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REPORT ON THE

HOME OFFICE AUDIT

MARINER HEALTH CARE INC ATLANTA GEORGIA

FISCAL PERIOD ENDED DECEMBER 31 2011

Audits Section - Sacramento Financial Audits Branch

Audits and Investigations Department of Health Care Services

Section Chief Robert G Kvick Audit Supervisor Kelly Ostrom Auditor Janice L Varrone

Sttate of CalifoorniamdashHealth and Humman Servicees Agency DDepartmment of HHealth CCare Seervices

TOOBY DOUGLAS EDMUNDD G BROWN JR DIRECTOR GOVERNOR

June 4 2013

Brian Kaarpodinis Director Consolidattion Accounnting Fundammental Admiinistrative SServices LLLC 920 Ridggebrook Rooad Sparks MD 21152

MARINEER HEALTHH CARE INNC FISCAL PERIOD EENDED DECEMBER 331 2011

We havee examinedd the Medi-CCal Home OOffice Costt Report forr the fiscal pperiod endeed Decembber 31 2011 Our exaamination wwas made under the auuthority of SSection 141170 of the WWelfare and Institutionss Code and accordinggly includedd such testss of the accounting recordss and such other auditing proceduures as we consideredd necessaryy in the circuumstances

In our oppinion the data presented in the Summary oof Audited Home Officce Costs to Health CCare Facilitiies represeents a propeer determinnation of home office aallowable coosts for the aabove fiscall period in aaccordancee with Medi--Cal reimbuursement principles TThe audited home officee cost will bbe incorporaated by seeparate adjuustment intto each applicabble facility aaudit report

This auddit report includes the

1 SSummary off Audited Home Officee Costs to HHealth Caree Facilities aand Supporrting SSchedules

2 AAudit Adjusttments Schedule

If you disagree withh the decision of the DDepartment the resultss of the homme office auudit may onlyy be appeaaled throughh each indivvidual facili tys audit reeport Pleaase refer to the appeal instructions in each faccilityrsquos auditt report

Financi al Audits BrancchAudits SectiionmdashSacramennto MS 2106 PO Box 9974413 Sacramennto CA 95899--7413

(916) 650-69994 (916) 650--6990 fax Internet Addrress wwwdhccscagov

Brian Karpodinis Page 2

If you have questions regarding this report you may call the Audits Sectionmdash Sacramento at (916) 650-6994

Original Signed By

Robert G Kvick Chief Audits SectionmdashSacramento Financial Audits Branch

Certified

TABLE OF CONTENTS

SCHEDULES

1 - SUMMARY OF AUDITED HOME OFFICE CAPITAL AND NONCAPITAL RELATED COSTS TO CHAIN COMPONENTS

2 - COMPARISON OF REPORTED AND AUDITED HOME OFFICE COSTS

3 - SUMMARY ALLOCATION OF HOME OFFICE COSTS - CAPITAL RELATED

3-1 - SUMMARY ALLOCATION OF HOME OFFICE COSTS - NONCAPITAL RELATED

4 - POOLED ALLOCATION OF HOME OFFICE COSTS TO CHAIN COMPONENTS

5 - FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS -CAPITAL RELATED

5-1 - FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS -NONCAPITAL RELATED

6 - FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS STATISTICS -CAPITAL RELATED

6-1 - FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS STATISTICS -NONCAPITAL RELATED

