STATE OF CALIFORNIA COMPUTATION OF MEDICAL INPATIENT ROUTINE SERVICE COST_PART2 docx
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STATE OF CALIFORNIA CONTRACT SCH 4B
Provider Name: Fiscal Period Ended:
USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008
Provider No:
HSC 30660G
SPECIAL CARE UNITS REPORTED AUDITED
1. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
2. Total Inpatient Days (Adj ) 0 0
3. Average Per Diem Cost $ 0.00 $ 0.00
4. Medi-Cal Inpatient Days (Adj ) 0 0
5. Cost Applicable to Medi-Cal $ 0 $ 0
6. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
7. Total Inpatient Days (Adj ) 0 0
8. Average Per Diem Cost $ 0.00 $ 0.00
9. Medi-Cal Inpatient Days (Adj ) 0 0
10. Cost Applicable to Medi-Cal $ 0 $ 0
11. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
12. Total Inpatient Days (Adj ) 0 0
13. Average Per Diem Cost $ 0.00 $ 0.00
14. Medi-Cal Inpatient Days (Adj ) 0 0
15. Cost Applicable to Medi-Cal $ 0 $ 0
16. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
17. Total Inpatient Days (Adj ) 0 0
18. Average Per Diem Cost $ 0.00 $ 0.00
19. Medi-Cal Inpatient Days (Adj ) 0 0
20. Cost Applicable to Medi-Cal $ 0 $ 0
21. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
22. Total Inpatient Days (Adj ) 0 0
23. Average Per Diem Cost $ 0.00 $ 0.00
24. Medi-Cal Inpatient Days (Adj ) 0 0
25. Cost Applicable to Medi-Cal $ 0 $ 0
26. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0
27. Total Inpatient Days (Adj ) 0 0
28. Average Per Diem Cost $ 0.00 $ 0.00
29. Medi-Cal Inpatient Days (Adj ) 0 0
30. Cost Applicable to Medi-Cal $ 0 $ 0
31. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ 0 $ 0
(To Contract Sch 4)
COMPUTATION OF
MEDI-CAL INPATIENT ROUTINE SERVICE COST
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STATE OF CALIFORNIA CONTRACT SCH 5
Provider Name: Fiscal Period Ended:
USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008
Provider No:
HSC 30660G
RATIO
COST TO
CHARGES
ANCILLARY COST CENTERS
37.00 Operating Room $ 5,222,093 $ 17,127,243 0.304900 $ 178,331 $ 54,373
38.00 Recovery Room 1,014,352 1,343,948 0.754756 6,458 4,874
39.00 Delivery Room and Labor Room 0 0 0.000000 0 0
41.00 Radiology - Diagnostic 4,823,241 9,416,051 0.512236 91,836 47,042
41.01 CT Scan 932,163 20,051,746 0.046488 68,491 3,184
41.02 Ultrasound 448,066 2,043,502 0.219264 3,228 708
41.03 Endoscopy 272,997 1,826,267 0.149484 534 80
42.00 Radiology - Therapeutic 6,118,075 23,386,129 0.261611 4,146 1,085
43.00 Radioisotope 551,454 1,471,178 0.374839 9,673 3,626
44.00 Laboratory 9,222,600 33,793,550 0.272910 363,841 99,296
44.01 Pathological Lab 0 0 0.000000 0 0
46.00 Whole Blood 0 0 0.000000 0 0
47.00 Blood Storing, Processing & Transfusion 3,484,612 3,346,946 1.041132 69,180 72,025
48.00 Intravenous Therapy 0 0 0.000000 0 0
49.00 Respiratory Therapy 1,182,676 3,703,274 0.319360 56,371 18,003
50.00 Physical Therapy 160,142 808,248 0.198135 14,066 2,787
51.00 Occupational Therapy 0 0 0.000000 0 0
52.00 Speech Pathology 0 0 0.000000 0 0
53.00 Electrocardiology 116,782 586,182 0.199225 10,132 2,019
