STATE OF CALIFORNIA COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST_part2 docx

STATE OF CALIFORNIA ADULT SUBACUTE SCH 2
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007
Provider No:
LTC70046F / 1174736839
COST CENTER
COL. DIRECT AND ALLOCATED EXPENSE
0.00 Adult Subacute $ 5,040,827 $ 2,266,789 $ (2,774,038)
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 539,009 153,104 (385,905)
3.01 New Cap Bldg. Memorial 0 0
3.02 New Cap Bldg. - Midtown 11,632 0 (11,632)
3.03 New Cap Bldg. Infusion 0 0
4.00 New Cap Rel Costs-Movable Equipment 66,887 51,624 (15,263)
4.01 New Equip Memorial 0 0
4.02 New Equip - Midtown 13,861 0 (13,861)
4.03 New Equip Infusion 0 0
4.07 00
4.08 00
5.00 Employee Benefits 1,247,208 665,496 (581,712)
6.01 Communication 7,902 0 (7,902)
6.02 Data Processing 0 0
6.03 Purchasing 4,536 1,138 (3,398)
6.04 Admitting 30,287 3,158 (27,129)
6.05 Business Office 31,527 19,093 (12,434)
6.06 00
6.07 00
6.08 00
6.00 Administrative and General 1,289,585 538,189 (751,396)
7.00 Maintenance and Repairs 1,978,078 1,012,179 (965,899)

8.00 Operation of Plant 3,695 1,422 (2,273)
9.00 Laundry and Linen Service 15,226 14,985 (241)
10.00 Housekeeping 1,246,422 705,851 (540,571)
11.00 Dietary 285,342 38,840 (246,502)
12.00 Cafeteria 220,556 117,672 (102,884)
13.00 Maintenance of Personnel 0 0
14.00 Nursing Administration 58,416 10,882 (47,534)
15.00 Central Services & Supply 2,087 544 (1,543)
16.00 Pharmacy 2,411 2,188 (223)
17.00 Medical Records and Library 187,580 27,809 (159,771)
18.00 Social Service 1,065,495 243,795 (821,700)
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 479,860 447,018 (32,842)
TOTAL DIRECT AND
101.00 ALLOCATED EXPENSES $ 13,828,429 $ 6,321,774 $ (7,506,655)
(To Adult Subacute Sch 1)
* From Schedule 8, Part I, Line 36.00
SUMMARY OF ADULT SUBACUTE FACILITY EXPENSES
REPORTED AUDITED * DIFFERENCE
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STATE OF CALIFORNIA ADULT SUBACUTE SCH 3
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007