7 - DIRECT ALLOCATION OF CAPITAL COSTS TO CHAIN COMPONENTS

7-1 - DIRECT ALLOCATION OF NONCAPITAL COSTS TO CHAIN COMPONENTS

8 - TRIAL BALANCE OF EXPENSES

9 - REPORTED HOME OFFICE COSTS

STATE OF CALIFORNIA SCHEDULE 1

SUMMARY OF AUDITED HOME OFFICE CAPITAL AND NONCAPITAL RELATED COSTS TO CHAIN COMPONENTS

HOME OFFICE NAME FISCAL PERIOD ENDED MARINER HEALTH CARE INC DECEMBER 31 2011

HEALTH CARE FACILITIES

PROVIDER NPI

FISCAL PERIODS ENDING DURING HOME OFFICE

FISCAL YEAR

CAPITAL RELATED

(SCHEDULE 3) 1

NONCAPITAL RELATED

(SCHEDULE 3-1) 2

TOTAL AUDITED HO COSTS

(COLUMN 1 + 2) 3FROM TO

1 Monterey Palms Health Care Center 1982676524 010111 123111 $9929 $270250 $280179 2 Autumn Hills Health Care Center 1659343192 010111 123111 9872 268956 278828 3 Fremont Health Care Center 1366414906 010111 123111 12461 338544 351004 4 Driftwood Health Care - Hayward 1487627725 010111 123111 9310 266802 276113 5 Almaden Health and Rehab Center 1548232184 010111 123111 8853 256824 265678 6 Driftwood Healthcare Santa Cruz 1548232150 010111 123111 8955 269802 278758 7 Florin Healthcare Center 1538131032 010111 123111 11599 321273 332871 8 Hayward Hills Healthcare Center 1801868302 010111 123111 8344 228203 236547 9 Inglewood Healthcare Center 1013989656 010111 123111 8103 220658 228761 10 Parkview Healthcare Center 1609840115 010111 123111 11045 301092 312137 11 Santa Monica Health Care Center 1720051295 010111 123111 6711 188213 194923 12 Skyline Healthcare - San Jose 1902879471 010111 123111 22491 621734 644225 13 Verdugo Vista Healthcare Center 1851364194 010111 123111 8527 232937 241464 14 Vale Healthcare Center 1932172491 010111 123111 20024 555904 575928 15 Palm Springs Health amp Rehab 1699747659 010111 123111 8222 223378 231599 16 Creekside Health Care Center 1811969355 010111 123111 9764 265280 275044 17 Pine Ridge Care Center 1376515817 010111 123111 9405 256030 265436 18 Rehab Center of Santa Monica 1083687560 010111 123111 13615 369898 383513 19 0 0 0 0 20 All Other Facilities Various 109 139552 139661

SUBTOTAL (LINES 1 THROUGH 20) $197337 $5595331 $5792668

OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $197337 $5595331 $5792668


COMPARISON OF REPORTED AND AUDITED HOME OFFICE COSTS



PROVIDER NPI


FISCAL YEAR

REPORTED HOME OFFICE

COSTS (SCH 9) 1

AUDITED HO COSTS

(SCH 3 amp 3-1) 2

VARIANCE

(COLUMN 2-1) 3FROM TO

1 Monterey Palms Health Care Center 1982676524 010111 123111 $428327 $280179 ($148149) 2 Autumn Hills Health Care Center 1659343192 010111 123111 426128 278828 (147300) 3 Fremont Health Care Center 1366414906 010111 123111 536934 351004 (185930) 4 Driftwood Health Care - Hayward 1487627725 010111 123111 415034 276113 (138921) 5 Almaden Health and Rehab Center 1548232184 010111 123111 397780 265678 (132102) 6 Driftwood Healthcare Santa Cruz 1548232150 010111 123111 412385 278758 (133627) 7 Florin Healthcare Center 1538131032 010111 123111 505939 332871 (173068) 8 Hayward Hills Healthcare Center 1801868302 010111 123111 361053 236547 (124506) 9 Inglewood Healthcare Center 1013989656 010111 123111 349674 228761 (120913) 10 Parkview Healthcare Center 1609840115 010111 123111 476951 312137 (164814) 11 Santa Monica Health Care Center 1720051295 010111 123111 295057 194923 (100134) 12 Skyline Healthcare - San Jose 1902879471 010111 123111 979823 644225 (335598) 13 Verdugo Vista Healthcare Center 1851364194 010111 123111 368691 241463 (127228) 14 Vale Healthcare Center 1932172491 010111 123111 874716 575928 (298788) 15 Palm Springs Health amp Rehab 1699747659 010111 123111 354280 231599 (122681) 16 Creekside Health Care Center 1811969355 010111 123111 420737 275044 (145693) 17 Pine Ridge Care Center 1376515817 010111 123111 405775 265436 (140339) 18 Rehab Center of Santa Monica 1083687560 010111 123111 586663 383513 (203150) 19 0 0 0 0 20 All Other Facilities Various 0 139661 139661

SUBTOTAL (LINES 1 THROUGH 20) $8595947 $5792668 ($2803279)

OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $8595947 $5792668 ($2803279)


SUMMARY ALLOCATION OF HOME OFFICE COSTS - CAPITAL RELATED



PROVIDER NPI


FISCAL YEAR

DIRECT

(SCHEDULE 7) 1

CAPITAL COSTFUNCTIONAL

(SCHEDULE 5) 2

SS CAPITAL COSTPOOLED

CAPITAL COSTS (SCHEDULE 4)

