SCHEDULE 5 PROGRAM: NON CONTRACT SCHEDULE OF MEDICAL ANCILLARY COSTS_part5 pdf

STATE OF CALIFORNIA
Provider Name:
ALHAMBRA HOSPITAL MEDICAL CENTER
TRIAL BALANCE
EXPENSES
ANCILLARY COST CENTERS
37.00 Operating Room
38.00 Recovery Room
39.00 Delivery Room and Labor Room
40.00 Anesthesiology
41.00 Radiology - Diagnostic
41.01
41.02
42.00 Radiology - Therapeutic
43.00 Radioisotope
44.00 Laboratory
44.01 Pathological Lab
46.00 Whole Blood
47.00 Blood Storing and Processing
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 Other Clinic Services
61.00 Emergency
62.00 Observation Beds
71.00
82.00
83.00
84.00
85.00
86.00
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Marketing
99.02
99.03
99.04
99.05
100.00 M.O.S.T
100.01 Outpatient Dailysis
100.02 Whittier - NRCC
100.03 El Monte - NRCC
100.04 Garfield - NRCC
TOTAL
SCHEDULE 8.3

Fiscal Period Ended:
JUNE 30, 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. 4, 12)
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)
000000003,167,973 3,167,973
000000000 0
000000000 0
000000000 0
000000002,434,853 2,434,853
000000000 0
000000000 0
000000000 0
00000000431,248 431,248
000000003,175,765 3,175,765
000000000 0
00000000873,403 873,403
000000000 0
000000000 0
000000002,532,287 2,532,287
00000000699,685 699,685
000000000 0
0000000077,916 77,916
00000000735,125 735,125
0000000075,249 75,249
000000003,159,034 3,159,034
000000004,077,315 4,077,315

00000000447,219 447,219
000000000 0
000000000 0
000000000 0
000000000 0
000000000 0
000000000 0
000000000 0
000000003,003,592 3,003,592
000000000 0
000000000 0
000000000 0
000000000 0
000000000 0
000000000 0
000000000 0
0000000024,993 24,993
000000000 0
000000000 0
000000000 0
0000000016,159 16,159
000000000 0
000000000 0
000000000 0
000000000 0
00000000148,019 148,019
00000000112,677 112,677
00000000074,09474,094
000000000213 213
000000000610,971 610,971

0
0 0 0 0 0 0 0 48,043,790 685,278 48,729,068
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STATE OF CALIFORNIA
SCHEDULE 9
Provider Name:
Fiscal Period Ended:
ALHAMBRA HOSPITAL MEDICAL CENTER
JUNE 30, 2007
OLD BLDG OLD MOVBLE NEW BLDG
NEW MOVBLE
STAT STAT STAT STAT STAT STAT STAT STAT
& FIXTURES EQUIP & FIXTURES EQUIP
(SQ FT) (SQ FT) (SQ FT) (SQ FT)
1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08
(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
4.00 New Cap Rel Costs-Movable Equipment
4.01
4.02
4.03
4.04
4.05
4.06
4.07
4.08

5.00 Employee Benefits 377 377
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 9,639 9,639
7.00 Maintenance and Repairs
8.00 Operation of Plant 16,432 16,432
9.00 Laundry and Linen Service 1,051 1,051
10.00 Housekeeping 1,141 1,141
11.00 Dietary 2,045 2,045
12.00 Cafeteria 5,233 5,233
13.00 Maintenance of Personnel
14.00 Nursing Administration 1,475 1,475
15.00 Central Services & Supply 11,618 11,618
16.00 Pharmacy 1,304 1,304
17.00 Medical Records and Library 2,319 2,319
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)
15,092
15,092
26.00 Intensive Care Unit 5,268 5,268
27.00 Coronary Care Unit
28.00 Neonatal Intensive Care Unit
29.00 Surgical Intensive Care
31.00 Subprovider I 8,804 8,804
0.00
32.00
33.00 Nursery
34.00 Medicare Certified Nursing Facility
35.00 Distinct Part Nursing Facility
36.00 Adult Subacute Care Unit 16,350 16,350
36.01 Subacute Care Unit II
36.02 Transitional Care Unit
STATISTICS FOR COST ALLOCATION (W/S B-1)
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STATE OF CALIFORNIA
SCHEDULE 9
Provider Name:
Fiscal Period Ended:
ALHAMBRA HOSPITAL MEDICAL CENTER
JUNE 30, 2007
OLD BLDG OLD MOVBLE NEW BLDG
NEW MOVBLE
STAT STAT STAT STAT STAT STAT STAT STAT