Provider No:
LTC70046F / 1174736839
TOTAL RATIO
TOTAL SUBACUTE
SUBACUTE
ANCILLARY CHARGES COST TO ANCILLARY ANCILLARY
COST * CHARGES CHARGES ** COSTS***
ANCILLARY COST CENTERS (Adult SA Sch 4)
37.00 Operating Room $ 51,301,416 $ 395,738,167 0.129635 $ 0 $ 0
41.00 Radiology - Diagnostic 18,502,870 68,721,118 0.269246 44,211 11,904
41.01 Ultrasound 2,687,148 23,489,714 0.114397 0 0
42.01 CT Scan 3,774,503 92,143,955 0.040963 0 0
44.00 Laboratory 17,229,864 185,096,760 0.093086 443,334 41,268
44.01 Pathology 1,372,240 30,641,729 0.044783 1,072 48
47.00
Blood Storing, Processing & Tra 6,308,423 7,552,437 0.835283 0 0
49.00 Respiratory Therapy 11,782,174 100,782,051 0.116907 2,724,445 318,508
50.00 Physical Therapy 4,797,291 16,189,980 0.296312 3,158 936
51.00 Occupational Therapy 914,453 3,198,707 0.285882 14,649 4,188
52.00 Speech Pathology 751,535 1,711,434 0.439126 6,534 2,869
53.00 Electrocardiology 1,664,553 23,342,567 0.071310 0 0
54.00 Electroencephalography 2,511,765 13,971,098 0.179783 0 0
55.00 Med Supply Charged to Patients 87,731,244 225,163,517 0.389633 571,773 222,782
56.00 Drugs Charged to Patients 34,831,693 221,077,833 0.157554 0 0
60.03 Peds Audiology 493,343 1,677,204 0.294146 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 $
246,654,516 $ 1,410,498,271 $ 3,809,176 $ 602,503
(To Adult Subacute Sch 1)
* From Schedule 8, Column 27
** Total Other Allowable Ancillary Charges included in the rate.
*** Total Other Ancillary Costs included in the rate.
SCHEDULE OF TOTAL OTHER ALLOWABLE ADULT SUBACUTE ANCILLARY COSTS**
TOTAL ANCILLARY
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STATE OF CALIFORNIA ADULT SUBACUTE SCH 4
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007
Provider No:
LTC70046F / 1174736839
ANCILLARY CHARGES
37.00 Operating Room $ 7,916 $ (7,916) $ 0
41.00 Radiology - Diagnostic 19,699 24,512 44,211
41.01 Ultrasound 1,524 (1,524) 0
42.01 CT Scan 21,517 (21,517) 0
44.00 Laboratory 197,539 245,795 443,334
44.01 Pathology 478 594 1,072
47.00
Blood Storing, Processing & Tra 1,617 (1,617) 0
49.00 Respiratory Therapy 1,213,950 1,510,495 2,724,445
50.00 Physical Therapy 1,407 1,751 3,158
51.00 Occupational Therapy 6,527 8,122 14,649
52.00 Speech Pathology 2,911 3,623 6,534
53.00 Electrocardiology 818 (818) 0
54.00 Electroencephalography 3,072 (3,072) 0
55.00
Med Supply Charged to Patients 254,769 317,004 571,773
56.00 Drugs Charged to Patients 1,577,915 (1,577,915) 0
60.03 Peds Audiology 2,845 (2,845) 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
101.00
TOTAL ANCILLARY CHARGES
$ 3,314,504 $ 494,672 $ 3,809,176
(Adj 40)
AUDITED
ADJUSTMENTS TO OTHER ALLOWABLE
ADULT SUBACUTE ANCILLARY CHARGES
(To Adult Subacute Sch 3)
REPORTED ADJUSTMENTS

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STATE OF CALIFORNIA
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007
Provider No:
LTC70046F / 1174736839
COL.
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 153,104 N/A
3.01 New Cap Bldg. Memorial 0 N/A
3.02 New Cap Bldg. - Midtown 0 N/A
3.03 New Cap Bldg. Infusion 0 N/A
4.00 New Cap Rel Costs-Movable Equipment 51,624 N/A
4.01 New Equip Memorial 0 N/A
4.02 New Equip - Midtown 0 N/A
4.03 New Equip Infusion 0 N/A
4.07 0N/A
4.08 0N/A
5.00 Employee Benefits 1,620 663,875
6.01 Communication 0 0
6.02 Data Processing 0 0
6.03 Purchasing 0 0
6.04 Admitting 54 0
6.05 Business Office 117 75
6.06 00
6.07 00
6.08 00
6.00 Administrative and General 5,106 44,342

7.00 Maintenance and Repairs 205,238 234,048
8.00 Operation of Plant 2 17
9.00 Laundry and Linen Service 864 180
10.00 Housekeeping 23,316 443,473
11.00 Dietary 3,269 27,823
12.00 Cafeteria 3,098 81,402
13.00 Maintenance of Personnel 0 0
14.00 Nursing Administration 179 8,545
15.00 Central Services & Supply 171 297
16.00 Pharmacy 23 1,452
17.00 Medical Records and Library 623 1,389
18.00 Social Service 3,160 201,085
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 8,842 301,564
101.00 TOTAL ALLOCATED INDIRECT EXPENSES $ 460,410 $ 2,009,566
(To Adult Subacute Sch 1)
ADULT SUBACUTE SCH 5
COST CENTER
EMP BENEFITS
AUDITED SAL &AUDITED CAP
ALLOCATION OF INDIRECT EXPENSES
ADULT SUBACUTE
(COL 2)
RELATED

(COL 1)ALLOCATED EXPENSES
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STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007
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 3.01 3.02 3.03 4.00 4.01 4.02 4.03 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
3,624,811
0
0
3.01
New Cap Bldg. Memorial

2,058,835
0
0
0
3.02
New Cap Bldg. - Midtown
81,184
0
0
0
0
3.03
New Cap Bldg. Infusion
85,371
0
0
0
0
0
4.00
New Cap Rel Costs-Movable Equipme
9,048,996
0
0
0
0
0
0
4.01
New Equip Memorial