3

TOTAL CAPITAL COSTS

(COL 1 TO 3)FROM TO

1 Monterey Palms Health Care Center 1982676524 010111 123111 $0 $0 $9928 $9929 2 Autumn Hills Health Care Center 1659343192 010111 123111 0 0 9872 9872 3 Fremont Health Care Center 1366414906 010111 123111 0 0 12461 12461 4 Driftwood Health Care - Hayward 1487627725 010111 123111 0 0 9310 9310 5 Almaden Health and Rehab Center 1548232184 010111 123111 0 0 8853 8853 6 Driftwood Healthcare Santa Cruz 1548232150 010111 123111 0 0 8955 8955 7 Florin Healthcare Center 1538131032 010111 123111 0 0 11599 11599 8 Hayward Hills Healthcare Center 1801868302 010111 123111 0 0 8344 8344 9 Inglewood Healthcare Center 1013989656 010111 123111 0 0 8103 8103 10 Parkview Healthcare Center 1609840115 010111 123111 0 0 11045 11045 11 Santa Monica Health Care Center 1720051295 010111 123111 0 0 6711 6711 12 Skyline Healthcare - San Jose 1902879471 010111 123111 0 0 22491 22491 13 Verdugo Vista Healthcare Center 1851364194 010111 123111 0 0 8526 8527 14 Vale Healthcare Center 1932172491 010111 123111 0 0 20024 20024 15 Palm Springs Health amp Rehab 1699747659 010111 123111 0 0 8222 8222 16 Creekside Health Care Center 1811969355 010111 123111 0 0 9764 9764 17 Pine Ridge Care Center 1376515817 010111 123111 0 0 9405 9405 18 Rehab Center of Santa Monica 1083687560 010111 123111 0 0 13615 13615 19 0 0 0 0 0 20 All Other Facilities Various 0 0 109 109

SUBTOTAL (LINES 1 THROUGH 20) $0 $0 $197337 $197337

OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0


GRAND TOTAL $0 $0 $197337 $197337 (To Schedule 1 amp 2)

STATE OF CALIFORNIA SCHEDULE 3-1

SUMMARY ALLOCATION OF HOME OFFICE COSTS - NONCAPITAL RELATED



PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2

POOLED COSTS (SCH 4)

3

TOTAL NONCAPITAL

COSTS (COL 1 TO 3)FROM TO



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0




POOLED ALLOCATION OF HOME OFFICE COSTS TO CHAIN COMPONENTS



PROVIDER TOTAL COST CAPITAL NONCAPITAL TOTAL POOLED NPI (SCH G COL 1) (SCH 8) (SCH 8) (COL 2 + 3)

1 2 3 4 (Adj 20)

1 Monterey Palms Health Care Center 1982676524 $8624578 $9928 $269750 $279679 2 Autumn Hills Health Care Center 1659343192 8575217 9872 268206 278078 3 Fremont Health Care Center 1366414906 10824072 12461 338544 351004 4 Driftwood Health Care - Hayward 1487627725 8087414 9310 252949 262260 5 Almaden Health and Rehab Center 1548232184 7690472 8853 240534 249388 6 Driftwood Healthcare Santa Cruz 1548232150 7779225 8955 243310 252266 7 Florin Healthcare Center 1538131032 10075279 11599 315124 326722 8 Hayward Hills Healthcare Center 1801868302 7248235 8344 226703 235047 9 Inglewood Healthcare Center 1013989656 7038997 8103 220158 228261 10 Parkview Healthcare Center 1609840115 9594801 11045 300096 311141 11 Santa Monica Health Care Center 1720051295 5829365 6711 182325 189035 12 Skyline Healthcare - San Jose 1902879471 19537170 22491 611063 633554 13 Verdugo Vista Healthcare Center 1851364194 7406705 8526 231659 240185 14 Vale Healthcare Center 1932172491 17394143 20024 544035 564059 15 Palm Springs Health amp Rehab 1699747659 7141933 8222 223378 231599 16 Creekside Health Care Center 1811969355 8481642 9764 265280 275044 17 Pine Ridge Care Center 1376515817 8169934 9405 255530 264936 18 Rehab Center of Santa Monica 1083687560 11826550 13615 369898 383513 19 0 0 0 0 0 20 All Other Facilities Various 95055 109 2973 3082


OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0


GRAND TOTAL $171420787 $197337 $5361516 $5558853 (To Schedule 3) (To Schedule 3-1)

MULTIPLIER 0001151 0031277


FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS - CAPITAL RELATED



PROVIDER NPI

100

Old Cap Related-

Buildings amp 101 200

Old Cap Related-Movable

201 400

New Cap Related-

Buildings amp 401

1 Monterey Palms Health Care Center 1982676524 $0 $0 $0 $0 $0 $0 2 Autumn Hills Health Care Center 1659343192 0 0 0 0 0 0 3 Fremont Health Care Center 1366414906 0 0 0 0 0 0 4 Driftwood Health Care - Hayward 1487627725 0 0 0 0 0 0 5 Almaden Health and Rehab Center 1548232184 0 0 0 0 0 0 6 Driftwood Healthcare Santa Cruz 1548232150 0 0 0 0 0 0 7 Florin Healthcare Center 1538131032 0 0 0 0 0 0 8 Hayward Hills Healthcare Center 1801868302 0 0 0 0 0 0 9 Inglewood Healthcare Center 1013989656 0 0 0 0 0 0 10 Parkview Healthcare Center 1609840115 0 0 0 0 0 0 11 Santa Monica Health Care Center 1720051295 0 0 0 0 0 0 12 Skyline Healthcare - San Jose 1902879471 0 0 0 0 0 0 13 Verdugo Vista Healthcare Center 1851364194 0 0 0 0 0 0 14 Vale Healthcare Center 1932172491 0 0 0 0 0 0 15 Palm Springs Health amp Rehab 1699747659 0 0 0 0 0 0 16 Creekside Health Care Center 1811969355 0 0 0 0 0 0 17 Pine Ridge Care Center 1376515817 0 0 0 0 0 0 18 Rehab Center of Santa Monica 1083687560 0 0 0 0 0 0 19 0 0 0 0 0 0 0 20 All Other Facilities Various 0 0 0 0 0 0

SUBTOTAL (LINES 1 THROUGH 20) $0 $0 $0 $0 $0 $0

OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500

New Cap Related-Movable

501 700

Insurance Premiums

800

Taxes and Licenses - Not

INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 (To Schedule 3)


FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS - NONCAPITAL RELATED



PROVIDER NPI

11

Salaries of Officers

12

Salaries and Temporary

Labor 13

Payroll Taxes

14

Employee Benefits-Payroll

Related 15

Employee Benefits-

Nonpayroll 16

Profit SharingPensio

n Plans 17

Legal Fees

1 Monterey Palms Health Care Center 1982676524 $0 $0 $0 $0 $0 $0 $0 2 Autumn Hills Health Care Center 1659343192 0 0 0 0 0 0 0 3 Fremont Health Care Center 1366414906 0 0 0 0 0 0 0 4 Driftwood Health Care - Hayward 1487627725 0 0 0 0 0 0 0 5 Almaden Health and Rehab Center 1548232184 0 0 0 0 0 0 0 6 Driftwood Healthcare Santa Cruz 1548232150 0 0 0 0 0 0 0 7 Florin Healthcare Center 1538131032 0 0 0 0 0 0 0 8 Hayward Hills Healthcare Center 1801868302 0 0 0 0 0 0 0 9 Inglewood Healthcare Center 1013989656 0 0 0 0 0 0 0 10 Parkview Healthcare Center 1609840115 0 0 0 0 0 0 0 11 Santa Monica Health Care Center 1720051295 0 0 0 0 0 0 0 12 Skyline Healthcare - San Jose 1902879471 0 0 0 0 0 0 0 13 Verdugo Vista Healthcare Center 1851364194 0 0 0 0 0 0 0 14 Vale Healthcare Center 1932172491 0 0 0 0 0 0 0 15 Palm Springs Health amp Rehab 1699747659 0 0 0 0 0 0 0 16 Creekside Health Care Center 1811969355 0 0 0 0 0 0 0 17 Pine Ridge Care Center 1376515817 0 0 0 0 0 0 0 18 Rehab Center of Santa Monica 1083687560 0 0 0 0 0 0 0 19 0 0 0 0 0 0 0 0 20 All Other Facilities Various 0 0 0 0 0 0 0

