REPORT ON THE COST REPORT REVIEW SETON MEDICAL CENTER DALY CITY, CALIFORNIA PROVIDER _part5 ppt

STATE OF CALIFORNIA
Provider Name:
SETON MEDICAL CENTER
GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Costs - Bldg and Fixtures
2.00 Old Cap Rel Costs - Movable Equipment
3.00 New Cap Rel Costs - Bldg and Fixtures
3.01 New Cap Rel Costs - Bldg (Coastside)
4.00 New Cap Rel Costs - Movable Equipment
4.01 New Cap Rel Costs - Equip (Coastside)
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 and Supply
16.00 Pharmacy
17.00 Medical Records and Library
18.00 Social Service
19.00
19.02
19.03
21.00 Nursing School
21.01 Clinical Pastoral Education
22.00 Intern and Res Service - Salary and Fringes
23.00 Intern and Res - Other Program
24.00 Paramedical Ed Program
INPATIENT ROUTINE COST CENTERS
25.00
Adults and 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
31.01 Subprovider 2 Psych
32.00
33.00 Nursery
34.00 Medicare Certified Nursing Facility
35.00 Distinct Part Nursing Facility
36.00 Other Long Term Care
36.01 Subacute Care Unit II

36.02 Transitional Care Unit
SCHEDULE 9.1
Fiscal Period Ended:
JUNE 30, 2008
EMP BENE NONPATIENT DATA PURCHASING ADMITTING CASHIERING STAT STAT STAT ADM & GEN MAINT &
(GROSS TELEPHONES PROCESSING RECEIVING (GROSS ACCOUNTS (ACCUM REPAIRS
SALARIES)
(# OF PHONES)
(DP TIME) (SUPPLY COST) REVENUE) (GROSS REV) COST) (SQ FT)
5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 7.00
(Adj 3)
376,503
30
1,372,878 11 2,306
1,431,609 23 393 157,839
713
5,198,704 98 600 432,089
2,129,985 37 600 5,520 5,468,128
1 23,120 4,077,426 8,450
216,673 4 95,396 1,783,889 4,534
2,414,892 11 321,501 3,967,073 2,572
1,875,596 24 1,542,421 4,047,559 10,211
1,673,609 9 1,376,067 2,839,822 8,318
0
4,148,442 20 201,934 6,307,305 3,621
140,520 11 90,174 1,713,757 8,016
3,033,057 26 7,865,722 5,863,502 4,107
1,487,897 44 209,452 3,530,881 10,473
573,301 5 1,102 783,791 480
0

0
0
0
0
0
37,500
0
28,117,790
96
1,429,951
236,227,228
236,227,228
44,324,632
70,870
6,152,260 12 312,320 43,249,710 43,249,710 9,678,945 6,016
5,741,984 12 276,563 43,834,825 43,834,825 8,661,144 6,052
0
0
0
0
0
599,609 2 17,597 4,011,290 4,011,290 799,818 229
11,027,194 26 752,459 47,692,933 47,692,933 16,809,136 32,395
0
5,545,755 19 560,713 57,386,505 57,386,505 9,161,041 13,441
0
0
STATISTICS FOR COST ALLOCATION (W/S B-1)
This is trial version
www.adultpdf.com

STATE OF CALIFORNIA
Provider Name:
SETON 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 Radiology - P. O. B.
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 Gastro Intestinal Services
59.01 Cardiac Cath Lab

59.02 CT/MRI
59.03
60.00 Clinic
60.01 Wound Care
60.02 Out-Patient Psychiatry
60.03 Diabetes Treatment Center
60.04 OB/GYN Clinic
61.00 Emergency
62.00 Observation Beds
71.00 Home Health Agency
85.00
86.00
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop and Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Satelite Clinic - Airport
99.02 HIV Serviceis
99.03 Women Service Line
99.04 Community Health Education
100.00 Marketing
100.01 SF Heart Institute
100.02 MD Office Building
100.04 Mission Servicies
100.05 Auxillary Group
100.07 Foundation
TOTAL
COST TO BE ALLOCATED
UNIT COST MULTIPLIER - SCH 8