54.00 Electroencephalography 0 0 0.000000 0 0
55.00 Medical Supplies Charged to Patients 6,512,926 14,325,190 0.454649 222,332 101,083
56.00 Drugs Charged to Patients 35,718,461 142,260,796 0.251077 583,610 146,531
57.00 Renal Dialysis 270,958 643,413 0.421125 25,482 10,731
58.00 ASC (Non-Distinct Part) 0 0 0.000000 0 0
59.00 0 0 0.000000 0 0
59.01 0 0 0.000000 0 0
59.02 0 0 0.000000 0 0
59.03 0 0 0.000000 0 0
60.00 Clinic 5,795,254 3,825,526 1.514891 0 0
60.01 Infusion Therapy Clinic 3,827,283 6,031,983 0.634498 0 0
60.02 Cancer Clinic 776,882 360,197 2.156826 0 0
62.00 Observation Beds 0 1,297 0.000000 0 0
65.00 Ambulance Services 85,605 0 0.000000 0 0
82.00 0 0 0.000000 0 0
83.00 0 0 0.000000 0 0
84.00 0 0 0.000000 0 0
85.00 0 0 0.000000 0 0
86.00 0 0 0.000000 0 0
TOTAL $ 86,536,624 $ 286,352,666 $ 1,707,711 $ 567,447
(To Contract Sch 3)
* From Schedule 8, Column 27
COST
(Contract Sch 6)
CHARGES
(Adj )
ANCILLARY
COST*
CHARGES
TOTAL ANCILLARY
MEDI-CALTOTAL MEDI-CAL
SCHEDULE OF MEDI-CAL ANCILLARY COSTS
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STATE OF CALIFORNIA CONTRACT SCH 6
Provider Name: Fiscal Period Ended:
USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008
Provider No:
HSC 30660G
ANCILLARY CHARGES
37.00 Operating Room $ 87,030 $ 91,301 $ 178,331
38.00 Recovery Room 6,779 (321) 6,458
39.00 Delivery Room and Labor Room 0 0
41.00 Radiology - Diagnostic 42,149 49,687 91,836
41.01 CT Scan 28,342 40,149 68,491
41.02 Ultrasound 7,364 (4,136) 3,228
41.03 Endoscopy 3,618 (3,084) 534
42.00 Radiology - Therapeutic 2,610 1,536 4,146
43.00 Radioisotope 3,218 6,455 9,673
44.00 Laboratory 182,708 181,133 363,841
44.01 Pathological Lab 0 0
46.00 Whole Blood 0 0
47.00 Blood Storing, Processing & Transfusion 33,045 36,135 69,180
48.00 Intravenous Therapy 0 0
49.00 Respiratory Therapy 71,290 (14,919) 56,371
50.00 Physical Therapy 7,118 6,948 14,066
51.00 Occupational Therapy 0 0
52.00 Speech Pathology 0 0
53.00 Electrocardiology 3,687 6,445 10,132
54.00 Electroencephalography 0 0
55.00
Medical Supplies Charged to Patients 82,045 140,287 222,332
56.00 Drugs Charged to Patients 287,504 296,106 583,610
57.00 Renal Dialysis 27,042 (1,560) 25,482
58.00 ASC (Non-Distinct Part) 0 0
59.00 0 0
59.01 0 0
59.02 0 0
59.03 0 0
60.00 Clinic 822 (822) 0
60.01 Infusion Therapy Clinic 2,325 (2,325) 0
60.02 Cancer Clinic 0 0
62.00 Observation Beds 0 0
65.00 Ambulance Services 0 0
82.00 0 0
83.00 0 0
84.00 0 0
85.00 0 0
86.00 0 0
TOTAL MEDI-CAL ANCILLARY CHARGES $ 878,696 $ 829,015 $ 1,707,711
(To Contract Sch 5)
AUDITEDADJUSTMENTSREPORTED
(Adj 3)
ADJUSTMENTS TO MEDI-CAL CHARGES
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STATE OF CALIFORNIA CONTRACT SCH 7
Provider Name: Fiscal Period Ended:
USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008
Provider No:
HSC 30660G
PROFESSIONAL
SERVICE
COST CENTERS
40.00 Anesthesiology $ 0 $ 0 0.000000 $ $ 0
41.00 Radiology - Diagnostic 0 0 0.000000 0
43.00 Radioisotope 0 0 0.000000 0
44.00 Laboratory 0 0 0.000000 0
53.00 Electrocardiology 0 0 0.000000 0
