REPORT ON THE COST REPORT REVIEW MARIAN MEDICAL CENTER SANTA MARIA_part3 pdf

STATE OF CALIFORNIA SCHEDULE 7
PROGRAM: NONCONTRACT
Provider Name: Fiscal Period Ended:
MARIAN MEDICAL CENTER JUNE 30, 2009

Provider No:
ZZT30107G
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 Schedule 3)
COMPUTATION OF PROFESSIONAL
COMPONENT OF HOSPITAL BASED
REMUNERATION
HBP TOTAL CHARGES
TO ALL PATIENTS
MEDI-CAL MEDI-CAL
COST
RATIO OF
REMUNERATION CHARGES
(Adj ) (Adj ) (Adj )

PHYSICIAN'S REMUNERATION
TO CHARGES
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STATE OF CALIFORNIA DPNF SCH 1
Provider Name: Fiscal Period Ended:
MARIAN MEDICAL CENTER JUNE 30, 2009
Provider No:
LTC55256H
REPORTED AUDITED DIFFERENCE
COMPUTATION OF DISTINCT PART (DP)
NURSING FACILITY PER DIEM
1. Distinct Part Ancillary Cost (DPNF Sch 3) $ 0 $ 0 $ 0
2. Distinct Part Routine Cost (DPNF Sch 2) $ 0 $ 10,927,168 $ 10,927,168

3. Total Distinct Part Facility Cost (Lines 1 & 2) $ 0 $ 10,927,168 $ 10,927,168
4. Total Distinct Part Patient Days (Adj 24) 30,806 30,973 167
5. Average DP Per Diem Cost (Line 3 / Line 4) $ 0.00 $ 352.80 $ 352.80
DPNF OVERPAYMENT AND OVERBILLINGS
6. Medi-Cal Overpayments (Adj ) $ 0 $ 0 $ 0
7. Medi-Cal Credit Balances (Adj ) $ 0 $ 0 $ 0
8. MEDI-CAL SETTLEMENT Due Provider (State) $ 0 $ 0 $ 0
(To Summary of Findings)
GENERAL INFORMATION
9. Total Available Distinct Part Beds (C/R, W/S S-3) 95 95 0
10. Total Licensed Capacity (All levels) (Adj ) 262 262 0

11. Total Medi-Cal DP Patient Days (Adj ) 0 0 0
CAPITAL RELATED COST
12. Direct Capital Related Cost N/A $ 0 N/A

13. Indirect Capital Related Cost (DPNF Sch 5) N/A $ 473,245 N/A
14. Total Capital Related Cost (Lines 12 & 13) N/A $ 473,245 N/A
TOTAL SALARY & BENEFITS
15. Direct Salary & Benefits Expenses N/A $ 4,382,428 N/A
16. Allocated Salary & Benefits (DPNF Sch 5) N/A $ 3,487,661 N/A
17. Total Salary & Benefits Expenses (Lines 15 & 16) N/A $ 7,870,089 N/A
COMPUTATION OF
DISTINCT PART NURSING FACILITY PER DIEM
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STATE OF CALIFORNIA DPNF SCH 2
Provider Name: Fiscal Period Ended:
MARIAN MEDICAL CENTER JUNE 30, 2009
Provider No:
LTC55256H
COST CENTER
COL. DIRECT AND ALLOCATED EXPENSE
0.00 Distinct Part $ $ 4,699,183 $ 4,699,183
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 155,201 155,201
4.00 New Cap Rel Costs-Movable Equipment 40,800 40,800
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 1,357,554 1,357,554
6.01 Non-Patient Telephones 0 0
6.02 Data Processing 0 0
6.03 Purchasing/Receiving 0 0
6.04 Patient Admitting 0 0
6.05 Patient Business Office 0 0
6.06 00
6.07 00
6.08 00
6.00 Administrative and General 1,342,245 1,342,245
7.00 Maintenance and Repairs 509,764 509,764
8.00 Operation of Plant 241,805 241,805
9.00 Laundry and Linen Service 235,340 235,340
10.00 Housekeeping 260,684 260,684
11.00 Dietary 1,134,552 1,134,552
12.00 Cafeteria 263,783 263,783
13.00 Maintenance of Personnel 0 0
14.00 Nursing Administration 637,383 637,383
15.00 Central Services & Supply 5,760 5,760
16.00 Pharmacy 0 0
17.00 Medical Records and Library 43,114 43,114
18.00 Social Service 0 0
19.00 00
19.02 00
19.03 00
20.00 00
21.00 Nursing School 0 0
22.00 Intern & Res Service-Salary & Fringes 0 0
23.00 Intern & Res Other Program 0 0
24.00 Paramedical Ed Program 0 0

