STATE OF CALIFORNIA RECONCILIATION OF THE PROVIDER''''S ADJUSTMENTS TO THE AUDIT REPORT _part1 docx

STATE OF CALIFORNIA
Provider Name:
NEW VISTA NURSING & REHABILITATION CENTER
155.02 Social Services - Fringe Benefits
155.03 Social Services - Agency Staff
155.04 Social Services - Other - Nonlabor
160.00 Activities
160.01 Activities - Salaries and Wages
160.02 Activities - Fringe Benefits
160.03 Activities - Agency Staff
160.04 Activities - Other - Nonlabor
165.00 Administration
165.01 Administration - Salaries and Wages
165.02 Administration - Fringe Benefits
165.03 Administration - Medical Records - Salaries and Wages
165.04 Administration - Medical Records - Fringe Benefits
165.05 Administration - Medical Records - Agency Staff
165.06 Administration - Medical Records - Other - Nonlabor
165.07 Administration - Facility License Fees
165.08 Administration - Liability Insurance
165.09 Administration - Caregiver Training
165.10 Administration - Quality Assurance Fees
165.11 Administration - Other - Nonlabor
170.00 Inservice Education - Nursing
170.01 Inservice Education - Nursing - Salaries and Wages
170.02 Inservice Education - Nursing - Fringe Benefits
170.03 Inservice Education - Nursing - Agency Staff
170.04 Inservice Education - Nursing - Other - Nonlabor
175.00 Total
Schedule 8A-1
Page 2

Provider Number: Provider NPI: OSHPD Facility Number: Fiscal Period:
ZZT06031H 1386631885 206190236 JANUARY 1, 2008 THROUGH DECEMBER 31, 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
10 11 12 13 14 15 16 17
RECONCILIATION OF THE PROVIDER'S ADJUSTMENTS TO THE AUDIT REPORT
4,477 7,650 4,652 2,060 55,635 469,722 (525,071)
(4,477) (4,652) (2,060) (55,635) (469,722) 525,071
000000000000
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STATE OF CALIFORNIA Schedule 8A-2
Page 1
Provider Name: Provider Number: Provider NPI: OSHPD Facility Number: Fiscal Period:
NEW VISTA NURSING & REHABILITATION CENTER ZZT06031H 1386631885 206190236 JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
(Pages 1 & 2) 18 19 20 21 22 23 24 25 26
5.00 Plant Operations and Maintenance 0
5.01 Plant Operations and Maintenance - Salaries and Wages 0
5.02 Plant Operations and Maintenance - Fringe Benefits 0
5.03 Plant Operations and Maintenance - Agency Staff 0
5.04 Plant Operations and Maintenance - Other - Nonlabor 0
10.00 Housekeeping 0
10.01 Housekeeping - Salaries and Wages 0
10.02 Housekeeping - Fringe Benefits 0
10.03 Housekeeping - Agency Staff 0
10.04 Housekeeping - Other - Nonlabor (475) (475)
15.00 Depreciation: Bldgs and Improvements 0
20.00 Depreciation: Leasehold Improvements 0
25.00 Depreciation: Equipment 0
30.00 Depreciation and Amortization - Other 0

35.00 Leases and Rentals (515,777) 1,754 4,469 (522,000)
40.00 Property Taxes 65,154 65,154
45.00 Property Insurance 20,240 20,240
50.00 Interest-Property, Plant, and Equipment 166,994 166,994
55.00 Interest-Other 0
60.00 Laundry and Linen 0
60.01 Laundry and Linen - Salaries and Wages 0
60.02 Laundry and Linen - Fringe Benefits 0
60.03 Laundry and Linen - Agency Staff 0
60.04 Laundry and Linen - Other - Nonlabor 0
65.00 Dietary 0
65.01 Dietary - Salaries and Wages 0
65.02 Dietary - Fringe Benefits 0
65.03 Dietary - Agency Staff 0
65.04 Dietary - Other - Nonlabor 0
70.00 Provision for Bad Debts 0
75.00 Patient Supplies 0
75.01 Patient Supplies - Salaries and Wages 0
75.02 Patient Supplies - Fringe Benefits 0
75.03 Patient Supplies - Agency Staff 0
75.04 Patient Supplies - Other - Nonlabor 0
77.00 Specialized Support Surfaces 0
80.00 Physical Therapy 0
80.01 Physical Therapy - Salaries and Wages 0
80.02 Physical Therapy - Fringe Benefits 0
80.03 Physical Therapy - Agency Staff 0
80.04 Physical Therapy - Other - Nonlabor 0
81.00 Respiratory Therapy 0
81.01 Respiratory Therapy - Salaries and Wages 0
81.02 Respiratory Therapy - Fringe Benefits 0

