STATE OF CALIFORNIA COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST_part4 doc

STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 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 7,861,187 (4,236,376) 3,624,811
3.01 New Cap Bldg. Memorial 2,058,835 0 2,058,835
3.02 New Cap Bldg. - Midtown 81,184 0 81,184
3.03 New Cap Bldg. Infusion 85,371 0 85,371
4.00 New Cap Rel Costs-Movable Equipment 10,482,996 (1,434,000) 9,048,996
4.01 New Equip Memorial 9,337,189 (1,702,612) 7,634,577
4.02 New Equip - Midtown 68,804 (12,704) 56,100
4.03 New Equip Infusion 15,753 (2,909) 12,844
4.07 00
4.08 00
5.00 Employee Benefits 61,015,301 (6,727,865) 54,287,436
6.01 Communication 676,657 (676,657) 0
6.02 Data Processing 10,316,463 (6,737,584) 3,578,879
6.03 Purchasing 2,020,126 (1,452,308) 567,818
6.04 Admitting 3,629,837 (2,840,815) 789,022
6.05 Business Office 1,477,941 4,500,026 5,977,967
6.06 00
6.07 00
6.08 00
6.00 Administrative and General 83,632,712 (8,618,946) 75,013,766
7.00 Maintenance and Repairs 8,585,410 389,604 8,975,014
8.00 Operation of Plant 2,296,035 (1,401,571) 894,464
9.00 Laundry and Linen Service 308,632 0 308,632
10.00 Housekeeping 6,609,326 (426,223) 6,183,103

11.00 Dietary 1,767,455 0 1,767,455
12.00 Cafeteria 3,962,807 0 3,962,807
13.00 Maintenance of Personnel 0 0
14.00 Nursing Administration 7,229,372 0 7,229,372
15.00 Central Services & Supply 804,773 0 804,773
16.00 Pharmacy 10,152,599 685,355 10,837,954
17.00 Medical Records and Library 5,709,737 1,053,556 6,763,293
18.00 Social Service 3,782,897 0 3,782,897
19.00 00
19.02 00
19.03 00
20.00 00
21.00 Nursing School 00
22.00 Intern & Res Service-Salary & Fringes 1,168,403 1,635,713 2,804,116
23.00 Intern & Res Other Program 1,635,712 (1,635,712) 0
24.00 Paramedical Ed Program 518,315 0 518,315
INPATIENT ROUTINE COST CENTERS
25.00 Adults & Pediatrics (Gen Routine) 49,678,121 3,291,548 52,969,669
26.00 Intensive Care Unit 11,040,256 496,943 11,537,199
27.00 Coronary Care Unit 6,094,102 0 6,094,102
28.00 00
29.00 00
30.00 Neonatal Intensive Care Unit 14,564,614 0 14,564,614
30.01 Pediatric ICU 4,680,840 0 4,680,840
32.00 00
33.00 Nursery 2,905,606 0 2,905,606
34.00 Medicare Certified Nursing Facility 0 0
35.00 Distinct Part Nursing Facility 1,882,523 2,774,038 4,656,561
36.00 Adult Subacute Care Unit 5,040,827 (2,774,038) 2,266,789
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:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007

REPORTED ADJUSTMENTS
TRIAL BALANCE OF EXPENSES
(From Sch 10A)
AUDITED
ANCILLARY COST CENTERS
37.00 Operating Room $ 27,675,926 $ 0 $ 27,675,926
37.01 Lithotripsy 230,652 0 230,652
39.00 Delivery Room and Labor Room 8,926,636 0 8,926,636
40.00 Anesthesiology 2,227,337 0 2,227,337
41.00 Radiology - Diagnostic 8,918,663 0 8,918,663
41.01 Ultrasound 1,629,422 0 1,629,422
41.02 Gamma Knife 404,246 0 404,246
42.01 CT Scan 1,807,193 0 1,807,193
43.00 Radioisotope 2,256,256 0 2,256,256
44.00 Laboratory 10,755,367 0 10,755,367
44.01 Pathology 749,468 0 749,468
47.00 Blood Storing, Processing & Tra 5,194,563 0 5,194,563
49.00 Respiratory Therapy 6,804,891 0 6,804,891
50.00 Physical Therapy 2,532,546 0 2,532,546