TOTAL DIRECT AND
101.00 ALLOCATED EXPENSES $ 0 $ 10,927,168 $ 10,927,168
(To DPNF Sch 1)
* From Schedule 8, Part I, line 34 plus line 35.
REPORTED * AUDITED *
SUMMARY OF DISTINCT PART FACILITY EXPENSES
DIFFERENCE
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STATE OF CALIFORNIA DPNF SCH 3
Provider Name: Fiscal Period Ended:
MARIAN MEDICAL CENTER JUNE 30, 2009
Provider No:
LTC55256H
RATIO
COST TO
CHARGES
ANCILLARY COST CENTERS (From DPNF Sch 4)
49.00 Respiratory Therapy $ 3,502,159 $ 8,505,764 0.411739 $ 0 $ 0
55.00
Med Supply Charged to Patients 9,262,668 35,024,732 0.264461 0 0
56.00 Drugs Charged to Patients 8,084,628 79,938,761 0.101135 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0

0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0
0.000000 0 0

0.000000 0 0
101.00 TOTAL $ 20,849,455 $ 123,469,257 $ 0 $ 0
(To DPNF Sch 1)
* From Schedule 8, Column 27.
** Total Distinct Part Ancillar
y
Char
g
es included in the rat
e
*** Total Distinct Part Ancillary Costs included in the rate.
SCHEDULE OF TOTAL DISTINCT PART ANCILLARY COSTS
TOTAL ANCILLARY
CHARGES
TOTAL
ANCILLARY
TOTAL
COST * COST***
TOTAL
ANCILLARY
CHARGES **
DP ANCILLARY
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STATE OF CALIFORNIA DPNF SCH 4
Provider Name: Fiscal Period Ended:
MARIAN MEDICAL CENTER JUNE 30, 2009
Provider No:
LTC55256H
ANCILLARY CHARGES

49.00 Respiratory Therapy $ $ $ 0
55.00 Med Supply Charged to Patients 0
56.00 Drugs Charged to Patients 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
TOTAL DP ANCILLARY CHARGES $ 0 $ 0 $ 0
(To DPNF Sch 3)
ADJUSTMENTS
(Adj )
ADJUSTMENTS TO TOTAL
DISTINCT PART ANCILLARY CHARGES
AUDITEDREPORTED
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STATE OF CALIFORNIA DPNF SCH 5
Provider Name: Fiscal Period Ended:
MARIAN MEDICAL CENTER JUNE 30, 2009
Provider No:
LTC55256H
COL. COST CENTER
1.00 Old Cap Rel Costs-Bldg & Fixtures $ 0 $ N/A
2.00 Old Cap Rel Costs-Movable Equipment 0 N/A
3.00 New Cap Rel Costs-Bldg & Fixtures 155,201 N/A