54.00 Electroencephalography 0 0 0.000000 0
61.00 Emergency 0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
0 0 0.000000 0
TOTAL $ 0 $ 0 $ 0 $ 0
(To Contract Sch 3)
HBP
TO ALL PATIENTS
RATIO OF
REMUNERATION
TOTAL CHARGES
COMPUTATION OF PROFESSIONAL
COMPONENT OF HOSPITAL BASED
(Adj )(Adj ) (Adj )
PHYSICIAN'S REMUNERATION
TO CHARGES
MEDI-CAL
CHARGES
MEDI-CAL
COSTREMUNERATION
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STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period Ended:
USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008
NET EXP FOR
OLD CAPITAL
OLD
NEW CAPITAL
NEW
TRIAL BALANCE COST ALLOC BLDG & MOVABLE BLDG & MOVABLE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC
EXPENSES (From Sch 10) FIXTURES EQUIP FIXTURES EQUIP COST COST COST COST COST COST COST
0.00 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07
COMPUTATION OF COST ALLOCATION (W/S B)
GENERAL SERVICE COST CENTER
1.00
Old Cap Rel Costs-Bldg & Fixtures
2,100,657
2.00
Old Cap Rel Costs-Movable Equipmen
3,155,027
0
3.00
New Cap Rel Costs-Bldg & Fixtures
1,666,012
0
0
4.00
New Cap Rel Costs-Movable Equipme
946,993
0
0
0
4.01
0
0
0
0
0
4.02
0
0
0
0
0
0
4.03
0
0
0
0
0
0
0
4.04
0
0
0
0
0
0
0
0
4.05
0
0
0
0
0
0
0
0
0
4.06
0
0
0
0
0
0
0
0
0
0
4.07
0
0
0
0
0
0
0
0
0
0
0
4.08
0
0
0
0
0
0
0
0
0
0
0
0
5.00
Employee Benefits
272,344
5,476
8,224
4,343
2,469
0
0
0
0
0
0
0
6.01
Non-Patient Telephones
0
0
0
0
0
0
0
0
0
0
0
0
6.02
Data Processing
0
0
0
0
0
0
0
0
0
0
0
0
6.03
Purchasing/Receiving
0
0
0
0
0
0
0
0
0
0
0
0
6.04
Patient Admitting
0
0
0
0
0
0
0
0
0
0
0
0
6.05
Patient Business Office
0
0
0
0
0
0
0
0
0
0
0
0
6.06
0
0
0
0
0
0
0
0
0
0
0
0
6.07
0
0
0
0
0
0
0
0
0
0
0
0
6.08
0
0
0
0
0
0
0
0
0
0
0
0
6.00
Administrative and General
22,344,383
293,350
440,590
232,654
132,245
0
0
0
0
0
0
0
7.00
Maintenance and Repairs
0
0
0
0
0
0
0
0
0
0
0
0
8.00
Operation of Plant
2,709,159
3,249
4,880
2,577
1,465
0
0
0
0
0
0
0
9.00
Laundry and Linen Service
223,273
12,815
19,248
10,164
5,777
0
0
0
0
0
0
0
10.00
Housekeeping
923,699
13,294
19,966
10,543
5,993
0
0
0
0
0
0
0
11.00
Dietary
1,200,886
68,167
102,382
54,063
30,730
0
0
0
0
0
0
0
12.00
Cafeteria
0
0
0
0
0
0
0
0
0
0
0
0
13.00
Maintenance of Personnel
0
0
0
0
0
0
0
0
0
0
0
0
14.00
Nursing Administration
1,445,400
2,853
4,286
2,263
1,286
0
0
0
0
0
0
0
15.00 Central Services & Supply 377,319 31,288 46,992 24,814 14,1050000000
16.00 Pharmacy 3,189,308 47,600 71,491 37,751 21,4580000000
17.00 Medical Records and Library 2,243,335 46,726 70,178 37,058 21,0640000000
18.00
Social Service
445,097
9,385
14,095
7,443
4,231
0
0
0
0
0
0
0
19.00
0
0
0
0
0
0
0
0
0
0
0
0
19.02
0
0
0
0
0
0
0
0
0
0
0
0
19.03
0
0
0
0
0
0
0
0
0
0
0
0
20.00 000000000000
21.00 Nursing School 000000000000
22.00
Intern & Res Service-Salary & Fringes
245
0
0
0
0
0
0
0
0
0
0
0
23.00 Intern & Res Other Program 1,625,79000000000000
24.00Paramedical Ed Program 000000000000
INPATIENT ROUTINE COST CENTERS
25.00
Adults & Pediatrics (Gen Routine)
8,435,787
299,618
450,003
237,624
135,070
0
0
0
0
0
0
0
26.00 Intensive Care Unit 4,448,758 59,920 89,996 47,522 27,0130000000