81.03 Respiratory Therapy - Agency Staff 0
81.04 Respiratory Therapy - Other - Nonlabor 0
82.00 Occupational Therapy 0
82.01 Occupational Therapy - Salaries and Wages 0
ADJUSTMENTS TO REPORTED COSTS
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STATE OF CALIFORNIA Schedule 8A-2
Page 1
Provider Name: Provider Number: Provider NPI: OSHPD Facility Number: Fiscal Period:
NEW VISTA NURSING & REHABILITATION CENTER ZZT06031H 1386631885 206190236 JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
(Pages 1 & 2) 18 19 20 21 22 23 24 25 26
ADJUSTMENTS TO REPORTED COSTS
82.02 Occupational Therapy - Fringe Benefits 0
82.03 Occupational Therapy - Agency Staff 0
82.04 Occupational Therapy - Other - Nonlabor 0
83.00 Speech Pathology 0
83.01 Speech Pathology - Salaries and Wages 0
83.02 Speech Pathology - Fringe Benefits 0
83.03 Speech Pathology - Agency Staff 0
83.04 Speech Pathology - Other - Nonlabor 0
85.00 Pharmacy 0
85.01 Pharmacy - Salaries and Wages 0
85.02 Pharmacy - Fringe Benefits 0
85.03 Pharmacy - Agency Staff 0
85.04 Pharmacy - Other - Nonlabor 0
90.00 Laboratory 0
90.01 Laboratory - Salaries and Wages 0
90.02 Laboratory - Fringe Benefits 0

90.03 Laboratory - Agency Staff 0
90.04 Laboratory - Other - Nonlabor 0
95.00 Home Health Services 0
95.01 Home Health Services - Salaries and Wages 0
95.02 Home Health Services - Fringe Benefits 0
95.03 Home Health Services - Agency Staff 0
95.04 Home Health Services - Other - Nonlabor 0
100.00 Other Ancillary Services 0
100.01 Other Ancillary Services - Salaries and Wages 0
100.02 Other Ancillary Services - Fringe Benefits 0
100.03 Other Ancillary Services - Agency Staff 0
100.04 Other Ancillary Services - Other - Nonlabor 0
100.06 Subacute Ancillary Services 0
100.07 Subacute Ancillary Services - Salaries and Wages 0
100.08 Subacute Ancillary Services - Fringe Benefits 0
100.09 Subacute Ancillary Services - Agency Staff 0
100.10 Subacute Ancillary Services - Other - Nonlabor 0
100.12 Subacute Pediatrics Ancillary Services 0
105.00 Skilled Nursing Care 0
105.01 Skilled Nursing Care - Salaries and Wages 0
105.02 Skilled Nursing Care - Fringe Benefits 0
105.03 Skilled Nursing Care - Agency Staff 0
105.04 Skilled Nursing Care - Other - Nonlabor 924
110.00 Intermediate Care 0
115.00 Mentally Disordered 0
120.00 Developmentally Disabled 0
125.00 Subacute Care 0
125.01 Subacute Care - Salaries and Wages 0
125.02 Subacute Care - Fringe Benefits 0
125.03 Subacute Care - Agency Staff 0