7,634,577
0
0
0
0
0
0
0
4.02
New Equip - Midtown
56,100
0
0
0
0
0
0
0
0
4.03
New Equip Infusion
12,844
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

54,287,436
0
0
78,270
53,460
781
0
0
0
0
0
0
6.01
Communication
0
0
0
0
0
0
0
0
0
0
0
0
6.02
Data Processing
3,578,879
0

0
0
0
0
0
1,881
0
0
0
0
6.03
Purchasing
567,818
0
0
0
0
0
0
0
0
0
0
0
6.04
Admitting
789,022
0
0
5,057

8,747
0
0
0
0
0
0
0
6.05
Business Office
5,977,967
0
0
0
10,144
322
0
4,041
22,411
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
75,013,766
0
0
159,987
54,393
2,329
0
398,755
103,026
4,262
4,835
0
7.00
Maintenance and Repairs
8,975,014
0
0
1,333,173
770,381
11,679
0
502,160
354,462
1,180

0
0
8.00
Operation of Plant
894,464
0
0
0
0
0
0
0
0
0
0
0
9.00
Laundry and Linen Service
308,632
0
0
0
0
16,341
0
0
4,849
575
0
0

10.00
Housekeeping
6,183,103
0
0
59,448
41,469
2,865
0
84,055
18,581
1,848
0
0
11.00
Dietary
1,767,455
0
0
92,829
37,876
4,009
0
33,532
13,997
8,167
0
0
12.00
Cafeteria

3,962,807
0
0
57,191
13,086
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
7,229,372
0

0
27,032
9,986
1,561
0
53,477
25,330
0
0
0
15.00 Central Services & Supply 804,773 0 0 107,387 81,542 1,435 0 529,907 407,569 20,391 0 0
16.00 Pharmacy 10,837,954 0 0 32,743 16,727 427 0 29,886 8,686000
17.00 Medical Records and Library 6,763,293 0 0 65,340 17,196 0 0 2,592 2,636000
18.00
Social Service
3,782,897
0
0
7,495
36,948
391
0
0
4,459
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
2,804,116
0
0
0
0
0
0
0
0
0
0
0
23.00Intern & Res Other Program 000000000000
24.00 Paramedical Ed Program 518,315 0 0 4,953 1,7890000000
INPATIENT ROUTINE COST CENTERS
25.00
Adults & Pediatrics (Gen Routine)

52,969,669
0
0
584,694
287,998
0
0
92,977
209,140
0
0
0
26.00 Intensive Care Unit 11,537,199 0 0 112,401 32,134 0 0 292,210 163,799000
27.00 Coronary Care Unit 6,094,10200035,57000072,435000
28.00 000000000000
29.00 000000000000
30.00 Neonatal Intensive Care Unit 14,564,61400044,264000468,251000
30.01 Pediatric ICU 4,680,84000033,19700068,270000
32.00 000000000000
33.00 Nursery 2,905,60600014,4690000000
34.00
Medicare Certified Nursing Facility
0
0
0
0
0
0
0
0

0
0
0
0
35.00
Distinct Part Nursing Facility
4,656,561
0
0
0
0
38,190
0
18,498
0
18,987
0
0
36.00
Adult Subacute Care Unit
2,266,789
0
0
153,104
0
0
0
51,624
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:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007
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 3.01 3.02 3.03 4.00 4.01 4.02 4.03 4.07

COMPUTATION OF COST ALLOCATION (W/S B)
ANCILLARY COST CENTERS
37.00
Operating Room
27,675,926
0
0
213,723
74,704
0
0
1,871,095
1,665,426
0
0
0
37.01
Lithotripsy
230,652
0
0
0
0
0
0
0
0
0
0
0

39.00
Delivery Room and Labor Room
8,926,636
0
0
0
77,527
0
0
0
241,305
0
0
0
40.00
Anesthesiology
2,227,337
0
0
1,878
627
0
0
253,612
207,770
0
0
0
41.00 Radiology - Diagnostic 8,918,663 0 0 82,560 23,417 0 0 2,844,524 1,034,840000
41.01 Ultrasound 1,629,422 0 0 5,729 4,947 0 0 47,879 106,173000