4.00 New Cap Rel Costs-Movable Equipment 40,800 N/A
4.01 0N/A
4.02 0N/A
4.03 0N/A
4.04 0N/A
4.05 0N/A
4.06 0N/A
4.07 0N/A
4.08 0N/A
5.00 Employee Benefits 3,502 1,354,052
6.01 Non-Patient Telephones 0 0
6.02 Data Processing 0 0
6.03 Purchasing/Receiving 0 0
6.04 Patient Admitting 0 0
6.05 Patient Business Office 0 0
6.06 00
6.07 00
6.08 00
6.00 Administrative and General 134,772 660,815
7.00 Maintenance and Repairs 39,107 156,378
8.00 Operation of Plant 7,075 89,188
9.00 Laundry and Linen Service 8,611 47,248
10.00 Housekeeping 6,234 147,154
11.00 Dietary 44,957 367,762
12.00 Cafeteria 14,015 95,625
13.00 Maintenance of Personnel 0 0
14.00 Nursing Administration 15,687 537,179
15.00 Central Services & Supply 669 2,958
16.00 Pharmacy 0 0
17.00 Medical Records and Library 2,616 29,300

18.00 Social Service 0 0
19.00 00
19.02 00
19.03 00
20.00 00
21.00 Nursing School 0 0
22.00 Intern & Res Service-Salary & Fringes 0 0
23.00 Intern & Res Other Program 0 0
24.00 Paramedical Ed Program 0 0

101 TOTAL ALLOCATED INDIRECT EXPENSES $ 473,245 $ 3,487,661
* These amounts include both Skilled Nursing Facility expenses, (To DPNF SCH 1)
line 34 and Nursing Facility expenses, line 35.
(COL 1)
EMP BENEFITS *
(COL 2)
RELATED *
ALLOCATION OF INDIRECT EXPENSES
DISTINCT PART NURSING FACILITY
AUDITED CAP AUDITED SAL &
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STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period Ended:
MARIAN MEDICAL CENTER JUNE 30, 2009
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
0
2.00
Old Cap Rel Costs-Movable Equipmen
0
0
3.00
New Cap Rel Costs-Bldg & Fixtures
4,459,793
0
0
4.00
New Cap Rel Costs-Movable Equipme
6,975,938
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
22,740,100
0
0
49,864
8,950
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
23,093,189
0
0
2,093,674
857,361

0
0
0
0
0
0
0
7.00
Maintenance and Repairs
4,854,205
0
0
240,220
160,666
0
0
0
0
0
0
0
8.00
Operation of Plant
2,408,602
0
0
1,583
35,078
0
0

0
0
0
0
0
9.00
Laundry and Linen Service
886,908
0
0
19,011
0
0
0
0
0
0
0
0
10.00
Housekeeping
2,165,800
0
0
14,672
733
0
0
0
0

0
0
0
11.00
Dietary
1,403,139
0
0
30,292
8,071
0
0
0
0
0
0
0
12.00
Cafeteria
1,475,863
0
0
62,068
10,297
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
1,806,659
0
0
11,656
2,865
0
0
0
0
0
0
0
15.00 Central Services & Supply 401,519 0 0 56,222 47,8570000000

16.00 Pharmacy 2,395,762 0 0 23,498 139,2610000000
17.00 Medical Records and Library 1,132,829 0 0 27,350 51,1920000000
18.00
Social Service
0
0
0
0
0
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
0
0
0
0
0
0
0
0
0
0
0
0
23.00Intern & Res Other Program 000000000000
24.00Paramedical Ed Program 000000000000
INPATIENT ROUTINE COST CENTERS
25.00
Adults & Pediatrics (Gen Routine)
13,625,389
0
0
306,763
525,125
0
0
0
0
0
0

0
26.00 Intensive Care Unit 3,413,530 0 0 57,830 177,4120000000
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
33.00 Nursery 1,479,069 0 0 21,030 18,9760000000
34.00
Medicare Certified Nursing Facility
4,699,183
0
0
155,201
40,800
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:
MARIAN MEDICAL CENTER JUNE 30, 2009
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
4,910,229
0
0
263,456
514,869
0
0