& FIXTURES EQUIP & FIXTURES EQUIP
(SQ FT) (SQ FT) (SQ FT) (SQ FT)
1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08
(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 9,932 9,932
38.00 Recovery Room
39.00 Delivery Room and Labor Room
40.00 Anesthesiology
41.00 Radiology - Diagnostic 13,668 13,668
41.01
41.02
42.00 Radiology - Therapeutic
43.00 Radioisotope 200 200
44.00 Laboratory 3,527 3,527
44.01 Pathological Lab
46.00 Whole Blood 43 43
47.00 Blood Storing and Processing
48.00 Intravenous Therapy
49.00 Respiratory Therapy 1,014 1,014
50.00 Physical Therapy 4,858 4,858
51.00 Occupational Therapy
52.00 Speech Pathology 480 480
53.00 Electrocardiology 1,782 1,782
54.00 Electroencephalography 1,072 1,072
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 Other Clinic Services
61.00 Emergency 6,268 6,268
62.00 Observation Beds
71.00
82.00
83.00
84.00
85.00
86.00
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen 480 480
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Marketing 200 200
99.02
99.03
99.04
99.05
100.00 M.O.S.T 303 303
100.01 Outpatient Dailysis 2,164 2,164
100.02 Whittier - NRCC
100.03 El Monte - NRCC
100.04 Garfield - NRCC
TOTAL 0 0 144,139 144,13900000000

COST TO BE ALLOCATED 0 0 2,769,328000000000
UNIT COST MULTIPLIER - SCH 8 0.000000 0.000000 19.212899 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000
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STATE OF CALIFORNIA
Provider Name:
ALHAMBRA HOSPITAL MEDICAL CENTER
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
4.00 New Cap Rel Costs-Movable Equipment
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 CENTERS
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
31.00 Subprovider I
0.00
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:
JUNE 30, 2007
EMP BENE STAT STAT STAT STAT STAT STAT STAT STAT ADM & GEN MAINT &
(GROSS (ACCUM REPAIRS
SALARIES) COST) (SQ FT)
5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 7.00
(Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )
3,497,465
0
7,817 3,039,656
280,940
111,684
389,348 868,174
218,628 643,769
0
753,985 1,122,757
108,545 426,480
891,124 1,312,419
311,318 681,026
50,804 62,825
0
0
0

0
0
0
0
0
5,517,521
7,609,181
2,192,256 3,241,588
0
0
0
1,532,748 2,648,039
0
0
0
0
0
1,828,926 2,699,815
0
0
STATISTICS FOR COST ALLOCATION (W/S B-1)
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STATE OF CALIFORNIA
Provider Name:
ALHAMBRA HOSPITAL MEDICAL CENTER
ANCILLARY COST CENTERS
37.00 Operating Room
38.00 Recovery Room
39.00 Delivery Room and Labor Room

40.00 Anesthesiology
41.00 Radiology - Diagnostic
41.01
41.02
42.00 Radiology - Therapeutic
43.00 Radioisotope
44.00 Laboratory
44.01 Pathological Lab
46.00 Whole Blood
47.00 Blood Storing and Processing
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 Other Clinic Services
61.00 Emergency
62.00 Observation Beds
71.00

82.00
83.00
84.00
85.00
86.00
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Marketing
99.02
99.03
99.04
99.05
100.00 M.O.S.T
100.01 Outpatient Dailysis
100.02 Whittier - NRCC
100.03 El Monte - NRCC
100.04 Garfield - NRCC
TOTAL
COST TO BE ALLOCATED
UNIT COST MULTIPLIER - SCH 8
SCHEDULE 9.1
Fiscal Period Ended:
JUNE 30, 2007
EMP BENE STAT STAT STAT STAT STAT STAT STAT STAT ADM & GEN MAINT &
(GROSS (ACCUM REPAIRS
SALARIES) COST) (SQ FT)
5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 7.00

(Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )
STATISTICS FOR COST ALLOCATION (W/S B-1)
1,421,943 2,168,770
0
0
0
794,334 1,710,477
0
0
0
369,491
1,228,107 2,525,786
0
772,065
0
0
1,325,290 2,055,624
464,604
0
53,881
92,325 564,698
37,389
2,123,993
2,113,763
389,381
0
0
0
0
0

0
0
1,175,508 2,412,395
0
0
0
0
0
0
0
9,222
0
0
0
3,843
0
0
0
0
28,386 120,820
41,577
0
0
0
23,366,3780000000042,686,132 0
280,580000000005,357,658 0
0.012008 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.125513 0.000000
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STATE OF CALIFORNIA

Provider Name:
ALHAMBRA HOSPITAL MEDICAL CENTER
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
4.00 New Cap Rel Costs-Movable Equipment
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 CENTERS
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
31.00 Subprovider I
0.00
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:
JUNE 30, 2007
OPER LAUNDRY HOUSE- DIETARY CAFETERIA MAINT OF NURSING CENT SERV PHARMACY MED REC SOC SERV STAT
PLANT & LINEN KEEPING (MEALS (MEALS PERSONNEL ADMIN & SUPPLY (COSTS (GROSS (TIME
(SQ FT) (LB LNDRY) (HR SERV) SERVED) SERVED) (# HOUSED) (NURSE HR) (CST REQ) REQUIS) SALARIES) SPENT)
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 ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj 13) (Adj ) (Adj )
1,051
1,141
2,045 2,045
5,233 5,233
1,475 1,475 2,457
11,618 4,640 11,618 381
1,304 1,304 1,535 3
2,319 2,319 1,025
0
15,092
385,244
15,092
40,523
9,815
4,160
8,738
34,105,250
3,838
5,268 95,602 5,268 3,180 2,324 2,080 5,478 8,674,500 158
8,804 91,730 8,804 9,584 2,873 2,080 117 0

16,350 210,242 16,350 3,540 3,648 8,949 8,914,800 2,170
STATISTICS FOR COST ALLOCATION (W/S B-1)
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STATE OF CALIFORNIA
Provider Name:
ALHAMBRA HOSPITAL MEDICAL CENTER
ANCILLARY COST CENTERS
37.00 Operating Room
38.00 Recovery Room
39.00 Delivery Room and Labor Room
40.00 Anesthesiology
41.00 Radiology - Diagnostic
41.01
41.02
42.00 Radiology - Therapeutic
43.00 Radioisotope
44.00 Laboratory
44.01 Pathological Lab
46.00 Whole Blood
47.00 Blood Storing and Processing
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 Other Clinic Services
61.00 Emergency
62.00 Observation Beds
71.00
82.00
83.00
84.00
85.00
86.00
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Marketing
99.02
99.03
99.04
99.05
100.00 M.O.S.T
100.01 Outpatient Dailysis
100.02 Whittier - NRCC
100.03 El Monte - NRCC