41.02
Gamma Knife
404,246
0
0
2,584
0
0
0
430,120
0
0
0
0
42.01
CT Scan
1,807,193
0
0
7,874
2,464
0
0
172,183
353,625
0
0
0
43.00 Radioisotope 2,256,256 0 0 31,399 11,555 0 0 425,535 2,259000
44.00 Laboratory 10,755,367 0 0 37,929 40,211 0 0 1,255 340,495000

44.01 Pathology 749,468 0 0 18,900 7,206 0 0 14,910 20,264000
47.00 Blood Storing, Processing & Tra 5,194,563 0 0 9,36400000000
49.00 Respiratory Therapy 6,804,891 0 0 33,579 9,546 0 0 197,017 322,658000
50.00 Physical Therapy 2,532,546 0 0 62,782 10,766 0 0 5,350 1,566000
51.00 Occupational Therapy 504,046 0 0 11,785 5,8230000000
52.00
Speech Pathology
452,350
0
0
4,376
837
0
0
385
18,692
0
0
0
53.00
Electrocardiology
785,849
0
0
7,520
13,904
0
0
2,918
213,461

0
0
0
54.00 Electroencephalography 1,324,453 0 0 23,035 9,536 0 0 184,534 27,085000
55.00 Medical Supplies Charged to Patients 70,229,7300000006,598069100
56.00 Drugs Charged to Patients 15,847,405 0 0 1,215 1,211 0 0 1,112 21,581000
57.00 Renal Dialysis 5,607,350 0 0 70,276 1,775 0 0 175,7720000
59.00 Cath Lab Invasive 5,777,62000034,761000938,528000
59.01
O/P Pediatric Treatment
773,912
0
0
0
12,048
0
0
0
19,582
0
0
0
60.01
Heart Fail Clinic
354,986
0
0
0
0
0

0
0
50,797
0
0
0
60.02 Sleep Center 1,292,63200000077,2520000
60.03 Peds Audiology 335,9600003,87100013,334000
60.04 Development OP Clinic 2,396,73400025,0100009,151000
60.05 Infusion 8,051,6000000043,0620008,0090
60.00 Clinic 527,54700011,1290004,484000
60.06
Cancer Risk Assess Clinic
167,151
0
0
14,472
0
0
0
0
0
0
0
0
61.00
Emergency
11,820,076
0
0

62,153
20,474
0
0
233,990
64,326
0
0
0
62.00Observation Beds 000000000000
64.00Home Program Dialysis 9,49200000000000
83.00 Kidney Acquisition 1,263,58900018,431000611000
85.00 Heart Acquistion 273,90000000001,699000
85.01
Pancreas Acquisition
40,137
0
0
0
0
0
0
0
0
0
0
0
88.00
Interest Expense
0

0
0
0
0
0
0
0
0
0
0
0
90.00
Other Capital Related Costs
0
0
0
0
0
0
0
0
0
0
0
0
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen 000000000000
97.00 Research 1,171,169 0 0 24,7660002,9443,561000
98.00Physicians' Private Office 000000000000
99.00 Nonpaid Workers 000000000000

100.00
Beauty Clinic
17,894
0
0
0
0
853
0
0
0
0
0
0
100.01
Grants
2,288,204
0
0
0
24,895
0
0
0
1,323
0
0
0
100.02 Dialysis Contract Services 237,1590000008160000
100.03 Home Infusion 000000000000

100.04 Long Term Care Pharmacy 261,593 0 0 15,807 0 0 42,309 690000
100.05 Spa OP Lab 20,35800000000000
100.06 Foundation 00000003,5322,082000
100.08 SHSSR Home Office 000000000000
100.09
Other Related Organization
0
0
0
0
10,785
0
0
0
0
0
0
0
100.10 SCP 000000000000
TOTAL
529,271,243
0
0
3,624,811
2,058,835
81,184
85,371
9,048,996
7,634,577
56,100

12,844
0
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STATE OF CALIFORNIA
Provider Name:
SUTTER MEDICAL CENTER - SACRAMENTO
TRIAL BALANCE
EXPENSES
GENERAL SERVICE COST CENTER
1.00
Old Cap Rel Costs-Bldg & Fixtures
2.00
Old Cap Rel Costs-Movable Equipmen
3.00
New Cap Rel Costs-Bldg & Fixtures
3.01
New Cap Bldg. Memorial
3.02
New Cap Bldg. - Midtown
3.03
New Cap Bldg. Infusion
4.00
New Cap Rel Costs-Movable Equipme
4.01
New Equip Memorial
4.02
New Equip - Midtown
4.03
New Equip Infusion