27.00 Coronary Care Unit 000000000000
28.00 Neonatal Intensive Care Unit 000000000000
29.00Surgical Intensive Care 000000000000
30.00 Subprovider I 000000000000
31.00 Subprovider II 000000000000
32.00 000000000000
33.00Nursery 000000000000
34.00
Medicare Certified Nursing Facility
0
0
0
0
0
0
0
0
0
0
0
0
35.00
Distinct Part Nursing Facility
0
0
0
0
0
0
0
0
0
0
0
0
36.00
Adult Subacute Care Unit
0
0
0
0
0
0
0
0
0
0
0
0
36.01
Subacute Care Unit II
0
0
0
0
0
0
0
0
0
0
0
0
36.02 Transitional Care Unit 000000000000
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STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period Ended:
USC KENNETH NORRIS JR. CANCER HOSPITAL MAY 31, 2008
NET EXP FOR
OLD CAPITAL
OLD
NEW CAPITAL
NEW
TRIAL BALANCE COST ALLOC BLDG & MOVABLE BLDG & MOVABLE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC
EXPENSES (From Sch 10) FIXTURES EQUIP FIXTURES EQUIP COST COST COST COST COST COST COST
0.00 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07
COMPUTATION OF COST ALLOCATION (W/S B)
ANCILLARY COST CENTERS
37.00
Operating Room
2,303,248
119,989
180,214
95,162
54,092
0
0
0
0
0
0
0
38.00
Recovery Room
533,183
21,656
32,525
17,175
9,763
0
0
0
0
0
0
0
39.00
Delivery Room and Labor Room
0
0
0
0
0
0
0
0
0
0
0
0
41.00
Radiology - Diagnostic
2,898,185
117,136
175,929
92,899
52,806
0
0
0
0
0
0
0
41.01 CT Scan 497,279 10,226 15,358 8,110 4,6100000000
41.02 Ultrasound 324,659 2,062 3,096 1,635 9290000000
41.03
Endoscopy
195,727
0
0
0
0
0
0
0
0
0
0
0
42.00
Radiology - Therapeutic
2,871,179
270,029
405,563
214,157
121,731
0
0
0
0
0
0
0
43.00 Radioisotope 341,294 8,741 13,129 6,933 3,9410000000
44.00 Laboratory 5,324,930 239,665 359,958 190,076 108,0430000000
44.01Pathological Lab 000000000000
46.00Whole Blood 000000000000
47.00
Blood Storing, Processing & Transfusio
2,653,772 10,292 15,458 8,162 4,6400000000
48.00 Intravenous Therapy 000000000000
49.00 Respiratory Therapy 700,464 29,737 44,663 23,585 13,4060000000
50.00
Physical Therapy
114,822
0
0
0
0
0
0
0
0
0
0
0
51.00
Occupational Therapy
0
0
0
0
0
0
0
0
0
0
0
0
52.00 Speech Pathology 000000000000
53.00Electrocardiology 75,1112,0623,0961,6359290000000
54.00 Electroencephalography 000000000000
55.00 Medical Supplies Charged to Patients 4,388,48500000000000
56.00 Drugs Charged to Patients 23,403,76100000000000
57.00
Renal Dialysis
208,227
0
0
0
0
0
0
0
0
0
0
0
58.00
ASC (Non-Distinct Part)
0
0
0
0
0
0
0
0
0
0
0
0
59.00 000000000000
59.01 000000000000
59.02 000000000000
59.03 000000000000
60.00 Clinic 3,142,964 206,909 310,761 164,098 93,2760000000
60.01
Infusion Therapy Clinic
1,910,887
119,049
178,802
94,417
53,668
0
0
0
0
0
0
0
60.02
Cancer Clinic
395,958
33,547
50,386
26,606
15,123
0
0
0
0
0
0
0
62.00Observation Beds 000000000000
65.00Ambulance Services 67,47300000000000
82.00 000000000000
83.00 000000000000
84.00
0
0
0
0
0
0
0
0
0
0
0
0
85.00
0
0
0
0
0
0
0
0
0
0
0
0
86.00
0
0
0
0
0
0
0
0
0
0
0
0
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen 185,440 14,267 21,428 11,315 6,4320000000
97.00Research 000000000000