SCHEDULE 9.1
Fiscal Period Ended:
JUNE 30, 2008
EMP BENE NONPATIENT DATA PURCHASING ADMITTING CASHIERING STAT STAT STAT ADM & GEN MAINT &
(GROSS TELEPHONES PROCESSING RECEIVING (GROSS ACCOUNTS (ACCUM REPAIRS
SALARIES)
(# OF PHONES)
(DP TIME) (SUPPLY COST) REVENUE) (GROSS REV) COST) (SQ FT)
5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 7.00
(Adj 3)
STATISTICS FOR COST ALLOCATION (W/S B-1)
6,495,689 92 275,179 46,551,832 46,551,832 10,819,069 7,139
0
1,096,290 12 9,202 9,753,262 9,753,262 1,653,622 3,175
1 129,638 24,227,696 24,227,696 404,892 2,904
5,343,667 67 351,837 34,164,284 34,164,284 9,054,560 17,406
742,410 25 72,858 17,961,854 17,961,854 1,684,632 8,606
0
1,451,300 14 171,111 35,728,737 35,728,737 3,063,051 7,705
733,590 16 808,405 21,822,957 21,822,957 2,343,063 4,391
5,300,912 52 2,051,344 110,799,606 110,799,606 11,304,644 11,940
0
1,653,269 1,841,109 1,841,109 1,901,135 351
0
441,775 46,198 2,644,037 2,644,037 728,879 1,644
3,668,069 19 279,241 61,636,378 61,636,378 6,190,355 8,141
1,503,733 23 54,468 19,344,898 19,344,898 3,707,064 10,894
368,122 83,578 4,375,860 4,375,860 890,500 7,314
194,949 2,559 1,907,513 1,907,513 283,403 80
1,277,417 17 35,201 33,984,619 33,984,619 2,148,351 4,083

56,496 3 6,458 523,728 523,728 105,218 334
18,683,105 198,819,832 198,819,832 22,405,161
161,356,094 161,356,094 8,750,085
747,385 4 85,623 7,884,886 7,884,886 1,160,081 548
2,240,201 46 253,207 28,444,139 28,444,139 4,004,561 8,336
1,113,147 58,791 8,806,895 8,806,895 1,655,461 1,444
1,746,224 32 352,924 66,299,845 66,299,845 3,562,407 8,922
157,561 3 4,900 41,721,087 41,721,087 541,514 2,246
0
0
924,040 26 385,164 7,249,740 7,249,740 2,108,205 9,774
266,749 12 41,615 986,994 986,994 629,837 4,300
217,518 5 2,976 158,827 158,827 349,679 960
394,484 54,162 1,821,437 1,821,437 1,757,116 4,294
6,388,928 35 105,171 68,445,820 68,445,820 9,761,739 11,566
0
4,255,334 72 159,719 7,502,313 6,473,243 7,129
0
0
86,268 2 126,279 288,612 949
0
0
0
0
0
0
0
294,602 6 6,687 897,862 487
457,067 25 6,392 1,013,897 5,977
41,183 41 91,698 3,058,101 112

110,567 135
8 6,095 149,549 1,436
8 44,655 1,083
131,263,368 1,187 4,612 42,126,994 1,451,666,457 1,459,168,770000254,860,118 355,590
42,603,915 1,047,157 5,844,447 5,744,864 2,821,576 5,781,75400023,749,024 5,977,673
0.324568 882.188016 1267.226203 0.136370 0.001944 0.003962 0.000000 0.000000 0.000000 0.093185 16.810577
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
SETON MEDICAL CENTER
GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Costs - Bldg and Fixtures
2.00 Old Cap Rel Costs - Movable Equipment
3.00 New Cap Rel Costs - Bldg and Fixtures
3.01 New Cap Rel Costs - Bldg (Coastside)
4.00 New Cap Rel Costs - Movable Equipment
4.01 New Cap Rel Costs - Equip (Coastside)
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 and Supply
16.00 Pharmacy
17.00 Medical Records and Library
18.00 Social Service
19.00
19.02
19.03
21.00 Nursing School
21.01 Clinical Pastoral Education
22.00 Intern and Res Service - Salary and Fringes
23.00 Intern and Res - Other Program
24.00 Paramedical Ed Program
INPATIENT ROUTINE COST CENTERS
25.00
Adults and 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
31.01 Subprovider 2 Psych
32.00
33.00 Nursery
34.00 Medicare Certified Nursing Facility
35.00 Distinct Part Nursing Facility
36.00 Other Long Term Care
36.01 Subacute Care Unit II
36.02 Transitional Care Unit
SCHEDULE 9.2