4.07

4.08

5.00
Employee Benefits
6.01
Communication
6.02
Data Processing
6.03
Purchasing
6.04
Admitting
6.05
Business Office
6.06

6.07

6.08

6.00
Administrative and General
7.00
Maintenance and Repairs
8.00
Operation of Plant
9.00
Laundry and Linen Service

10.00
Housekeeping
11.00
Dietary
12.00
Cafeteria
13.00
Maintenance of Personnel
14.00
Nursing Administration
15.00 Central Services & Supply
16.00 Pharmacy
17.00 Medical Records and Library
18.00
Social Service
19.00

19.02

19.03

20.00
21.00 Nursing School
22.00
Intern & Res Service-Salary & Fringes
23.00 Intern & Res Other Program
24.00 Paramedical Ed Program
INPATIENT ROUTINE COST CENTER
25.00
Adults & Pediatrics (Gen Routine)

26.00 Intensive Care Unit
27.00 Coronary Care Unit
28.00
29.00
30.00 Neonatal Intensive Care Unit
30.01 Pediatric ICU
32.00
33.00 Nursery
34.00
Medicare Certified Nursing Facility
35.00
Distinct Part Nursing Facility
36.00
Adult Subacute Care Unit
36.01
Subacute Care Unit II
36.02 Transitional Care Unit
SCHEDULE 8.1
Fiscal Period Ended:
DECEMBER 31, 2007
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
4,578
0
11
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
1,234,584
0
39,229
179
0
0
0
0
0
77,015,345
0
630,065
0
42,463
612
0
0
0
0

0
12,621,189
2,149,282
0
0
0
0
0
0
0
0
0
0
894,464
152,320
0
0
0
0
0
0
0
0
0
0
330,396
56,264
0
1,082,713
0

17,584
5,033
0
0
0
0
0
7,496,700
1,276,624
0
466,947
0
75,525
1,199
0
0
0
0
0
2,501,536
425,990
0
782,998
0
615
2,011
0
0
0
0

0
4,818,708
820,585
0
0
0
0
0
0
0
0
0
0
0
0
0
1,615,934
0
53,455
546
0
0
0
0
0
9,016,691
1,535,466
0 334,372 0 30,211 377000002,317,963394,729
0 2,061,170 0 775,961 1,8590000013,765,4152,344,133
09,87402,2805000006,863,2171,168,748

0
883,695
0
369
216
0
0
0
0
0
4,716,470
803,175
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

2,804,116
477,517
0000000000 00
096,818001400000621,890105,903
0
12,871,775
0
1,658,106
15,402
132,572
801,549
0
0
0
69,623,883
11,856,357
0 2,559,374 0 293,740 3,750 27,287 164,98400015,186,8792,586,197
0 1,407,552 0 110,091 1,627 13,369 80,8310007,815,5781,330,927
0000000000 00
0000000000 00
0 3,442,823 0 53,845 3,557 52,196 315,58600018,945,1363,226,196
0 1,101,235 0 61,584 1,237 12,890 77,9350006,037,1871,028,082
0000000000 00
0 537,349 0 10,203 1,057 4,802 29,0310003,502,515596,449
0
0
0
0
0
0

0
0
0
0
0
0
0
837,813
0
0
292
7,281
44,020
0
0
0
5,621,641
957,318
0
665,496
0
0
1,138
3,158
19,093
0
0
0
3,160,401
538,189

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:
SUTTER MEDICAL CENTER - SACRAMENTO
TRIAL BALANCE
EXPENSES
ANCILLARY COST CENTERS
37.00
Operating Room
37.01
Lithotripsy
39.00
Delivery Room and Labor Room
40.00
Anesthesiology
41.00 Radiology - Diagnostic

41.01 Ultrasound
41.02
Gamma Knife
42.01
CT Scan
43.00 Radioisotope
44.00 Laboratory
44.01 Pathology
47.00 Blood Storing, Processing & Tra
49.00 Respiratory Therapy
50.00 Physical Therapy
51.00 Occupational Therapy
52.00
Speech Pathology
53.00
Electrocardiology
54.00 Electroencephalography
55.00 Medical Supplies Charged to Patients
56.00 Drugs Charged to Patients
57.00 Renal Dialysis
59.00 Cath Lab Invasive
59.01
O/P Pediatric Treatment
60.01
Heart Fail Clinic
60.02 Sleep Center
60.03 Peds Audiology
60.04 Development OP Clinic
60.05 Infusion
60.00 Clinic