125.04 Subacute Care - Other - Nonlabor 0
126.00 Subacute Care - Pediatrics 0
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STATE OF CALIFORNIA Schedule 8A-2
Page 1
Provider Name: Provider Number: Provider NPI: OSHPD Facility Number: Fiscal Period:
NEW VISTA NURSING & REHABILITATION CENTER ZZT06031H 1386631885 206190236 JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
(Pages 1 & 2) 18 19 20 21 22 23 24 25 26
ADJUSTMENTS TO REPORTED COSTS
130.00 Hospice Inpatient Care 0
135.00 Other Routine Services 0
136.00 Residential Care 0
140.00 Beauty and Barber 0
145.00 Other Nonreimbursable 0
155.00 Social Services 0
155.01 Social Services - Salaries and Wages 0
155.02 Social Services - Fringe Benefits 0
155.03 Social Services - Agency Staff 0
155.04 Social Services - Other - Nonlabor 0
160.00 Activities 0
160.01 Activities - Salaries and Wages 0
160.02 Activities - Fringe Benefits 0
160.03 Activities - Agency Staff 0
160.04 Activities - Other - Nonlabor 0
165.00 Administration 0
165.01 Administration - Salaries and Wages (61,420) (61,420)
165.02 Administration - Fringe Benefits (10,278) (10,278)
165.03 Administration - Medical Records - Salaries and Wages 0

165.04 Administration - Medical Records - Fringe Benefits 0
165.05 Administration - Medical Records - Agency Staff 0
165.06 Administration - Medical Records - Other - Nonlabor 0
165.07 Administration - Facility License Fees 0
165.08 Administration - Liability Insurance 0
165.09 Administration - Caregiver Training 0
165.10 Administration - Quality Assurance Fees 0
165.11 Administration - Other - Nonlabor 5,921 (1,754) (4,469) 15,831 (682) (1,945) (1,060)
170.00 Inservice Education - Nursing 0
170.01 Inservice Education - Nursing - Salaries and Wages 0
170.02 Inservice Education - Nursing - Fringe Benefits 0
170.03 Inservice Education - Nursing - Agency Staff 0
170.04 Inservice Education - Nursing - Other - Nonlabor 0
175.00 Total ($328,717) 0 0 (71,698) (522,000) 268,219 (682) (1,945) (1,060) (475)
(To Sch 8)
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STATE OF CALIFORNIA
Provider Name:
NEW VISTA NURSING & REHABILITATION CENTER
5.00 Plant Operations and Maintenance
5.01 Plant Operations and Maintenance - Salaries and Wages
5.02 Plant Operations and Maintenance - Fringe Benefits
5.03 Plant Operations and Maintenance - Agency Staff
5.04 Plant Operations and Maintenance - Other - Nonlabor
10.00 Housekeeping
10.01 Housekeeping - Salaries and Wages
10.02 Housekeeping - Fringe Benefits
10.03 Housekeeping - Agency Staff
10.04 Housekeeping - Other - Nonlabor

15.00 Depreciation: Bldgs and Improvements
20.00 Depreciation: Leasehold Improvements
25.00 Depreciation: Equipment
30.00 Depreciation and Amortization - Other
35.00 Leases and Rentals
40.00 Property Taxes
45.00 Property Insurance
50.00 Interest-Property, Plant, and Equipment
55.00 Interest-Other
60.00 Laundry and Linen
60.01 Laundry and Linen - Salaries and Wages
60.02 Laundry and Linen - Fringe Benefits
60.03 Laundry and Linen - Agency Staff
60.04 Laundry and Linen - Other - Nonlabor
65.00 Dietary
65.01 Dietary - Salaries and Wages
65.02 Dietary - Fringe Benefits
65.03 Dietary - Agency Staff
65.04 Dietary - Other - Nonlabor
70.00 Provision for Bad Debts
75.00 Patient Supplies
75.01 Patient Supplies - Salaries and Wages
75.02 Patient Supplies - Fringe Benefits
75.03 Patient Supplies - Agency Staff
75.04 Patient Supplies - Other - Nonlabor
77.00 Specialized Support Surfaces
80.00 Physical Therapy
80.01 Physical Therapy - Salaries and Wages
80.02 Physical Therapy - Fringe Benefits
80.03 Physical Therapy - Agency Staff