98.00Physicians' Private Office 000000000000
99.00 Nonpaid Workers 000000000000
99.01
0
0
0
0
0
0
0
0
0
0
0
0
99.02
0
0
0
0
0
0
0
0
0
0
0
0
99.03 000000000000
99.04 000000000000
99.05 000000000000
100.00 Doctors Meals 000000000000
100.01 000000000000
100.02 000000000000
100.03
0
0
0
0
0
0
0
0
0
0
0
0
100.05 Public Relations 617,091 1,550 2,329 1,230 6990000000
TOTAL
110,907,611
2,100,657
3,155,027
1,666,012
946,993
0
0
0
0
0
0
0
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STATE OF CALIFORNIA
Provider Name:
USC KENNETH NORRIS JR. CANCER HOSPIT
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
4.00
New Cap Rel Costs-Movable Equipme
4.01
4.02
4.03
4.04
4.05
4.06
4.07
4.08
5.00
Employee Benefits
6.01
Non-Patient Telephones
6.02
Data Processing
6.03
Purchasing/Receiving
6.04
Patient Admitting
6.05
Patient 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 Neonatal Intensive Care Unit
29.00 Surgical Intensive Care
30.00 Subprovider I
31.00 Subprovider II
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 8.1
Fiscal Period Ended:
MAY 31, 2008
ADMINIS-
ALLOC EMPLOYEE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ACCUMULATE TRATIVE &
COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL
4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00
COMPUTATION OF COST ALLOCATION (W/S B)
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
48,012
0
0
0
0
0
0
0
0
23,491,233
0
0
0
0
0
0
0
0
0
0
0
0
0
324
0
0
0
0
0
0
0
0
2,721,654
731,385
0
0
0
0
0
0
0
0
0
0
271,277
72,900
0
0
0
0
0
0
0
0
0
0
973,495
261,605
0
4,496
0
0
0
0
0
0
0
0
1,460,724
392,537
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
11,906
0
0
0
0
0
0
0
0
1,467,994
394,491
01,40600000000495,924133,269
09,001000000003,376,609907,390
011,936000000002,430,297653,089
0
3,650
0
0
0
0
0
0
0
0
483,900
130,038
0
0
0
0
0
0
0
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0
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0
0
0
0
0
0
0
0
0
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0
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0
0
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0
0
0
0
0000000000 00
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0
3
0
0
0
0
0
0
0
0
248
67
00000000001,625,790436,895
0000000000 00
0
58,891
0
0
0
0
0
0
0
0
9,616,994
2,584,356
024,488000000004,697,6971,262,403
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0000000000 00
0000000000 00
0000000000 00
0000000000 00
0000000000 00
0000000000 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
0
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This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
USC KENNETH NORRIS JR. CANCER HOSPIT
TRIAL BALANCE
EXPENSES
ANCILLARY COST CENTERS
37.00
Operating Room
38.00
Recovery Room
39.00
Delivery Room and Labor Room
41.00
Radiology - Diagnostic
41.01 CT Scan
41.02 Ultrasound
41.03
Endoscopy
42.00
Radiology - Therapeutic
43.00 Radioisotope
44.00 Laboratory
44.01 Pathological Lab
46.00 Whole Blood
47.00
Blood Storing, Processing & Transfusio
48.00 Intravenous Therapy