60.06
Cancer Risk Assess Clinic
61.00
Emergency
62.00 Observation Beds
64.00 Home Program Dialysis
83.00 Kidney Acquisition
85.00 Heart Acquistion
85.01
Pancreas Acquisition
88.00
Interest Expense
90.00
Other Capital Related Costs
NONREIMBURSABLE COST CENTER
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
100.00
Beauty Clinic
100.01
Grants
100.02 Dialysis Contract Services
100.03 Home Infusion
100.04 Long Term Care Pharmacy
100.05 Spa OP Lab
100.06 Foundation
100.08 SHSSR Home Office
100.09

Other Related Organization
100.10 SCP
TOTAL
SCHEDULE 8.1
Fiscal Period Ended:
DECEMBER 31, 2007
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
5,579,556
0
22,068
282,566
117,807
955,170
0
0
0
38,458,041
6,549,078
0
0
0
0
0
51
5,798

0
0
0
236,501
40,274
0
2,071,567
0
27,790
5,854
27,540
186,486
0
0
0
11,564,705
1,969,371
0
488,547
0
3,833
11,943
24,198
174,438
0
0
0
3,394,184
578,001
0 1,317,721 0 26,703 21,353 17,729 165,86800014,453,3792,461,288

0 284,692 0 3 117 5,304 56,6960002,140,962364,588
0
9,117
0
0
16
54
20,391
0
0
0
866,530
147,563
0
252,633
0
0
1,403
19,171
222,403
0
0
0
2,838,948
483,449
0 265,887 0 18,587 5,696 5,167 43,6040003,065,945522,105
0 1,679,563 0 36,703 18,818 55,553 446,75700013,412,6512,284,061
0006,492447,63773,958000898,880153,072
039,76701302832,49718,2290005,264,833896,556
0 1,477,504 0 71,722 6,809 38,711 243,2520009,205,6881,567,651

0 660,913 0 21,379 199 6,156 39,0770003,340,734568,899
0 116,642 0 0 94 1,231 7,721000647,342110,237
0
102,760
0
0
1
524
4,131
0
0
0
584,057
99,460
0
165,723
0
4,361
108
8,474
56,341
0
0
0
1,258,660
214,339
0 201,733 0 44,669 856 4,407 33,7210001,854,028315,725
000010,03189,288543,46400070,879,80212,070,229
00017,4085,96172,827533,60300016,502,3222,810,206
0 967,180 0 0 6,033 3,780 78,2150006,910,3811,176,779

0 1,055,920 0 11,233 99,296 25,225 237,8880008,180,4721,393,065
0
180,935
0
0
305
39
4,255
0
0
0
991,076
168,772
0
80,545
0
0
59
0
637
0
0
0
487,023
82,936
0 247,565 0 0 328 0 12,1410001,629,918277,561
049,370008884904,048000407,96069,472
0 673,206 0 141 254 0 7,0120003,111,508529,863
0 206,387 0 0 38,822 2,327 56,5650008,406,7721,431,602
0 128,481 0 0 81 0 3,055000674,777114,909

0
27,106
0
0
12
0
1,171
0
0
0
209,913
35,746
0
2,363,897
0
42,268
8,123
13,081
246,985
0
0
0
14,875,372
2,533,150
0000000000 00
0000433078300010,7081,824
0 151,018 0 0 51 0 1,6800001,435,379244,433
039,11900130365000315,09553,658
0
1,397

0
0
0
0
114
0
0
0
41,648
7,092
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
0 243,572 0 0 87000001,446,099246,258
0000000000 00
0000000000 00
0
4,228
0
0
2
0
17
0
0
0
22,993
3,916
0
477,682
0
0
424
0
0
0
0
0

2,792,529
475,544
049,188001170404000287,68448,990
0000000000 00
0 131,660 0 0 20600000451,64576,911
0000190400020,3813,471
00000000005,614956
0000000000 00
0
0
0
0
0
0
0
0
0
0
10,785
1,837
0000000000 00
0
54,419,947
0
3,580,760
567,818
802,825
6,019,472
0
0