80.04 Physical Therapy - Other - Nonlabor
81.00 Respiratory Therapy
81.01 Respiratory Therapy - Salaries and Wages
81.02 Respiratory Therapy - Fringe Benefits
81.03 Respiratory Therapy - Agency Staff
81.04 Respiratory Therapy - Other - Nonlabor
82.00 Occupational Therapy
82.01 Occupational Therapy - Salaries and Wages
Schedule 8A-2
Page 2
Provider Number: Provider NPI: OSHPD Facility Number: Fiscal Period:
ZZT06031H 1386631885 206190236 JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
27
ADJUSTMENTS TO REPORTED COSTS
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STATE OF CALIFORNIA
Provider Name:
NEW VISTA NURSING & REHABILITATION CENTER
82.02 Occupational Therapy - Fringe Benefits
82.03 Occupational Therapy - Agency Staff
82.04 Occupational Therapy - Other - Nonlabor
83.00 Speech Pathology
83.01 Speech Pathology - Salaries and Wages
83.02 Speech Pathology - Fringe Benefits
83.03 Speech Pathology - Agency Staff
83.04 Speech Pathology - Other - Nonlabor
85.00 Pharmacy
85.01 Pharmacy - Salaries and Wages

85.02 Pharmacy - Fringe Benefits
85.03 Pharmacy - Agency Staff
85.04 Pharmacy - Other - Nonlabor
90.00 Laboratory
90.01 Laboratory - Salaries and Wages
90.02 Laboratory - Fringe Benefits
90.03 Laboratory - Agency Staff
90.04 Laboratory - Other - Nonlabor
95.00 Home Health Services
95.01 Home Health Services - Salaries and Wages
95.02 Home Health Services - Fringe Benefits
95.03 Home Health Services - Agency Staff
95.04 Home Health Services - Other - Nonlabor
100.00 Other Ancillary Services
100.01 Other Ancillary Services - Salaries and Wages
100.02 Other Ancillary Services - Fringe Benefits
100.03 Other Ancillary Services - Agency Staff
100.04 Other Ancillary Services - Other - Nonlabor
100.06 Subacute Ancillary Services
100.07 Subacute Ancillary Services - Salaries and Wages
100.08 Subacute Ancillary Services - Fringe Benefits
100.09 Subacute Ancillary Services - Agency Staff
100.10 Subacute Ancillary Services - Other - Nonlabor
100.12 Subacute Pediatrics Ancillary Services
105.00 Skilled Nursing Care
105.01 Skilled Nursing Care - Salaries and Wages
105.02 Skilled Nursing Care - Fringe Benefits
105.03 Skilled Nursing Care - Agency Staff
105.04 Skilled Nursing Care - Other - Nonlabor
110.00 Intermediate Care

115.00 Mentally Disordered
120.00 Developmentally Disabled
125.00 Subacute Care
125.01 Subacute Care - Salaries and Wages
125.02 Subacute Care - Fringe Benefits
125.03 Subacute Care - Agency Staff
125.04 Subacute Care - Other - Nonlabor
126.00 Subacute Care - Pediatrics
Schedule 8A-2
Page 2
Provider Number: Provider NPI: OSHPD Facility Number: Fiscal Period:
ZZT06031H 1386631885 206190236 JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
27
ADJUSTMENTS TO REPORTED COSTS
924
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STATE OF CALIFORNIA
Provider Name:
NEW VISTA NURSING & REHABILITATION CENTER
130.00 Hospice Inpatient Care
135.00 Other Routine Services
136.00 Residential Care
140.00 Beauty and Barber
145.00 Other Nonreimbursable
155.00 Social Services
155.01 Social Services - Salaries and Wages
155.02 Social Services - Fringe Benefits
155.03 Social Services - Agency Staff