0
0
0
0
0
37.01
Gastro Intestinal Service
211,921
0
0
10,920
9,749
0
0
0
0
0
0
0
37.20
Cardicac Cath Lab
1,096,026
0
0
8,427
560,950
0
0
0
0

0
0
0
38.00
Recovery Room
0
0
0
0
0
0
0
0
0
0
0
0
39.00 Delivery Room and Labor Room 4,096,133 0 0 70,607 130,6540000000
40.00 Anesthesiology 135,499 0 0 760 58,4330000000
41.00
Radiology - Diagnostic
3,316,761
0
0
102,608
1,687,480
0
0
0
0

0
0
0
41.01
CT Scan and MRI
513,844
0
0
4,625
745,294
0
0
0
0
0
0
0
43.00 Radioisotope 1,287,006 0 0 4,986 7,7570000000
44.00 Laboratory 5,128,126 0 0 53,728 111,3240000000
44.01Pathological Lab 000000000000
46.00 Whole Blood & Packed Red Blood 1,555,570 0 0 2,605 1,6170000000
47.00 Blood Storing and Processing 000000000000
48.00 Intravenous Therapy 103,85500000000000
49.00 Respiratory Therapy 1,854,924 0 0 70,109 52,7220000000
50.00
Physical Therapy
1,686,892
0
0
43,768

12,183
0
0
0
0
0
0
0
51.00
Occupational Therapy
655,034
0
0
19,048
1,907
0
0
0
0
0
0
0
52.00 Speech Pathology 000000000000
53.00 Electrocardiology 1,089,607 0 0 77,376 88,9110000000
54.00 Electroencephalography 63,2190008,7940000000
55.00 Medical Supplies Charged to Patients 6,784,187000460,3500000000
55.01 Medical Supplies Chrg. Pat. - IMP 8,335,66300000000000
56.00
Drugs Charged to Patients
3,702,317

0
0
0
8,466
0
0
0
0
0
0
0
57.00
Renal Dialysis
290,292
0
0
3,441
0
0
0
0
0
0
0
0
58.00ASC (Non-Distinct Part) 000000000000
59.00 Ultrasound 339,981 0 0 2,506 84,2290000000
59.02 000000000000
59.03 000000000000
60.00 Clinic 504,077 0 0 116,420 4,1020000000

60.01
Other Clinic Services
0
0
0
0
0
0
0
0
0
0
0
0
61.00
Emergency
5,209,925
0
0
161,597
69,537
0
0
0
0
0
0
0
62.00Observation Beds 000000000000
71.00 Home Health Agency 10,130,828 0 0 105,213 85,1030000000

89.00 Utilization Review 0000166,7580000000
93.00 Hospice 2,138,604 0 0 61,58200000000


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
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen 000000000000
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 000000000000
100.01 Foundation 0 0 0 49,86400000000
100.02 000000000000
100.03
Community Relations
2,245,202
0
0
55,212
20,104

0
0
0
0
0
0
0
100.04 000000000000
TOTAL
166,803,199
0
0
4,459,793
6,975,938
0
0
0
0
0
0
0
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STATE OF CALIFORNIA
Provider Name:
MARIAN MEDICAL CENTER
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 CENTE
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:
JUNE 30, 2009
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

3,434,543
0
0
0
0
0
0
0
0
29,478,767
0
354,353
0
0
0
0
0
0
0
0
5,609,443
1,204,152
0
215,566
0
0
0
0
0
0

0
0
2,660,829
571,187
0
27,788
0
0
0
0
0
0
0
0
933,707
200,434
0
351,643
0
0
0
0
0
0
0
0
2,532,849
543,714
0
102,249

0
0
0
0
0
0
0
0
1,543,751
331,390
0
130,511
0
0
0
0
0
0
0
0
1,678,739
360,367
0
0
0
0
0
0
0
0