0
529,271,243
77,015,345
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
SUTTER MEDICAL CENTER - SACRAMENTO
TRIAL BALANCE
EXPENSES
GENERAL SERVICE COST CENTER
1.00
Old Cap Rel Costs-Bldg & Fixtures
2.00
Old Cap Rel Costs-Movable Equipmen
3.00
New Cap Rel Costs-Bldg & Fixtures
3.01
New Cap Bldg. Memorial
3.02
New Cap Bldg. - Midtown
3.03
New Cap Bldg. Infusion
4.00
New Cap Rel Costs-Movable Equipme
4.01
New Equip Memorial
4.02
New Equip - Midtown
4.03

New Equip Infusion
4.07

4.08

5.00
Employee Benefits
6.01
Communication
6.02
Data Processing
6.03
Purchasing
6.04
Admitting
6.05
Business Office
6.06

6.07

6.08

6.00
Administrative and General
7.00
Maintenance and Repairs
8.00
Operation of Plant
9.00

Laundry and Linen Service
10.00
Housekeeping
11.00
Dietary
12.00
Cafeteria
13.00
Maintenance of Personnel
14.00
Nursing Administration
15.00 Central Services & Supply
16.00 Pharmacy
17.00 Medical Records and Library
18.00
Social Service
19.00

19.02

19.03

20.00
21.00 Nursing School
22.00
Intern & Res Service-Salary & Fringes
23.00 Intern & Res Other Program
24.00 Paramedical Ed Program
INPATIENT ROUTINE COST CENTER
25.00

Adults & Pediatrics (Gen Routine)
26.00 Intensive Care Unit
27.00 Coronary Care Unit
28.00
29.00
30.00 Neonatal Intensive Care Unit
30.01 Pediatric ICU
32.00
33.00 Nursery
34.00
Medicare Certified Nursing Facility
35.00
Distinct Part Nursing Facility
36.00
Adult Subacute Care Unit
36.01
Subacute Care Unit II
36.02 Transitional Care Unit
SCHEDULE 8.2
Fiscal Period Ended:
DECEMBER 31, 2007
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
0
393,014

0
2,928
613,697
84
3,461
427,966
378,093
0
0
263,666
0
0
0
0
0
0
0
178,710
2,676
6,772
124,625
0
211,084
0
709,943 188,150 0 495,084 0 78,311 0 0
216,468 3,345 0 150,956 0 209,461 0 0 6,481
431,968 0 0 301,237 0 2,388 0 0 45 0
49,547
0
0

34,552
0
136,277
0
15,468
1,657
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
32,7460022,836012,7190107119000

3,865,448
118,660
134,753
2,695,600
2,861,667
1,553,953
0
4,421,089
34,029
161,444
1,167,489
2,964,429
743,088 23,331 17,510 518,198 135,817 265,362 0 887,739 7,044 27,901 240,306 283,025
0 19,150 9,812 0 144,662 155,943 0 476,674 3,136 16,896 117,734 176,552
000000000000
000000000000
0 89,810 9,745 0 0 361,826 0 1,295,820 7,489 9,376 459,664 618,655
0 9,282 4,821 0 0 122,079 0 383,750 2,409 10,703 113,515 157,445
000000000000
083600068,763048,136739342,284321,608
0
0
0
0
0
0
0
0
0
0

0
0
1,228,875
26,007
0
0
637,943
198,247
0
44,250
2,213
66,394
64,117
991,636
1,012,179
1,422
14,985
705,851
38,840
117,672
0
10,882
544
2,188
27,809
243,795
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:
SUTTER MEDICAL CENTER - SACRAMENTO
TRIAL BALANCE
EXPENSES
ANCILLARY COST CENTERS
37.00
Operating Room
37.01
Lithotripsy
39.00
Delivery Room and Labor Room
40.00
Anesthesiology
41.00 Radiology - Diagnostic
41.01 Ultrasound
41.02
Gamma Knife
42.01

CT Scan
43.00 Radioisotope
44.00 Laboratory
44.01 Pathology
47.00 Blood Storing, Processing & Tra
49.00 Respiratory Therapy
50.00 Physical Therapy
51.00 Occupational Therapy
52.00
Speech Pathology
53.00
Electrocardiology
54.00 Electroencephalography
55.00 Medical Supplies Charged to Patients
56.00 Drugs Charged to Patients
57.00 Renal Dialysis
59.00 Cath Lab Invasive
59.01
O/P Pediatric Treatment
60.01
Heart Fail Clinic
60.02 Sleep Center
60.03 Peds Audiology
60.04 Development OP Clinic
60.05 Infusion
60.00 Clinic
60.06
Cancer Risk Assess Clinic
61.00
Emergency