Fiscal Period Ended:
JUNE 30, 2008
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 (TIME
(SQ FT) (LB LNDRY) (HR SERV) SERVED) HRS) (# HOUSED) (NURSE HR) (CST REQ) REQUIS) REVENUE) 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 3) (Adj 4)
4,534
2,572
10,211 2,392
8,318
3,621 65,816
8,016 936 2,832
4,107 936 53,308 10,141
10,473 43,849
480 12,881 1
0
70,870

668,569
20,384
157,088
423,313
378,634
940,030
46,141
236,227,228
4,464
6,016 70,595 3,328 5,598 74,647 68,932 218,662 10,771 43,249,710 396
6,052 70,392 1,872 11,818 70,833 65,747 198,683 8,912 43,834,825 401
229 0 15,323 229 4,011,290
32,395 800,037 17,056 178,192 249,204 235,505 323,767 9,615 47,692,933 5,164
13,441 128,668 2,912 52,898 120,453 113,780 457,474 28,870 57,386,505 1,495
STATISTICS FOR COST ALLOCATION (W/S B-1)
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
SETON 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 Radiology - P. O. B.
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 Gastro Intestinal Services
59.01 Cardiac Cath Lab
59.02 CT/MRI
59.03
60.00 Clinic
60.01 Wound Care
60.02 Out-Patient Psychiatry
60.03 Diabetes Treatment Center
60.04 OB/GYN Clinic
61.00 Emergency
62.00 Observation Beds
71.00 Home Health Agency
85.00
86.00
NONREIMBURSABLE COST CENTERS

96.00 Gift, Flower, Coffee Shop and Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Satelite Clinic - Airport
99.02 HIV Serviceis
99.03 Women Service Line
99.04 Community Health Education
100.00 Marketing
100.01 SF Heart Institute
100.02 MD Office Building
100.04 Mission Servicies
100.05 Auxillary Group
100.07 Foundation
TOTAL
COST TO BE ALLOCATED
UNIT COST MULTIPLIER - SCH 8
SCHEDULE 9.2

Fiscal Period Ended:
JUNE 30, 2008
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 (TIME
(SQ FT) (LB LNDRY) (HR SERV) SERVED) HRS) (# HOUSED) (NURSE HR) (CST REQ) REQUIS) REVENUE) 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 3) (Adj 4)
STATISTICS FOR COST ALLOCATION (W/S B-1)
7,139 54,387 4,160 97,642 62,712 36,774 18,771 46,551,832
3,175 17,616 17,616 4,129 1,333 9,753,262
2,904 17,224 5,425 24,227,696

17,406 67,124 3,640 94,463 8,755 21,468 3,862 34,164,284
8,606 14,141 8,116 156 17,961,854
7,705 24,004 1,149 952 117 35,728,737
4,391 14,794 12,124 34,663 715 21,822,957
11,940 2,184 119,692 51 316,811 86 110,799,606
351 1,841,109
1,644 5,867 4,955 32,462 1,620 2,644,037
8,141 69,792 347 632 1,658 61,636,378
10,894 19,441 36,704 10,025 24,032 53 19,344,898
7,314 7,272 99 23,911 1 4,375,860
80 3,864 1,907,513
4,083 20,313 1,679 12,001 6 33,984,619
334 1,550 4,083 523,728
198,819,832
7,797,109 161,356,094
548 16,589 74,881 2,104 7,884,886
8,336 31,456 39,526 23,543 21,522 12,317 28,444,139
1,444 728 12,599 12,594 5,473 2,180 8,806,895
8,922 20,358 2,704 17,297 9,195 8,443 19,252 66,299,845
2,246 4,418 453 41,721,087
9,774 12,217 17,202 13,036 236,447 933 7,249,740
4,300 7,101 312 986,994
960 728 5,066 255 18 158,827
4,294 11,912 14,791 1,821,437
11,566 148,819 5,928 86,330 75,730 30,114 10,512 68,445,820
7,129 77,716 30,507 107,795 768
949 2,031
487 7,199 6 52
5,977 1,248 8,504
112 1,739 2,488

