 7,215 0 66,432 324,569 10,708 625,532 29 7,748 695,862 1,435,379 162,035 2,007 151,034 315,095 5,787 73 47,191 41,648 0 0 0 1,008,899 15 13,296 1,446,099 2,875 0 0 17,511 284 6,964 22,993 1,978,606 13 65,110 2,792,529 203,741 17,944 167,502 287,684 0 545,350 31,654 451,645 1,835 3 2,940 1,523 20,381 5,614 0 10,785 0 225,413,014 1,627 1,320,983 87,099,493 2,011,064,091 2,493,937,305 0 0 0 452,255,897 259,357 54,419,947 0 3,580,760 567,818 802,825 6,019,47300077,015,345 14,770,471 0.241423 0.000000 2.710678 0.006519 0.000399 0.002414 0.000000 0.000000 0.000000 0.170292 56.950346 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 3.01 New Cap Bldg. Memorial 3.02 New Cap Bldg. - Midtown 3.03 New Cap Bldg. Infusion 4.00 New Cap Rel Costs-Movable Equipment 4.01 New Equip Memorial 4.02 New Equip - Midtown 4.03 New Equip Infusion 4.07 4.08 5.00 Employee Benefits 6.01 Communication 6.02 Data Processing 6.03 Purchasing 6.04 Admitting 6.05 Business Office 6.06 6.07 6.08 6.00 Administrative and General 7.00 Maintenance and Repairs 8.00 Operation of Plant 9.00 Laundry and Linen Service 10.00 Housekeeping 11.00 Dietary 12.00 Cafeteria 13.00 Maintenance of Personnel 14.00 Nursing Administration 15.00 Central Services & Supply 16.00 Pharmacy 17.00 Medical Records and Library 18.00 Social Service 19.00 19.02 19.03 20.00 21.00 Nursing School 22.00 Intern & Res Service-Salary & Fringes 23.00 Intern & Res Other Program 24.00 Paramedical Ed Program INPATIENT ROUTINE COST CENTERS 25.00 Adults & Pediatrics (Gen Routine) 26.00 Intensive Care Unit 27.00 Coronary Care Unit 28.00 29.00 30.00 Neonatal Intensive Care Unit 30.01 Pediatric ICU 32.00 33.00 Nursery 34.00 Medicare Certified Nursing Facility 35.00 Distinct Part Nursing Facility 36.00 Adult Subacute Care Unit 36.01 Subacute Care Unit II 36.02 Transitional Care Unit SCHEDULE 9.2 Fiscal Period Ended: DECEMBER 31, 2007 OPER LAUNDRY HOUSE- DIETARY CAFETERIA MAINT OF NURSING CENT SERV PHARMACY MED REC SOC SERV STAT PLANT & LINEN KEEPING (MEALS (PROD. PERSONNEL ADMIN & SUPPLY (COSTS (GROSS (PATIENT (BIO HRS) (LB LNDRY) (SQ FT) SERVED) HOURS) (# HOUSED) (DIR. NUR HR) (CST REQ) REQUIS) SALARIES) DAYS) 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 (Adj ) (Adj ) (Adj ) (Adj 23) (Adj 20) (Adj ) (Adj 23) (Adj 23) (Adj 21) (Adjs 24, 25) (Adj 22) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) 21,271 1 25,146 10,776 6,639 32 49,205 3,138 155,676 2,250 12,466 57,755 40 3,801 154,479 118,287 7,585 1,761 818 870 100,505 2,759 30,249 575 9,380 19 2,180 1,419 979,037 67,874 345,548 1,146,049 788,595 621,052 187,311 332,091,295 96,194 279 127,221 13,048 16,400 195,706 158,347 128,553 32,372 68,354,722 9,184 229 71,287 17,468 115,009 85,025 57,229 19,603 33,489,217 5,729 1,074 70,801 266,849 231,137 136,681 10,878 130,750,990 20,075 111 35,026 90,034 68,450 43,969 12,418 32,289,219 5,109 10 50,713 8,586 13,495 3 12,027,690 10,436 311 77,032 146,208 7,893 40,387 77,032 18,237,908 32,178 17 108,869 17,773 4,690 86,784 1,941 9,929 2,538 7,910,270 7,911 STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO ANCILLARY COST CENTERS 37.00 Operating Room 37.01 Lithotripsy 39.00 Delivery Room and Labor Room 40.00 Anesthesiology 41.00 Radiology - Diagnostic 41.01 Ultrasound 41.02 Gamma Knife 42.01 CT Scan 43.00 Radioisotope 44.00 Laboratory 44.01 Pathology 47.00 Blood Storing, Processing & Tra 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 59.00 Cath Lab Invasive 59.01 O/P Pediatric Treatment 60.01 Heart Fail Clinic 60.02 Sleep Center 60.03 Peds Audiology 60.04 