51.00 Occupational Therapy 504,046 0 504,046
52.00 Speech Pathology 452,350 0 452,350
53.00 Electrocardiology 785,849 0 785,849
54.00 Electroencephalography 1,324,453 0 1,324,453
55.00 Medical Supplies Charged to Patients 70,229,730 0 70,229,730
56.00 Drugs Charged to Patients 16,532,760 (685,355) 15,847,405
57.00 Renal Dialysis 5,607,350 0 5,607,350
59.00 Cath Lab Invasive 5,777,620 0 5,777,620
59.01 O/P Pediatric Treatment 773,912 0 773,912
60.01 Heart Fail Clinic 354,986 0 354,986
60.02 Sleep Center 1,292,632 0 1,292,632
60.03 Peds Audiology 335,960 0 335,960
60.04 Development OP Clinic 2,396,734 0 2,396,734
60.05 Infusion 8,051,600 0 8,051,600
60.00 Clinic 527,547 0 527,547
60.06 Cancer Risk Assess Clinic 167,151 0 167,151
61.00 Emergency 11,820,076 0 11,820,076
62.00 Observation Beds 0 0
64.00 Home Program Dialysis 9,492 0 9,492
83.00 Kidney Acquisition 1,263,589 0 1,263,589
85.00 Heart Acquistion 273,900 0 273,900
85.01 Pancreas Acquisition 40,137 0 40,137
88.00 Interest Expense 0 0 0
90.00 Other Capital Related Costs 0 0 0
SUBTOTAL $ 551,813,758 $ (26,538,892) $ 525,274,866
NONREIMBURSABLE COST CENTERS
96.00 Gift, Flower, Coffee Shop & Canteen 0 0
97.00 Research 75,265 1,095,904 1,171,169
98.00 Physicians' Private Office 0 0
99.00 Nonpaid Workers 0 0

100.00 Beauty Clinic 17,894 0 17,894
100.01 Grants 1,300,542 987,662 2,288,204
100.02 Dialysis Contract Services 237,159 0 237,159
100.03 Home Infusion 00
100.04 Long Term Care Pharmacy 261,593 0 261,593
100.05 Spa OP Lab 20,358 0 20,358
100.06 Foundation 00
100.08 SHSSR Home Office 0 0
100.09 Other Related Organization 0 0
100.10 SCP 00
100.99 SUBTOTAL $ 1,912,811 $ 2,083,566 $ 3,996,377
101 TOTAL $ 553,726,569 $ (24,455,326) $ 529,271,243
(To Schedule 8)
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STATE OF CALIFORNIA SCHEDULE 10A
Page 1
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007
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 & 2)123456789101112
GENERAL SERVICE COST CENTER
1.00
Old Cap Rel Costs-Bldg & Fixtures
$0
2.00
Old Cap Rel Costs-Movable Equipment
0
3.00
New Cap Rel Costs-Bldg & Fixtures

(4,236,376)
(4,505,904) (1,074)
3.01
New Cap Bldg. Memorial
0
3.02
New Cap Bldg. - Midtown
0
3.03
New Cap Bldg. Infusion
0
4.00
New Cap Rel Costs-Movable Equipment
(1,434,000)
(1,867,552) (343,456) 716,965
4.01
New Equip Memorial
(1,702,612)
(1,702,612)
4.02
New Equip - Midtown
(12,704)
(12,704)
4.03
New Equip Infusion
(2,909)
(2,909)
4.07

0

4.08

0
5.00
Employee Benefits
(6,727,865)
(5,098,628) (6,527,297) 220,042 2,798,009 1,134,866
6.01
Communication
(676,657)
(676,657)
6.02
Data Processing
(6,737,584)
(8,509,614) (1,806,849) 3,578,879
6.03
Purchasing
(1,452,308)
(2,020,126) 567,818
6.04
Admitting
(2,840,815)
(3,629,837) 789,022
6.05
Business Office
4,500,026
(1,458,979) 5,959,005
6.06