135 2,091
1,436 1,883
1,083
347,140 2,106,857 71,136 405,594 1,956,965 0 1,134,597 3,208,330 7,983,987 1,451,666,457 11,920 0
4,599,429 2,086,413 4,414,057 4,880,098 3,354,489 0 7,116,713 2,177,348 6,689,686 4,249,886 893,337 0
13.249492 0.990296 62.050963 12.031978 1.714128 0.000000 6.272459 0.678655 0.837888 0.002928 74.944403 0.000000
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
SETON MEDICAL CENTER
GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Costs - Bldg and Fixtures
2.00 Old Cap Rel Costs - Movable Equipment
3.00 New Cap Rel Costs - Bldg and Fixtures
3.01 New Cap Rel Costs - Bldg (Coastside)
4.00 New Cap Rel Costs - Movable Equipment
4.01 New Cap Rel Costs - Equip (Coastside)
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 and Supply
16.00 Pharmacy
17.00 Medical Records and Library
18.00 Social Service
19.00
19.02
19.03
21.00 Nursing School
21.01 Clinical Pastoral Education
22.00 Intern and Res Service - Salary and Fringes
23.00 Intern and Res - Other Program
24.00 Paramedical Ed Program
INPATIENT ROUTINE COST CENTERS
25.00
Adults and 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
31.01 Subprovider 2 Psych
32.00
33.00 Nursery
34.00 Medicare Certified Nursing Facility
35.00 Distinct Part Nursing Facility
36.00 Other Long Term Care
36.01 Subacute Care Unit II
36.02 Transitional Care Unit
SCHEDULE 9.3
Fiscal Period Ended:
JUNE 30, 2008
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 21.00 21.01 22.00 23.00 24.00
100
100
STATISTICS FOR COST ALLOCATION (W/S B-1)
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
SETON 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 Radiology - P. O. B.
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 Gastro Intestinal Services
59.01 Cardiac Cath Lab
59.02 CT/MRI
59.03
60.00 Clinic
60.01 Wound Care
60.02 Out-Patient Psychiatry
60.03 Diabetes Treatment Center
60.04 OB/GYN Clinic
61.00 Emergency

62.00 Observation Beds
71.00 Home Health Agency
85.00
86.00
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop and Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
99.01 Satelite Clinic - Airport
99.02 HIV Serviceis
99.03 Women Service Line
99.04 Community Health Education
100.00 Marketing
100.01 SF Heart Institute
100.02 MD Office Building
100.04 Mission Servicies
100.05 Auxillary Group
100.07 Foundation
TOTAL
COST TO BE ALLOCATED
UNIT COST MULTIPLIER - SCH 8
SCHEDULE 9.3
Fiscal Period Ended:
JUNE 30, 2008
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 21.00 21.01 22.00 23.00 24.00
STATISTICS FOR COST ALLOCATION (W/S B-1)

00001001000
0000040,9940
0.000000 0.000000 0.000000 0.000000 0.000000 409.944204 0.000000
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:
SETON MEDICAL CENTER JUNE 30, 2008

GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Costs - Bldg and Fixtures $ $ 0 $ 0
2.00 Old Cap Rel Costs - Movable Equipment 0 0
3.00 New Cap Rel Costs - Bldg and Fixtures 5,821,852 0 5,821,852
3.01 New Cap Rel Costs - Bldg (Coastside) 223,990 0 223,990
4.00 New Cap Rel Costs - Movable Equipment 5,960,225 0 5,960,225
4.01 New Cap Rel Costs - Equip (Coastside) 235,710 0 235,710
4.03 00
4.04 00
4.05 00
4.06 00
4.07 00
4.08 00
5.00 Employee Benefits 42,277,282 119,954 42,397,236
6.01 Non-Patient Telephones 913,175 0 913,175
6.02 Data Processing 5,742,357 0 5,742,357
6.03 Purchasing/Receiving 2,202,391 0 2,202,391
6.04 Patient Admitting 1,660,196 0 1,660,196
6.05 Patient Business Office 4,878,222 0 4,878,222

6.06 00
6.07 00
6.08 00
6.00 Administrative and General 20,619,332 0 20,619,332
7.00 Maintenance and Repairs 3,759,864 0 3,759,864
8.00 Operation of Plant 3,780,037 0 3,780,037
9.00 Laundry and Linen Service 1,561,107 0 1,561,107
10.00 Housekeeping 3,057,978 0 3,057,978
11.00 Dietary 2,883,233 0 2,883,233
12.00 Cafeteria 1,827,951 0 1,827,951
13.00 Maintenance of Personnel 0 0
14.00 Nursing Administration 4,803,473 0 4,803,473
15.00 Central Services and Supply 1,397,214 0 1,397,214
16.00 Pharmacy 3,644,295 0 3,644,295
17.00 Medical Records and Library 2,621,955 0 2,621,955
18.00 Social Service 579,884 0 579,884
19.00 00
19.02 00
19.03 00
21.00 Nursing School 00
21.01 Clinical Pastoral Education 0 0
22.00 Intern and Res Service - Salary and Fringes 0 0
23.00 Intern and Res - Other Program 37,500 0 37,500
24.00 Paramedical Ed Program 0 0
INPATIENT ROUTINE COST CENTERS
25.00 Adults and Pediatrics (Gen Routine) 31,013,785 49,491 31,063,276
26.00 Intensive Care Unit 7,164,651 0 7,164,651
27.00 Coronary Care Unit 6,280,183 0 6,280,183
28.00 Neonatal Intensive Care Unit 0 0
29.00 Surgical Intensive Care 0 0

31.00 Subprovider 00
31.01 Subprovider 2 Psych 0 0
32.00 00
33.00 Nursery 618,890 (49,491) 569,399
34.00 Medicare Certified Nursing Facility 12,111,585 0 12,111,585
35.00 Distinct Part Nursing Facility 0 0
36.00 Other Long Term Care 6,462,288 0 6,462,288
36.01 Subacute Care Unit II 0 0
36.02 Transitional Care Unit 0 0
(From Sch 10A)
AUDITEDREPORTED ADJUSTMENTS
TRIAL BALANCE OF EXPENSES
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:
SETON MEDICAL CENTER JUNE 30, 2008

(From Sch 10A)
AUDITEDREPORTED ADJUSTMENTS
TRIAL BALANCE OF EXPENSES
ANCILLARY COST CENTERS
37.00 Operating Room $ 8,069,310 $ 0 $ 8,069,310
38.00 Recovery Room 00
39.00 Delivery Room and Labor Room 1,118,132 0 1,118,132
40.00 Anesthesiology 142,425 0 142,425
41.00 Radiology - Diagnostic 6,529,583 0 6,529,583
41.01 Radiology - P. O. B. 1,164,303 0 1,164,303
41.02 00
42.00 Radiology - Therapeutic 2,077,814 0 2,077,814