155.04 Social Services - Other - Nonlabor
160.00 Activities
160.01 Activities - Salaries and Wages
160.02 Activities - Fringe Benefits
160.03 Activities - Agency Staff
160.04 Activities - Other - Nonlabor
165.00 Administration
165.01 Administration - Salaries and Wages
165.02 Administration - Fringe Benefits
165.03 Administration - Medical Records - Salaries and Wages
165.04 Administration - Medical Records - Fringe Benefits
165.05 Administration - Medical Records - Agency Staff
165.06 Administration - Medical Records - Other - Nonlabor
165.07 Administration - Facility License Fees
165.08 Administration - Liability Insurance
165.09 Administration - Caregiver Training
165.10 Administration - Quality Assurance Fees
165.11 Administration - Other - Nonlabor
170.00 Inservice Education - Nursing
170.01 Inservice Education - Nursing - Salaries and Wages
170.02 Inservice Education - Nursing - Fringe Benefits
170.03 Inservice Education - Nursing - Agency Staff
170.04 Inservice Education - Nursing - Other - Nonlabor
175.00 Total
Schedule 8A-2
Page 2
Provider Number: Provider NPI: OSHPD Facility Number: Fiscal Period:
ZZT06031H 1386631885 206190236 JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ
27

ADJUSTMENTS TO REPORTED COSTS
924000000000
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State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
28
MC530
Adj. Page or As Increase As
No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted
RECONCILIATION OF THE PROVIDER'S RECORDS TO THE AUDIT REPORT
1 10.1(4) 5 14 8A-1 5.00 Plant Operations and Maintenance $716,944 ($729,871) ($12,927) *
Not Reported 8A-1 5.01 Plant Operations and Maintenance - Salaries and Wages 0 239,859 239,859
Not Reported 8A-1 5.02 Plant Operations and Maintenance - Fringe Benefits 0 74,635 74,635
Not Reported 8A-1 5.04 Plant Operations and Maintenance - Other - Nonlabor 0 415,377 415,377 *
2 10.1(4) 10 14 8A-1 10.00 Housekeeping $218,595 ($218,595) $0
Not Reported 8A-1 10.01 Housekeeping - Salaries and Wages 0 91,052 91,052
Not Reported 8A-1 10.02 Housekeeping - Fringe Benefits 0 28,681 28,681
Not Reported 8A-1 10.04 Housekeeping - Other - Nonlabor 0 98,862 98,862 *
3 10.1(4) 60 14 8A-1 60.00 Laundry and Linen $237,688 ($237,688) $0
Not Reported 8A-1 60.01 Laundry and Linen - Salaries and Wages 0 111,295 111,295
Not Reported 8A-1 60.02 Laundry and Linen - Fringe Benefits 0 38,796 38,796
Not Reported 8A-1 60.04 Laundry and Linen - Other - Nonlabor 0 87,597 87,597
4 10.1(4) 65 14 8A-1 65.00 Dietary $530,508 ($530,508) $0
Not Reported 8A-1 65.01 Dietary - Salaries and Wages 0 223,097 223,097
Not Reported 8A-1 65.02 Dietary - Fringe Benefits 0 73,362 73,362
Not Reported 8A-1 65.04 Dietary - Other - Nonlabor 0 234,049 234,049
5 10.1(4) 105 14 8A-1 105.00 Skilled Nursing Care $3,904,464 ($3,904,464) $0
Not Reported 8A-1 105.01 Skilled Nursing Care - Salaries and Wages 0 2,636,321 2,636,321
Not Reported 8A-1 105.02 Skilled Nursing Care - Fringe Benefits 0 873,156 873,156

Not Reported 8A-1 105.04 Skilled Nursing Care - Other - Nonlabor 0 394,987 394,987 *
6 10.1(4) 155 14 8A-1 155.00 Social Services $128,382 ($128,382) $0
Not Reported 8A-1 155.01 Social Services - Salaries and Wages 0 96,897 96,897
Not Reported 8A-1 155.02 Social Services - Fringe Benefits 0 22,647 22,647
Not Reported 8A-1 155.04 Social Services - Other - Nonlabor 0 8,838 8,838
-Continued on next page-
*Balance carried forward from prior/to subsequent adjustments Page 1
Adjustments
NEW VISTA NURSING & REHABILITATION CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008 ZZT06031H
Report References
Cost Report
Audit Report
Explanation of Audit Adjustments
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State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
28
MC530
Adj. Page or As Increase As
No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted
Adjustments
NEW VISTA NURSING & REHABILITATION CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008 ZZT06031H
Report References
Cost Report
Audit Report
Explanation of Audit Adjustments
RECONCILIATION OF THE PROVIDER'S RECORDS TO THE AUDIT REPORT
-Continued from previous page-
7 10.1(4) 160 14 8A-1 160.00 Activities $121,605 ($121,605) $0