0
0
0
0
0
524,187
0
0
0
0
0
0
0
0
2,345,366
503,468
092,11100000000597,708 128,307
0 785,819000000003,344,340 717,913
0 269,177000000001,480,548 317,822
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
0000000000 00
0000000000 00
0
0
0
0
0
0
0
0
0
0
0
0
0000000000 00
0000000000 00
0
3,914,058
0
0
0
0
0

0
0
0
18,371,335
3,943,685
0 927,150000000004,575,922 982,291
0000000000 00
0000000000 00
0000000000 00
0000000000 00
0000000000 00
0000000000 00
0 277,748000000001,796,823 385,715
0
1,357,554
0
0
0
0
0
0
0
0
6,252,739
1,342,245
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
0000000000 00
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
MARIAN MEDICAL CENTER
TRIAL BALANCE
EXPENSES
ANCILLARY COST CENTERS
37.00
Operating Room
37.01
Gastro Intestinal Service
37.20
Cardicac Cath Lab
38.00
Recovery Room
39.00 Delivery Room and Labor Room
40.00 Anesthesiology
41.00
Radiology - Diagnostic
41.01
CT Scan and MRI
43.00 Radioisotope
44.00 Laboratory
44.01 Pathological Lab
46.00 Whole Blood & Packed Red 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
55.01 Medical Supplies Chrg. Pat. - IMP
56.00
Drugs Charged to Patients
57.00
Renal Dialysis
58.00 ASC (Non-Distinct Part)
59.00 Ultrasound
59.02
59.03
60.00 Clinic
60.01
Other Clinic Services
61.00
Emergency
62.00 Observation Beds
71.00 Home Health Agency
89.00 Utilization Review
93.00 Hospice

NONREIMBURSABLE COST CENTE
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
100.01 Foundation
100.02
100.03
Community Relations
100.04
TOTAL
SCHEDULE 8.1
Fiscal Period Ended:
JUNE 30, 2009
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
1,151,502
0
0
0
0
0
0
0
0
6,840,056
1,468,321
0
61,087
0
0
0
0
0
0
0
0
293,678
63,042
0
312,737
0
0
0
0

0
0
0
0
1,978,140
424,638
0
0
0
0
0
0
0
0
0
0
0
0
0 929,925000000005,227,319 1,122,123
0000000000194,692 41,794
0
899,698
0
0
0
0
0
0
0
0

6,006,546
1,289,396
0
146,569
0
0
0
0
0
0
0
0
1,410,332
302,749
077,051000000001,376,800 295,551
0 857,677000000006,150,856 1,320,374
0000000000 00
00000000001,559,793 334,833
0000000000 00
031,82200000000135,677 29,125
0 462,670000000002,440,425 523,874
0
268,363
0
0
0
0
0
0
0

0
2,011,206
431,736
0
190,364
0
0
0
0
0
0
0
0
866,353
185,976
0000000000 00
0 318,317000000001,574,211 337,928
019,5770000000091,59019,661
00000000007,244,537 1,555,149
00000000008,335,663 1,789,376
0
0
0
0
0
0
0
0
0
0

3,710,783
796,576
0
0
0
0
0
0
0
0
0
0
293,733
63,054
0000000000 00
0 104,99400000000531,710 114,140
0000000000 00
0000000000 00
0 140,62400000000765,223 164,267
0
0
0
0
0
0
0
0
0
0
0

0
0
1,344,785
0
0
0
0
0
0
0
0
6,785,843
1,456,684
0000000000 00
0 2,054,5730000000012,375,717 2,656,635
0 474,61900000000641,377 137,681
00000000002,200,186 472,303
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
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
0000000000 00
0000000000 00
0000000000 00
0000000000 00
000000000049,86410,704
0000000000 00
0
187,503
0

0
0
0
0
0
0
0
2,508,020
538,385
0000000000 00
0
22,798,914
0
0
0
0
0
0
0
0
166,803,199
29,478,767
This is trial version
www.adultpdf.com