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
58.00
ASC (Non-Distinct Part)
59.00
59.01
59.02
59.03
60.00 Clinic
60.01
Infusion Therapy Clinic
60.02
Cancer Clinic
62.00 Observation Beds
65.00 Ambulance Services
82.00
83.00
84.00
85.00
86.00
NONREIMBURSABLE COST CENTER
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01
99.02
99.03
99.04
99.05
100.00 Doctors Meals
100.01
100.02
100.03
100.05 Public Relations
TOTAL
SCHEDULE 8.1
Fiscal Period Ended:
MAY 31, 2008
ADMINIS-
ALLOC EMPLOYEE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ACCUMULATE TRATIVE &
COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL
4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00
COMPUTATION OF COST ALLOCATION (W/S B)
0
13,352
0
0
0
0
0
0
0
0
2,766,058
743,317
0
2,997
0
0
0
0
0
0
0
0
617,299
165,886
0
0
0
0
0
0
0
0
0
0
0
0
0
11,382
0
0
0
0
0
0
0
0
3,348,336
899,792
03,58400000000539,167144,889
0000000000332,38289,320
0
954
0
0
0
0
0
0
0
0
196,681
52,854
0
11,007
0
0
0
0
0
0
0
0
3,893,666
1,046,337
01,09300000000375,131100,808
022,690000000006,245,3621,678,304
0000000000 00
0000000000 00
01,365000000002,693,688723,870
0000000000 00
05,85600000000817,712219,742
0
1,081
0
0
0
0
0
0
0
0
115,903
31,146
0
0
0
0
0
0
0
0
0
0
0
0
0000000000 00
0730000000082,90722,279
0000000000 00
00000000004,388,4851,179,309
000000000023,403,7616,289,247
0
0
0
0
0
0
0
0
0
0
208,227
55,956
0
0
0
0
0
0
0
0
0
0
0
0
0000000000 00
0000000000 00
0000000000 00
0000000000 00
022,246000000003,940,2541,058,857
0
16,600
0
0
0
0
0
0
0
0
2,373,423
637,805
0
3,215
0
0
0
0
0
0
0
0
524,836
141,038
0000000000 00
000000000067,47318,132
0000000000 00
0000000000 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
0
0
0
0
0
0
0
0
0
049400000000239,37564,327
0000000000 00
0000000000 00
0000000000 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
0000000000 00
0000000000 00
0000000000 00
0000000000 00
0000000000 00
0000000000 00
0
0
0
0
0
0
0
0
0
0
0
0
075300000000623,651167,593
0
292,855
0
0
0
0
0
0
0
0
110,907,611
23,491,233
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
USC KENNETH NORRIS JR. CANCER HOSPIT
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
4.00
New Cap Rel Costs-Movable Equipme
4.01
4.02
4.03
4.04
4.05
4.06
4.07
4.08
5.00
Employee Benefits
6.01
Non-Patient Telephones
6.02
Data Processing
6.03
Purchasing/Receiving
6.04
Patient Admitting
6.05
Patient 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 Neonatal Intensive Care Unit
29.00 Surgical Intensive Care
30.00 Subprovider I
31.00 Subprovider II
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 8.2
Fiscal Period Ended:
MAY 31, 2008
CENTRAL MEDICAL
MAINT & OPER LAUNDRY & MAINT OF NURSING SERVICE RECORDS SOCIAL
REPAIRS PLANT LINEN HOUSEKEEP DIETARY CAFE PERSONNEL ADMIN & SUPPLY PHARMACY & LIBRARY SERVICE
7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00
COMPUTATION OF COST ALLOCATION (W/S B)
0
0
24,604
0
25,522
0
0
130,872
0
48,482
0
0
0
0
1,496,998
0
0
0
0
0
0
0
5,478
0
2,029
0
47,373
0
0 60,069 0 22,253 0 9,475 0 0
091,385033,8540118,433000
089,707033,2320142,1200000
0
18,017
0
6,675