Not Reported 8A-1 160.01 Activities - Salaries and Wages 0 79,547 79,547
Not Reported 8A-1 160.02 Activities - Fringe Benefits 0 30,011 30,011
Not Reported 8A-1 160.04 Activities - Other - Nonlabor 0 12,047 12,047
8 10.1(4) 165 14 8A-1 165.00 Administration $1,640,410 ($1,659,535) ($19,125) *
Not Reported 8A-1 165.01 Administration - Salaries and Wages 0 288,407 288,407 *
Not Reported 8A-1 165.02 Administration - Fringe Benefits 0 62,829 62,829 *
Not Reported 8A-1 165.03 Administration - Medical Records - Salaries and Wages 0 87,388 87,388
Not Reported 8A-1 165.04 Administration - Medical Records - Fringe Benefits 0 16,517 16,517
Not Reported 8A-1 165.06 Administration - Medical Records - Other - Nonlabor 0 21,493 21,493
Not Reported 8A-1 165.07 Administration - Facility License Fees 0 29,455 29,455
Not Reported 8A-1 165.08 Administration - Liability Insurance 0 115,399 115,399
Not Reported 8A-1 165.10 Administration - Quality Assurance Fees 0 360,546 360,546
Not Reported 8A-1 165.11 Administration - Other - Nonlabor 0 677,501 677,501 *
9 10.1(4) 170 14 8A-1 170.00 In-Service Education - Nursing $126,073 ($126,073) $0
Not Reported 8A-1 170.01 In-Service Education - Nursing - Salaries and Wages 0 93,249 93,249
Not Reported 8A-1 170.02 In-Service Education - Nursing - Fringe Benefits 0 31,599 31,599
Not Reported 8A-1 170.04 Inservice Education - Nursing - Other - Nonlabor 0 1,225 1,225
To reclassify reported expenses for proper cost determination.
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
28
MC530
Adj. Page or As Increase As
No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted
Adjustments
NEW VISTA NURSING & REHABILITATION CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008 ZZT06031H

Report References
Cost Report
Audit Report
Explanation of Audit Adjustments
RECONCILIATION OF THE PROVIDER'S ADJUSTMENTS TO THE AUDIT REPORT
10 10.1(4) 5 14 8A-1 5.00 Plant Operations and Maintenance * ($12,927) $12,927 $0
Not Reported 8A-1 5.04 Plant Operations and Maintenance - Other - Nonlabor * 415,377 (12,927) 402,450
To reclassify the provider's elimination of radio and television service
expense for proper cost determination.
42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304
11 10.1(4) 165 14 8A-1 165.00 Administration * ($19,125) $4,477 ($14,648) *
Not Reported 8A-1 165.11 Administration - Other - Nonlabor * 677,501 (4,477) 673,024 *
To reclassify the provider's revenue abatement on other operating
revenue for proper cost determination.
42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304
12 10.1(4) 165 14 8A-1 165.00 Administration * ($14,648) $7,650 ($6,998) *
Not Reported 8A-1 105.04 Skilled Nursing Care - Other - Nonlabor * 394,987 (7,650) 387,337 *
To reclassify the provider's elimination of inpatient utilization expense
for proper cost determination.
42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304
13 10.1(4) 165 14 8A-1 165.00 Administration * ($6,998) $4,652 ($2,346) *
Not Reported 8A-1 165.11 Administration - Other - Nonlabor * 673,024 (4,652) 668,372 *
To reclassify the provider's elimination of advertising promotions
expense for proper cost determination.
42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304
14 10.1(4) 165 14 8A-1 165.00 Administration * ($2,346) $2,060 ($286) *
Not Reported 8A-1 165.11 Administration - Other - Nonlabor * 668,372 (2,060) 666,312 *
To reclassify the provider's elimination of dues and subscriptions
(CAHF Lobbying) expense for proper cost determination.
42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304

*Balance carried forward from prior/to subsequent adjustments Page 3
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