62.00 Observation Beds
64.00 Home Program Dialysis
83.00 Kidney Acquisition
85.00 Heart Acquistion
85.01
Pancreas Acquisition
88.00
Interest Expense
90.00
Other Capital Related Costs
NONREIMBURSABLE COST CENTER
96.00 Gift, Flower, Coffee Shop & Canteen
97.00 Research
98.00 Physicians' Private Office
99.00 Nonpaid Workers
100.00
Beauty Clinic
100.01
Grants
100.02 Dialysis Contract Services
100.03 Home Infusion
100.04 Long Term Care Pharmacy
100.05 Spa OP Lab
100.06 Foundation
100.08 SHSSR Home Office
100.09
Other Related Organization
100.10 SCP
TOTAL
SCHEDULE 8.2

Fiscal Period Ended:
DECEMBER 31, 2007
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)
1,412,938
153,781
62,942
985,323
0
595,566
0
1,087,457
61,841
36,352
1,391,244
0
0
0
0
0
0
0
0
0
0
0
8,446

0
0
46,996
30,403
0
0
236,203
0
726,782
8,193
14,239
271,624
0
12,415
0
0
8,658
0
52,402
0
7,995
6,672
286,349
254,076
0
545,812 122,256 12,484 380,626 0 191,558 0 76,285 8,047 9,541 241,594 0
37,872 1,422 2,550 26,410 0 30,407 0 247 112 0 82,580 0
17,085
84
0

11,914
0
2,039
0
0
46
59
29,701
0
52,053
2,174
2,633
36,299
0
33,891
0
987
132
0
323,938
0
207,584 6,606 5,073 144,760 0 24,595 0 8,701 591 8,796 63,511 0
250,752 34,285 602 174,864 0 267,873 0 0 146,899 7,156 650,720 0
124,949 0 111 87,13400003720107,7230
61,905 2,091 0 43,170 0 3,886 0 5,348 2,199 1,883 26,551 0
221,992 79,190 0 154,808 0 194,1870004,351354,3060
415,054 1,171 1,019 289,441 0 123,146 0 0 909 0 56,917 0
77,908 0 0 54,330 0 13,196 0 0 196 0 11,245 0
28,931
0

0
20,175
0
12,889
0
0
7
0
6,017
0
49,718
3,010
77
34,671
0
21,245
0
84
686
0
82,062
0
152,285 2,509 1,192 106,197 0 28,836 0 0 1,146 728 49,116 0
000000003,833,190156,445791,5770
8,030 24,418 0 5,600 0 37,727 0 155,378 491 14,510,309 777,214 0
464,601 0 1,657 323,993 0 129,447 0 209,883 13,218 1,292,827 113,923 0
0 0 7,682 0 34,021 108,151 0 230,811 5,195 2,184 346,494 0
0
6,606
2,081

0
0
21,345
0
66,838
534
2,476
6,197
0
0
0
58
0
0
10,404
0
0
463
0
928
0
0000038,958001,04917217,6840
02510009,6000016405,8960
0000082,349015,0082,016010,2130
0 33,031 2,997 0 21,043 27,852 0 68,453 1,811 1,326 82,389 0
016700018,26601636162534,4490
95,677
13,380
0
66,721

0
5,425
0
0
69
7
1,706
0
410,897
23,163
48,311
286,542
34,923
301,671
0
802,372
15,393
15,706
359,744
0
000000000000
00000000048,2271,1410
01,42200015,9710036702,4460
03340004,13700405310
0
0
0
0
0
148

0
0
0
0
166
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
163,732 1,338 0 114,180 0 39,520 0 39 704000
000000000000
000000000000
0
0
0
0
0
1,041
0
0
16
0
24
0
0
251
0
0
0
78,531
0
11,667
3,400
3
0
0
000004,260017,6152681,9085890
000000000000

104,504 4,097 0 72,877 0 20,245 0 0 1,098 59 0 0
00000000163050
000000000000
000000000000
0
0
0
0
0
0
0
0
0
0
0
0
000063,8180000000
14,770,471
1,046,784
386,660
9,169,267
3,972,735
6,281,053
0
11,076,025
4,184,181
16,696,260
8,767,601
5,757,145
This is trial version

www.adultpdf.com