43.00 Radioisotope 1,699,278 0 1,699,278
44.00 Laboratory 8,219,868 0 8,219,868
44.01 Pathological Lab 00
46.00 Whole Blood 1,652,619 0 1,652,619
47.00 Blood Storing and Processing 0 0
48.00 Intravenous Therapy 536,586 0 536,586
49.00 Respiratory Therapy 4,298,321 0 4,298,321
50.00 Physical Therapy 2,875,053 0 2,875,053
51.00 Occupational Therapy 479,862 0 479,862
52.00 Speech Pathology 205,737 0 205,737
53.00 Electrocardiology 1,371,483 0 1,371,483
54.00 Electroencephalography 68,665 0 68,665
55.00 Medical Supplies Charged to Patients 18,683,105 0 18,683,105
56.00 Drugs Charged to Patients 7,797,109 0 7,797,109
57.00 Renal Dialysis 836,705 0 836,705
58.00 ASC (Non-Distinct Part) 2,897,500 0 2,897,500
59.00 Gastro Intestinal Services 1,184,007 0 1,184,007
59.01 Cardiac Cath Lab 2,217,970 0 2,217,970
59.02 CT/MRI 162,680 0 162,680
59.03 00
60.00 Clinic 00
60.01 Wound Care 1,350,693 0 1,350,693
60.02 Out-Patient Psychiatry 371,887 0 371,887
60.03 Diabetes Treatment Center 239,997 0 239,997
60.04 OB/GYN Clinic 1,540,437 0 1,540,437
61.00 Emergency 6,875,131 0 6,875,131
62.00 Observation Beds 0 0
71.00 Home Health Agency 4,860,028 0 4,860,028
85.00 00
86.00 00

SUBTOTAL $ 273,666,893 $ 119,954 $ 273,786,847
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop and Canteen 213,432 0 213,432
97.00 Research 00
98.00 Physicians' Private Office 0 0
99.00 Nonpaid Workers 0 0
99.01 Satelite Clinic - Airport 0 0
99.02 HIV Serviceis 00
99.03 Women Service Line 0 0
99.04 Community Health Education 0 0
100.00 Marketing 781,507 0 781,507
100.01 SF Heart Institute 635,121 0 635,121
100.02 MD Office Building 2,994,547 0 2,994,547
100.04 Mission Servicies 105,880 0 105,880
100.05 Auxillary Group 91,807 0 91,807
100.07 Foundation 00
100.99 SUBTOTAL $ 4,822,294 $ 0 $ 4,822,294
101 TOTAL $ 278,489,187 $ 119,954 $ 278,609,141
(To Schedule 8)
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA SCHEDULE 10A
Page 1
Provider Name: Fiscal Period Ended:
SETON MEDICAL CENTER JUNE 30, 2008
TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
(Page 1) 1 2
GENERAL SERVICE COST CENTER
1.00
Old Cap Rel Costs - Bldg and Fixtures

$0
2.00
Old Cap Rel Costs - Movable Equipment
0
3.00
New Cap Rel Costs - Bldg and Fixtures
0
3.01
New Cap Rel Costs - Bldg (Coastside)
0
4.00
New Cap Rel Costs - Movable Equipment
0
4.01
New Cap Rel Costs - Equip (Coastside)
0
4.03

0
4.04

0
4.05

0
4.06

0
4.07

0
4.08

0
5.00
Employee Benefits
119,954
119,954
6.01
Non-Patient Telephones
0
6.02
Data Processing
0
6.03
Purchasing/Receiving
0
6.04
Patient Admitting
0
6.05
Patient Business Office
0
6.06

0
6.07

0
6.08

0
6.00
Administrative and General
0
7.00
Maintenance and Repairs
0
8.00
Operation of Plant
0
9.00
Laundry and Linen Service
0
10.00
Housekeeping
0
11.00
Dietary
0
12.00
Cafeteria
0
13.00
Maintenance of Personnel
0
14.00
Nursing Administration
0
15.00

Central Services and Supply
0
16.00
Pharmacy
0
17.00
Medical Records and Library
0
18.00 Social Service 0
19.00 0
19.02 0
19.03

0
21.00
Nursing School
0
21.01
Clinical Pastoral Education
0
22.00
Intern and Res Service - Salary and Fringes
0
23.00 Intern and Res - Other Program 0
24.00 Paramedical Ed Program 0

INPATIENT ROUTINE COST CENTERS
25.00 Adults and Pediatrics (Gen Routine) 49,491 49,491
26.00 Intensive Care Unit 0
27.00