0

6.07

0
6.08

0
6.00
Administrative and General
(8,618,946) 12,095,391 (2,916,739) (374,810) (384,733) (10,264,669) (67,329,154) 54,355,755
7.00
Maintenance and Repairs
389,604
(673,318) 1,062,922
8.00
Operation of Plant
(1,401,571)
(2,296,035) 894,464
9.00
Laundry and Linen Service
0
(308,631) 308,631
10.00
Housekeeping
(426,223)
(426,223)
11.00
Dietary
0
12.00
Cafeteria

0
13.00
Maintenance of Personnel
0
14.00
Nursing Administration
0
15.00
Central Services & Supply
0
16.00
Pharmacy
685,355
685,355
17.00
Medical Records and Library
1,053,556
(5,665,811) 6,719,367
18.00 Social Service 0
19.00 0
19.02 0
19.03

0
20.00

0
21.00
Nursing School
0

22.00
Intern & Res Service-Salary & Fringes
1,635,713
(1,168,403) 2,804,116
23.00 Intern & Res Other Program (1,635,712) (1,635,712)
24.00 Paramedical Ed Program 0

INPATIENT ROUTINE COST CENTERS
25.00 Adults & Pediatrics (Gen Routine) 3,291,548
2,916,739 374,809
26.00 Intensive Care Unit 496,943 496,943
27.00
Coronary Care Unit
0
28.00
0
29.00 0
30.00 Neonatal Intensive Care Unit 0
30.01 Pediatric ICU 0
32.00 0
33.00 Nursery 0
34.00 Medicare Certified Nursing Facility 0
35.00 Distinct Part Nursing Facility 2,774,038
25,853 47,448 2,700,737
36.00 Adult Subacute Care Unit (2,774,038) (25,853) (47,448) (2,700,737)
36.01
Subacute Care Unit II
0
36.02
Transitional Care Unit

0
ADJUSTMENTS TO REPORTED COSTS
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STATE OF CALIFORNIA SCHEDULE 10A
Page 1
Provider Name: Fiscal Period Ended:
SUTTER MEDICAL CENTER - SACRAMENTO DECEMBER 31, 2007
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 & 2)123456789101112
ADJUSTMENTS TO REPORTED COSTS

ANCILLARY COST CENTERS
37.00
Operating Room
0
37.01 Lithotripsy 0
39.00
Delivery Room and Labor Room
0
40.00
Anesthesiology
0
41.00
Radiology - Diagnostic
0
41.01
Ultrasound
0
41.02

Gamma Knife
0
42.01 CT Scan 0
43.00 Radioisotope 0
44.00
Laboratory
0
44.01
Pathology
0
47.00 Blood Storing, Processing & Tra 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
(685,355)
(685,355)
57.00 Renal Dialysis 0
59.00 Cath Lab Invasive 0
59.01 O/P Pediatric Treatment 0
60.01 Heart Fail Clinic 0
60.02 Sleep Center 0
60.03

Peds Audiology
0
60.04
Development OP Clinic
0
60.05 Infusion 0
60.00 Clinic 0
60.06 Cancer Risk Assess Clinic 0
61.00 Emergency 0
62.00 Observation Beds 0
64.00
Home Program Dialysis
0
83.00
Kidney Acquisition
0
85.00 Heart Acquistion 0
85.01 Pancreas Acquisition 0
88.00 Interest Expense 0
90.00 Other Capital Related Costs 0

NONREIMBURSABLE COST CENTERS
96.00
Gift, Flower, Coffee Shop & Canteen
0
97.00
Research
1,095,904
1,095,904
98.00

Physicians' Private Office
0
99.00 Nonpaid Workers 0
100.00 Beauty Clinic 0
100.01 Grants 987,662
987,662
100.02 Dialysis Contract Services 0
100.03
Home Infusion
0
100.04
Long Term Care Pharmacy
0
100.05 Spa OP Lab 0
100.06 Foundation 0
100.08 SHSSR Home Office 0
100.09 Other Related Organization 0
100.10 SCP 0
101.00
TOTAL
($24,455,326) 0 0000(1)2,083,566 (5,098,628) (6,912,030) (10,044,627) (91,147,086) 79,387,679
(To Sch 10)
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STATE OF CALIFORNIA
Provider Name:
SUTTER MEDICAL CENTER - SACRAMENTO
GENERAL SERVICE COST CENTER
1.00 Old Cap Rel Costs-Bldg & Fixtures
2.00 Old Cap Rel Costs-Movable Equipment