Development OP Clinic 60.05 Infusion 60.00 Clinic 60.06 Cancer Risk Assess Clinic 61.00 Emergency 62.00 Observation Beds 64.00 Home Program Dialysis 83.00 Kidney Acquisition 85.00 Heart Acquistion 85.01 Pancreas Acquisition 88.00 Interest Expense 90.00 Other Capital Related Costs NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop & Canteen 97.00 Research 98.00 Physicians' Private Office 99.00 Nonpaid Workers 100.00 Beauty Clinic 100.01 Grants 100.02 Dialysis Contract Services 100.03 Home Infusion 100.04 Long Term Care Pharmacy 100.05 Spa OP Lab 100.06 Foundation 100.08 SHSSR Home Office 100.09 Other Related Organization 100.10 SCP TOTAL COST TO BE ALLOCATED UNIT COST MULTIPLIER - SCH 8 SCHEDULE 9.2 Fiscal Period Ended: DECEMBER 31, 2007 OPER LAUNDRY HOUSE- DIETARY CAFETERIA MAINT OF NURSING CENT SERV PHARMACY MED REC SOC SERV STAT PLANT & LINEN KEEPING (MEALS (PROD. PERSONNEL ADMIN & SUPPLY (COSTS (GROSS (PATIENT (BIO HRS) (LB LNDRY) (SQ FT) SERVED) HOURS) (# HOUSED) (DIR. NUR HR) (CST REQ) REQUIS) SALARIES) DAYS) 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 (Adj ) (Adj ) (Adj ) (Adj 23) (Adj 20) (Adj ) (Adj 23) (Adj 23) (Adj 21) (Adjs 24, 25) (Adj 22) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) 1,839 457,302 24,810 439,233 193,971 1,128,616 42,176 395,738,167 2,402,318 562 220,892 174,201 129,637 149,519 16,521 77,263,163 218 38,647 1,426 121,764 332,229 72,271,840 1,462 90,703 9,584 141,275 13,607 146,853 11,070 68,721,118 17 18,528 665 22,425 44 2,042 23,489,714 1 300 1,504 840 68 8,448,396 26 19,128 914 24,995 176 2,410 92,143,955 79 36,857 3,645 18,139 1,552 10,779 10,205 18,065,542 410 4,375 4,403 197,558 2,680,969 8,303 185,096,760 803 2,194 6,782 30,641,729 25 1,087 2,866 954 40,137 2,185 7,552,437 947 3,898 143,214 5,048 100,782,051 14 7,405 7,288 90,821 16,595 16,189,980 1,368 9,732 3,570 3,198,707 508 9,506 126 1,711,434 36 561 873 15,668 15 12,526 23,342,567 30 8,663 2,674 21,267 20,924 845 13,971,098 69,957,296 181,512 225,163,517 292 141 27,824 27,715 8,958 16,835,228 221,077,833 12,039 8,158 95,468 37,437 241,242 1,499,971 32,405,270 55,816 4,108 79,762 41,170 94,805 2,534 98,559,937 79 15,121 15,742 11,922 9,753 2,873 1,762,807 418 7,673 8,453 263,899 28,732 19,136 200 5,030,065 3 7,080 2,991 1,677,204 60,733 2,677 36,785 2,904,991 395 21,772 2,541 20,541 12,210 33,058 1,538 23,435,371 2 13,471 29 11,243 293 1,265,531 160 1,680 4,001 1,258 8 485,177 277 351,000 7,215 4,217 222,484 143,120 280,921 18,222 102,328,771 55,954 324,569 17 11,779 6,696 695,862 4 3,051 73 151,034 109 47,191 16 2,875 29,146 7 12,851 768 284 6,964 3 57,917 2,081 62,043 4 3,142 3,142 4,889 2,214 167,502 49 1,835 14,931 20,031 68 2,977 1,523 7,706 12,518 2,809,246 230,878 479,710 4,632,313 0 1,975,644 76,363,024 19,371,424 2,493,937,305 186,816 0 1,046,784 386,660 9,169,267 3,972,735 6,281,053 0 11,076,025 4,184,181 16,696,260 8,767,602 5,757,145 0 83.622275 0.137638 39.714770 8.281534 1.355922 0.000000 5.606286 0.054793 0.861902 0.003516 30.817195 0.000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable Equipment 3.00 New Cap Rel Costs-Bldg & Fixtures 3.01 New Cap Bldg. Memorial 3.02 New Cap Bldg. - Midtown 3.03 New Cap Bldg. Infusion 4.00 New Cap Rel Costs-Movable Equipment 4.01 New Equip Memorial 4.02 New Equip - Midtown 4.03 New Equip Infusion 4.07 4.08 5.00 Employee Benefits 6.01 Communication 6.02 Data Processing 6.03 Purchasing 6.04 Admitting 6.05 Business Office 6.06 6.07 6.08 6.00 Administrative and General 7.00 Maintenance and Repairs 8.00 Operation of Plant 