Coronary Care Unit
0
28.00
Neonatal Intensive Care Unit
0
29.00 Surgical Intensive Care 0
31.00 Subprovider 0
31.01 Subprovider 2 Psych 0
32.00 0
33.00 Nursery (49,491) (49,491)
34.00 Medicare Certified Nursing Facility 0
35.00 Distinct Part Nursing Facility 0
36.00 Other Long Term Care 0
36.01
Subacute Care Unit II
0
36.02
Transitional Care Unit
0
ADJUSTMENTS TO REPORTED COSTS
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA SCHEDULE 10A
Page 1
Provider Name: Fiscal Period Ended:
SETON MEDICAL CENTER JUNE 30, 2008
TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
(Page 1) 1 2
ADJUSTMENTS TO REPORTED COSTS

ANCILLARY COST CENTERS
37.00
Operating Room
0
38.00 Recovery Room 0
39.00
Delivery Room and Labor Room
0
40.00
Anesthesiology
0
41.00
Radiology - Diagnostic
0
41.01
Radiology - P. O. B.
0
41.02

0
42.00 Radiology - Therapeutic 0
43.00 Radioisotope 0
44.00
Laboratory
0
44.01
Pathological Lab
0
46.00 Whole Blood 0
47.00 Blood Storing and Processing 0

48.00 Intravenous Therapy 0
49.00 Respiratory Therapy 0
50.00 Physical Therapy 0
51.00 Occupational Therapy 0
52.00 Speech Pathology 0
53.00
Electrocardiology
0
54.00
Electroencephalography
0
55.00 Medical Supplies Charged to Patients 0
56.00 Drugs Charged to Patients 0
57.00 Renal Dialysis 0
58.00 ASC (Non-Distinct Part) 0
59.00 Gastro Intestinal Services 0
59.01
Cardiac Cath Lab
0
59.02
CT/MRI
0
59.03 0
60.00 Clinic 0
60.01 Wound Care 0
60.02 Out-Patient Psychiatry 0
60.03 Diabetes Treatment Center 0
60.04
OB/GYN Clinic
0

61.00
Emergency
0
62.00 Observation Beds 0
71.00 Home Health Agency 0
85.00 0
86.00 0

NONREIMBURSABLE COST CENTERS
96.00
Gift, Flower, Coffee Shop and Canteen
0
97.00
Research
0
98.00
Physicians' Private Office
0
99.00 Nonpaid Workers 0
99.01 Satelite Clinic - Airport 0
99.02 HIV Serviceis 0
99.03 Women Service Line 0
99.04
Community Health Education
0
100.00
Marketing
0
100.01 SF Heart Institute 0
100.02 MD Office Building 0

100.04 Mission Servicies 0
100.05 Auxillary Group 0
100.07 Foundation 0
101.00
TOTAL
$119,954
0
119,954
0
0
0
0
0
0
0
0
0
0
(To Sch 10)
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
SETON MEDICAL CENTER
GENERAL SERVICE COST CENTER
1.00 Old Cap Rel Costs - Bldg and Fixtures
2.00 Old Cap Rel Costs - Movable Equipment
3.00 New Cap Rel Costs - Bldg and Fixtures
3.01 New Cap Rel Costs - Bldg (Coastside)
4.00 New Cap Rel Costs - Movable Equipment

4.01 New Cap Rel Costs - Equip (Coastside)
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 and Supply
16.00 Pharmacy
17.00 Medical Records and Library
18.00 Social Service
19.00

19.02
19.03
21.00 Nursing School
21.01 Clinical Pastoral Education
22.00 Intern and Res Service - Salary and Fringes
23.00 Intern and Res - Other Program
24.00 Paramedical Ed Program
INPATIENT ROUTINE COST CENTERS
25.00 Adults and 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
31.01 Subprovider 2 Psych
32.00
33.00 Nursery
34.00 Medicare Certified Nursing Facility
35.00 Distinct Part Nursing Facility
36.00 Other Long Term Care
36.01 Subacute Care Unit II
36.02 Transitional Care Unit
SCHEDULE 10A
Page 2
Fiscal Period Ended:
JUNE 30, 2008
AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
ADJUSTMENTS TO REPORTED COSTS
This is trial version

www.adultpdf.com