100.04 Garfield - NRCC
TOTAL
COST TO BE ALLOCATED
UNIT COST MULTIPLIER - SCH 8
SCHEDULE 9.2

Fiscal Period Ended:
JUNE 30, 2007
OPER LAUNDRY HOUSE- DIETARY CAFETERIA MAINT OF NURSING CENT SERV PHARMACY MED REC SOC SERV STAT
PLANT & LINEN KEEPING (MEALS (MEALS PERSONNEL ADMIN & SUPPLY (COSTS (GROSS (TIME
(SQ FT) (LB LNDRY) (HR SERV) SERVED) SERVED) (# HOUSED) (NURSE HR) (CST REQ) REQUIS) SALARIES) SPENT)
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 ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj 13) (Adj ) (Adj )
STATISTICS FOR COST ALLOCATION (W/S B-1)
9,932 30,924 9,932 2,509 2,080 15,068,744
13,668 12,930 13,668 1,377 71 10,756,349
200 200 1,854,743
3,527 21,342 3,527 2,232 106,469 21,740,182
43 43 623,641
1,014 1,014 2,103 77,881 19,155,590 34
4,858 9,102 4,858 2,155 3,958,002 437
480 480 530,593
1,782 1,782 976 4,110,438
1,072 1,072 105,813
1,502,617 6,182,537
2,195,398 28,451,429
1,789,364
6,268 73,754 6,268 1,329 9,377 6,232,588 74
480 480
200 200 227

303 303 111 0
2,164 2,164
117,691 935,510 115,499 56,827 34,922 0 10,400 1,721,855 2,195,398 172,254,563 6,711 0
3,421,172 346,753 158,870 1,039,400 883,887 0 1,370,770 845,077 1,555,697 863,048 70,710 0
29.069106 0.370657 1.375506 18.290598 25.310330 0.000000 131.804852 0.490795 0.708617 0.005010 10.536492 0.000000
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STATE OF CALIFORNIA
Provider Name:
ALHAMBRA HOSPITAL MEDICAL CENTER
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
4.00 New Cap Rel Costs-Movable Equipment
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 CENTERS
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

31.00 Subprovider I
0.00
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:
JUNE 30, 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 )
STATISTICS FOR COST ALLOCATION (W/S B-1)
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STATE OF CALIFORNIA
Provider Name:
ALHAMBRA HOSPITAL MEDICAL CENTER
ANCILLARY COST CENTERS
37.00 Operating Room
38.00 Recovery Room
39.00 Delivery Room and Labor Room
40.00 Anesthesiology
41.00 Radiology - Diagnostic
41.01

41.02
42.00 Radiology - Therapeutic
43.00 Radioisotope
44.00 Laboratory
44.01 Pathological Lab
46.00 Whole Blood
47.00 Blood Storing and Processing
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 Other Clinic Services
61.00 Emergency
62.00 Observation Beds
71.00
82.00
83.00
84.00

85.00
86.00
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Marketing
99.02
99.03
99.04
99.05
100.00 M.O.S.T
100.01 Outpatient Dailysis
100.02 Whittier - NRCC
100.03 El Monte - NRCC
100.04 Garfield - NRCC
TOTAL
COST TO BE ALLOCATED
UNIT COST MULTIPLIER - SCH 8
SCHEDULE 9.3
Fiscal Period Ended:
JUNE 30, 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 )
STATISTICS FOR COST ALLOCATION (W/S B-1)

0000000
0000000
0.000000 0.000000 0.000000 0.000000 0.000000 0.000000 0.000000
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STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:
ALHAMBRA HOSPITAL MEDICAL CENTER JUNE 30, 2007

GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Costs-Bldg & Fixtures $ $ 0 $ 0
2.00 Old Cap Rel Costs-Movable Equipment 0 0
3.00 New Cap Rel Costs-Bldg & Fixtures 2,324,939 444,389 2,769,328
4.00 New Cap Rel Costs-Movable Equipment 0 0
4.01 00
4.02 00
4.03 00
4.04 00
4.05 00
4.06 00
4.07 00
4.08 00
5.00 Employee Benefits 284,883 (11,546) 273,337
6.01 Non-Patient Telephones 0 0
6.02 Data Processing 00
6.03 Purchasing/Receiving 0 0
6.04 Patient Admitting 00
6.05 Patient Business Office 0 0
6.06 00