9.00 Laundry and Linen Service 10.00 Housekeeping 11.00 Dietary 12.00 Cafeteria 13.00 Maintenance of Personnel 14.00 Nursing Administration 15.00 Central Services & Supply 16.00 Pharmacy 17.00 Medical Records and Library 18.00 Social Service 19.00 19.02 19.03 20.00 21.00 Nursing School 22.00 Intern & Res Service-Salary & Fringes 23.00 Intern & Res Other Program 24.00 Paramedical Ed Program INPATIENT ROUTINE COST CENTERS 25.00 Adults & Pediatrics (Gen Routine) 26.00 Intensive Care Unit 27.00 Coronary Care Unit 28.00 29.00 30.00 Neonatal Intensive Care Unit 30.01 Pediatric ICU 32.00 33.00 Nursery 34.00 Medicare Certified Nursing Facility 35.00 Distinct Part Nursing Facility 36.00 Adult Subacute Care Unit 36.01 Subacute Care Unit II 36.02 Transitional Care Unit SCHEDULE 9.3 Fiscal Period Ended: DECEMBER 31, 2007 STAT STAT NONPHY NURSE I&R-SAL I&R-PRG PARAMED ANESTH SCHOOL & FRINGES COST EDUCAT (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) 19.02 19.03 20.00 21.00 22.00 23.00 24.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) 30,846 30,846 3,075 953 383 24 6,313 STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO ANCILLARY COST CENTERS 37.00 Operating Room 37.01 Lithotripsy 39.00 Delivery Room and Labor Room 40.00 Anesthesiology 41.00 Radiology - Diagnostic 41.01 Ultrasound 41.02 Gamma Knife 42.01 CT Scan 43.00 Radioisotope 44.00 Laboratory 44.01 Pathology 47.00 Blood Storing, Processing & Tra 49.00 Respiratory Therapy 50.00 Physical Therapy 51.00 Occupational Therapy 52.00 Speech Pathology 53.00 Electrocardiology 54.00 Electroencephalography 55.00 Medical Supplies Charged to Patients 56.00 Drugs Charged to Patients 57.00 Renal Dialysis 59.00 Cath Lab Invasive 59.01 O/P Pediatric Treatment 60.01 Heart Fail Clinic 60.02 Sleep Center 60.03 Peds Audiology 60.04 Development OP Clinic 60.05 Infusion 60.00 Clinic 60.06 Cancer Risk Assess Clinic 61.00 Emergency 62.00 Observation Beds 64.00 Home Program Dialysis 83.00 Kidney Acquisition 85.00 Heart Acquistion 85.01 Pancreas Acquisition 88.00 Interest Expense 90.00 Other Capital Related Costs NONREIMBURSABLE COST CENTERS 96.00 Gift, Flower, Coffee Shop & Canteen 97.00 Research 98.00 Physicians' Private Office 99.00 Nonpaid Workers 100.00 Beauty Clinic 100.01 Grants 100.02 Dialysis Contract Services 100.03 Home Infusion 100.04 Long Term Care Pharmacy 100.05 Spa OP Lab 100.06 Foundation 100.08 SHSSR Home Office 100.09 Other Related Organization 100.10 SCP TOTAL COST TO BE ALLOCATED UNIT COST MULTIPLIER - SCH 8 SCHEDULE 9.3 Fiscal Period Ended: DECEMBER 31, 2007 STAT STAT NONPHY NURSE I&R-SAL I&R-PRG PARAMED ANESTH SCHOOL & FRINGES COST EDUCAT (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) (ASG TIME) 19.02 19.03 20.00 21.00 22.00 23.00 24.00 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) STATISTICS FOR COST ALLOCATION (W/S B-1) 5,512 5,512 132 42 324 000036,35836,35811,246 00003,281,633 0 796,320 0.000000 0.000000 0.000000 0.000000 90.258903 0.000000 70.809183 This is trial version www.adultpdf.com . STATE OF CALIFORNIA Provider Name: SUTTER MEDICAL CENTER - SACRAMENTO TRIAL BALANCE EXPENSES GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg & Fixtures 2.00 Old Cap Rel Costs-Movable. PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT (Adj 15) 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) . PARAMED SUBTOTAL ADJUSTMENT COST COST COST COST ANESTH SCHOOL FRINGES PROGRAM EDUCAT (Adj 15) 19.00 19.02 19.03 20.00 21.00 22.00 23.00 24.00 25.00 26.00 27.00 COMPUTATION OF COST ALLOCATION (W/S B) 00000497,507