0
18,949
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
000000000000
000000000000
0
0
0
0
0
0
0
0
0
0
0
0
000000000000
000000000000
0
575,227
154,888
213,095
301,703
355,300
0
773,132
0
0
180,385
211,365
0 115,039 36,878 42,617 59,089 151,595 0 664,893 0 0 99,408 164,395
000000000000
000000000000
000000000000
000000000000
000000000000
000000000000
000000000000
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
000000000000
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
USC KENNETH NORRIS JR. CANCER HOSPIT
TRIAL BALANCE
EXPENSES
ANCILLARY COST CENTERS
37.00
Operating Room
38.00
Recovery Room
39.00
Delivery Room and Labor Room
41.00
Radiology - Diagnostic
41.01 CT Scan
41.02 Ultrasound
41.03
Endoscopy
42.00
Radiology - Therapeutic
43.00 Radioisotope
44.00 Laboratory
44.01 Pathological Lab
46.00 Whole Blood
47.00
Blood Storing, Processing & Transfusio
48.00 Intravenous Therapy
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
58.00
ASC (Non-Distinct Part)
59.00
59.01
59.02
59.03
60.00 Clinic
60.01
Infusion Therapy Clinic
60.02
Cancer Clinic
62.00 Observation Beds
65.00 Ambulance Services
82.00
83.00
84.00
85.00
86.00
NONREIMBURSABLE COST CENTER
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01
99.02
99.03
99.04
99.05
100.00 Doctors Meals
100.01
100.02
100.03
100.05 Public Relations
TOTAL
SCHEDULE 8.2
Fiscal Period Ended:
MAY 31, 2008
CENTRAL MEDICAL
MAINT & OPER LAUNDRY & MAINT OF NURSING SERVICE RECORDS SOCIAL
REPAIRS PLANT LINEN HOUSEKEEP DIETARY CAFE PERSONNEL ADMIN & SUPPLY PHARMACY & LIBRARY SERVICE
7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00
COMPUTATION OF COST ALLOCATION (W/S B)
0
230,363
47,941
85,339
0
80,535
0
201,014
0
0
180,351
0
0
41,576
22,127
15,402
0
14,212
0
123,701
0
0
14,150
0
0
0
0
0
0
0
0
0
0
0
0
0
0
224,885
0
83,309
0
75,797
0
0
0
0
97,734
0
019,63207,273018,9490000202,2520
03,95801,46600000020,9400
0
0
0
0
0
4,737
0
0
0
0
18,726
0
0
518,420
25,815
192,051
0
71,060
0
0
0
0
246,219
58,712
016,78206,21704,737000014,8810
0 460,124 55,317 170,455 0 132,6450000348,8030
000000000000
000000000000
019,75907,32004,737000035,2380
000000000000
057,092021,150028,424000038,5560
0
0
0
0
0
4,737
0
0
0
0
8,356
0
0
0
0
0
0
0
0
0
0
0
0
0
000000000000
03,95801,4660000006,1720
000000000000
00000000720,9880224,1440
0000000004,527,6721,497,7810
0
0
0
0
0
0
0
0
0
0
6,774
0
0
0
0
0
0
0
0
0
0
0
0
0
000000000000
000000000000
000000000000
000000000000
0 397,238 25,815 147,158 35,956 123,171000040,2770
0
228,558
0
84,670
0
61,585
0
154,626
0
0
63,507
223,107
0
64,407
0
23,860
0
18,949
0
0
0
0
3,792
0
000000000000
000000000000
000000000000
000000000000
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
027,390010,14704,737000000
000000000000
000000000000
000000000000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
000000000000
000000000000
000000000000
0000138,8690000000
000000000000
000000000000
0
0
0
0
0
0
0
0
0
0
0
0
02,97701,10304,737000000
0
3,453,038
368,780
1,260,622
2,032,615
1,496,998
0
1,917,366
720,988
4,527,672
3,348,446
657,579
This is trial version
www.adultpdf.com