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 Equipment
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 CENTERS
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 10A
Page 2
Fiscal Period Ended:
DECEMBER 31, 2007
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

13 14
270,602
60,043
745,143
6,627,485 (427,472)
ADJUSTMENTS TO REPORTED COSTS
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STATE OF CALIFORNIA
Provider Name:
SUTTER MEDICAL CENTER - SACRAMENTO
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 CENTERS
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
101.00 TOTAL
SCHEDULE 10A
Page 2
Fiscal Period Ended:
DECEMBER 31, 2007
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
13 14
ADJUSTMENTS TO REPORTED COSTS
0 7,703,273 (427,472) 0 0 0 000000000
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State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
47
Adj.
Audit
Work
As
Increase
As
No.
Report
Sheet
Part
Title

Line
Col.
Reported
(Decrease)
Adjusted
MEMORANDUM ADJUSTMENT
A
The provider reported Subacute Care Unit data on cost center line 34,
Skilled Nursing Facility, in the filed cost report, Worksheets A, B, B-1,
C and D-4. For proper cost determination, Subacute Care Unit data
should be reported on cost center lines below the Distinct Nursing Care
Facility cost center. Therefore, Subacute Care Unit data will be included
on line 36, Adult Subacute Care Unit, in the audit report. This is in
accordance with:
42 CFR 413.20, 413.24, and 413.53
CMS Pub. 15-1, Sections 2300, 2304, and 2336
Page
1
Report References
SUTTER MEDICAL CENTER - SACRAMENTO
Adjustments
Explanation of Audit Adjustments
JANUARY 1, 2007 THROUGH DECEMBER 31, 2007 HSC00108F / 1811946734
Cost Report
This is trial version
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State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
47
Adj.

Audit
Work
As
Increase
As
No.
Report
Sheet
Part
Title
Line
Col.
Reported
(Decrease)
Adjusted
Report References
SUTTER MEDICAL CENTER - SACRAMENTO
Adjustments
Explanation of Audit Adjustments
JANUARY 1, 2007 THROUGH DECEMBER 31, 2007 HSC00108F / 1811946734
Cost Report
RECLASSIFICATIONS OF REPORTED COSTS
1
10A
A
35.00
7
Distinct Part Nursing Facility
$1,882,523
$25,853

$1,908,376
*
10A
A
36.00
7
Adult Subacute Care Unit
5,040,827
(25,853)
5,014,974
*
To reclassify provider's medical supplies reclassification for
proper cost determination.
42 CFR 413.20 and 413.24
CMS Pub. 15-1, Sections 2300 and 2304
2
10A
A
35.00
7
Distinct Part Nursing Facility
*
$1,908,376
$47,448
$1,955,824
*
10A
A
36.00
7

Adult Subacute Care Unit
*
5,014,974
(47,448)
4,967,526
*
To reclassify provider's laundry reclassification for proper
cost determination.
42 CFR 413.20 and 413.24
CMS Pub. 15-1, Sections 2300 and 2304
3
10A
A
4.00
7
New Cap Rel Costs-Movable Equipment
$10,482,996
($1,867,552)
$8,615,444
*
10A
A
4.01
7
New Cap Rel Costs-Movable Equipment-Memorial
9,337,189
(1,702,612)
7,634,577
10A
A

4.02
7
Equipment-Midtown
68,804
(12,704)
56,100
10A
A
4.03
7
Equipment-Infusion
15,753
(2,909)
12,844
10A
A
6.02
7
Data Processing
10,316,463
(8,509,614)
1,806,849
*
10A
A
6.00
7
Administrative and General
83,632,712
12,095,391