6.07 00
6.08 00
6.00 Administrative and General 5,267,374 (136,906) 5,130,468
7.00 Maintenance and Repairs 0 0
8.00 Operation of Plant 2,723,856 0 2,723,856
9.00 Laundry and Linen Service 260,747 0 260,747
10.00 Housekeeping 89,762 0 89,762
11.00 Dietary 824,208 0 824,208
12.00 Cafeteria 540,603 0 540,603
13.00 Maintenance of Personnel 0 0
14.00 Nursing Administration 1,085,364 0 1,085,364
15.00 Central Services & Supply 201,961 0 201,961
16.00 Pharmacy 1,217,448 59,217 1,276,665
17.00 Medical Records and Library 632,733 0 632,733
18.00 Social Service 62,215 0 62,215
19.00 00
19.02 00
19.03 00
20.00 00
21.00 Nursing School 00
22.00 Intern & Res Service-Salary & Fringes 0 0
23.00 Intern & Res Other Program 0 0
24.00 Paramedical Ed Program 0 0
INPATIENT ROUTINE COST CENTERS
25.00 Adults & Pediatrics (Gen Routine) 7,252,966 0 7,252,966
26.00 Intensive Care Unit 3,114,050 0 3,114,050
27.00 Coronary Care Unit 0 0
28.00 Neonatal Intensive Care Unit 0 0
29.00 Surgical Intensive Care 0 0
31.00 Subprovider I 2,460,484 0 2,460,484

Subprovider II 00
32.00 00
33.00 Nursery 00
34.00 Medicare Certified Nursing Facility 0 0
35.00 Distinct Part Nursing Facility 0 0
36.00 Adult Subacute Care Unit 2,363,723 0 2,363,723
36.01 Subacute Care Unit II 0 0
36.02 Transitional Care Unit 0 0
REPORTED ADJUSTMENTS
TRIAL BALANCE OF EXPENSES
(From Sch 10A)
AUDITED
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STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:
ALHAMBRA HOSPITAL MEDICAL CENTER JUNE 30, 2007

REPORTED ADJUSTMENTS
TRIAL BALANCE OF EXPENSES
(From Sch 10A)
AUDITED
ANCILLARY COST CENTERS
37.00 Operating Room $ 1,960,873 $ 0 $ 1,960,873
38.00 Recovery Room 00
39.00 Delivery Room and Labor Room 0 0
40.00 Anesthesiology 00
41.00 Radiology - Diagnostic 1,438,337 0 1,438,337
41.01 00
41.02 00

42.00 Radiology - Therapeutic 0 0
43.00 Radioisotope 365,648 0 365,648
44.00 Laboratory 2,443,275 0 2,443,275
44.01 Pathological Lab 00
46.00 Whole Blood 771,239 0 771,239
47.00 Blood Storing and Processing 0 0
48.00 Intravenous Therapy 0 0
49.00 Respiratory Therapy 2,020,228 0 2,020,228
50.00 Physical Therapy 371,268 0 371,268
51.00 Occupational Therapy 0 0
52.00 Speech Pathology 44,659 0 44,659
53.00 Electrocardiology 529,352 0 529,352
54.00 Electroencephalography 16,793 0 16,793
55.00 Medical Supplies Charged to Patients 2,123,993 0 2,123,993
56.00 Drugs Charged to Patients 2,172,980 (59,217) 2,113,763
57.00 Renal Dialysis 389,381 0 389,381
58.00 ASC (Non-Distinct Part) 0 0
59.00 00
59.01 00
59.02 00
59.03 00
60.00 Clinic 00
60.01 Other Clinic Services 0 0
61.00 Emergency 2,277,853 0 2,277,853
62.00 Observation Beds 0 0
71.00 00
82.00 00
83.00 00
84.00 00
85.00 00

86.00 00
SUBTOTAL $ 47,633,195 $ 295,937 $ 47,929,132
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen 0 0
97.00 Research 00
98.00 Physicians' Private Office 0 0
99.00 Nonpaid Workers 0 0
99.01 Marketing 00
99.02 00
99.03 00
99.04 00
99.05 00
100.00 M.O.S.T 114,658 0 114,658
100.01 Outpatient Dailysis 0 0
100.02 Whittier - NRCC 00
100.03 El Monte - NRCC 0 0
100.04 Garfield - NRCC 00
100.99 SUBTOTAL $ 114,658 $ 0 $ 114,658
101 TOTAL $ 47,747,853 $ 295,937 $ 48,043,790
(To Schedule 8)
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