95,728,103
*
To reverse the provider's IT chargeback reclassification for
proper cost determination.
42 CFR 413.20 and 413.24
CMS Pub. 15-1, Sections 2300 and 2304
4
10A
A
6.00
7
Administrative and General
*
$95,728,103
($2,916,739)
$92,811,364
*
10A
A
25.00
7
Adults & Pediatrics (Gen Routine)
49,678,121
2,916,739
52,594,860
*
To reclassify the provider's uncompensated / on-call adjustment
to agree with the provider's general ledger.
42 CFR 413.20 and 413.24
CMS Pub. 15-1, Sections 2300 and 2304

*Balance carried forward from prior/to subsequent adjustments
Page
2
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State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
47
Adj.
Audit
Work
As
Increase
As
No.
Report
Sheet
Part
Title
Line
Col.
Reported
(Decrease)
Adjusted
Report References
SUTTER MEDICAL CENTER - SACRAMENTO
Adjustments
Explanation of Audit Adjustments
JANUARY 1, 2007 THROUGH DECEMBER 31, 2007 HSC00108F / 1811946734
Cost Report

RECLASSIFICATIONS OF REPORTED COSTS
5
10A
A
35.00
7
Distinct Part Nursing Facility
*
$1,955,824
$2,700,737
$4,656,561
10A
A
36.00
7
Adult Subacute Care Unit
*
4,967,526
(2,700,737)
2,266,789
To reclassify distinct part nursing facility expense, per provider's
general ledger, to the Distinct Part Nursing Facility cost center,
for proper cost determination.
42 CFR 413.5, 413.20 and 413.24
CMS Pub. 15-1, Sections 2300, 2304 and 2306
*Balance carried forward from prior/to subsequent adjustments
Page
3
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State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
47
Adj.
Audit
Work
As
Increase
As
No.
Report
Sheet
Part
Title
Line
Col.
Reported
(Decrease)
Adjusted
Report References
SUTTER MEDICAL CENTER - SACRAMENTO
Adjustments
Explanation of Audit Adjustments
JANUARY 1, 2007 THROUGH DECEMBER 31, 2007 HSC00108F / 1811946734
Cost Report
ADJUSTMENTS TO REPORTED COSTS
6
10A
A
6.00

7
Administrative and General
*
$92,811,364
($374,810)
$92,436,554
*
10A
A
16.00
7
Pharmacy
10,152,599
685,355
10,837,954
10A
A
25.00
7
Adults & Pediatrics (Gen Routine)
*
52,594,860
374,809
52,969,669
10A
A
56.00
7
Drugs Charged to Patients
16,532,760

(685,355)
15,847,405
To adjust provider's revenue abatement to agree with the
provider's general ledger.
42 CFR 413.20 and 413.24
CMS Pub. 15-1, Sections 2300 and 2304
7
10A
A
97.00
7
Research
$75,265
$1,095,904
$1,171,169
10A
A
100.01
7
Grant
1,300,542
987,662
2,288,204
To reverse the provider's abatement of revenue against
nonreimbursable cost centers.
42 CFR 413.9, 413.20, and 413.24
CMS Pub. 15-1, Sections 2300, 2304, and 2328
CMS Pub. 15-2, Section 3613
8
10A

A
5.00
7
Employee Benefits
$61,015,301
($5,098,628)
$55,916,673
*
To reverse Worksheet A-8 adjustment to increase worker's
compensation expense. For proper cost determination, cost
should be included on the Sutter Health home office cost statement.
42 CFR 413.17, 413.20 and 413.24
CMS Pub. 15-1, Sections 2102.3, 2150.2, 2300 and 2304
9
10A
A
5.00
7
Employee Benefits
*
$55,916,673
($6,527,297)
$49,389,376
*
10A
A
6.00
7
Administrative and General
*

92,436,554
(384,733)
92,051,821
*
To eliminate recorded home office worker's compensation expense
per the general ledger. For proper cost determination, cost should
be included on the Sutter Health home office cost statement.
42 CFR 413.17, 413.20 and 413.24
CMS Pub. 15-1, Sections 2102.3, 2150.2, 2300 and 2304
*Balance carried forward from prior/to subsequent adjustments
Page
4
This is trial version
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