SUBTOTAL (LINES 1 THROUGH 20) $0 $0 $0 $0 $0 $0 $0

OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18

Auditing amp Accounting

Fees 19

Utilities

20

Communication s

21

Travel amp Entertainment

22

Automobile

23

Supplies

24

Minor Equipment Expensed



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25

Repairs amp Maintenance

26

Dues amp Subscriptions

27

Contributions

28

Insurance Premium-Non

Capital Related 29

Taxes amp Licenses - Non Capital Related

30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33

Meetings amp Conferences

34

Contracted Professional

Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0


FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS STATISTICS - CAPITAL RELATED



PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401

(Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )

1 Monterey Palms Health Care Center 1982676524 0 0 0 0 0 0 2 Autumn Hills Health Care Center 1659343192 0 0 0 0 0 0 3 Fremont Health Care Center 1366414906 0 0 0 0 0 0 4 Driftwood Health Care - Hayward 1487627725 0 0 0 0 0 0 5 Almaden Health and Rehab Center 1548232184 0 0 0 0 0 0 6 Driftwood Healthcare Santa Cruz 1548232150 0 0 0 0 0 0 7 Florin Healthcare Center 1538131032 0 0 0 0 0 0 8 Hayward Hills Healthcare Center 1801868302 0 0 0 0 0 0 9 Inglewood Healthcare Center 1013989656 0 0 0 0 0 0 10 Parkview Healthcare Center 1609840115 0 0 0 0 0 0 11 Santa Monica Health Care Center 1720051295 0 0 0 0 0 0 12 Skyline Healthcare - San Jose 1902879471 0 0 0 0 0 0 13 Verdugo Vista Healthcare Center 1851364194 0 0 0 0 0 0 14 Vale Healthcare Center 1932172491 0 0 0 0 0 0 15 Palm Springs Health amp Rehab 1699747659 0 0 0 0 0 0 16 Creekside Health Care Center 1811969355 0 0 0 0 0 0 17 Pine Ridge Care Center 1376515817 0 0 0 0 0 0 18 Rehab Center of Santa Monica 1083687560 0 0 0 0 0 0 19 0 0 0 0 0 0 0 20 All Other Facilities Various 0 0 0 0 0 0

SUBTOTAL (LINES 1 THROUGH 20) 0 0 0 0 0 0

OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL 0 0 0 0 0 0

TOTAL STATISTICS 0 0 0 0 0 0 COST TO BE ALLOCATED (FROM SCHEDULE 8) $0 $0 $0 $0 $0 $0 UNIT COST MULTIPLIER 0000000 0000000 0000000 0000000 0000000 0000000





PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other

(Adj ) (Adj ) (Adj ) (Adj ) (Adj )

1 Monterey Palms Health Care Center 1982676524 0 0 0 0 0 2 Autumn Hills Health Care Center 1659343192 0 0 0 0 0 3 Fremont Health Care Center 1366414906 0 0 0 0 0 4 Driftwood Health Care - Hayward 1487627725 0 0 0 0 0 5 Almaden Health and Rehab Center 1548232184 0 0 0 0 0 6 Driftwood Healthcare Santa Cruz 1548232150 0 0 0 0 0 7 Florin Healthcare Center 1538131032 0 0 0 0 0 8 Hayward Hills Healthcare Center 1801868302 0 0 0 0 0 9 Inglewood Healthcare Center 1013989656 0 0 0 0 0 10 Parkview Healthcare Center 1609840115 0 0 0 0 0 11 Santa Monica Health Care Center 1720051295 0 0 0 0 0 12 Skyline Healthcare - San Jose 1902879471 0 0 0 0 0 13 Verdugo Vista Healthcare Center 1851364194 0 0 0 0 0 14 Vale Healthcare Center 1932172491 0 0 0 0 0 15 Palm Springs Health amp Rehab 1699747659 0 0 0 0 0 16 Creekside Health Care Center 1811969355 0 0 0 0 0 17 Pine Ridge Care Center 1376515817 0 0 0 0 0 18 Rehab Center of Santa Monica 1083687560 0 0 0 0 0 19 0 0 0 0 0 0 20 All Other Facilities Various 0 0 0 0 0

SUBTOTAL (LINES 1 THROUGH 20) 0 0 0 0 0

OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0


GRAND TOTAL 0 0 0 0 0

TOTAL STATISTICS 0 0 0 0 0 COST TO BE ALLOCATED (FROM SCHEDULE 8) $0 $0 $0 $0 $0 UNIT COST MULTIPLIER 0000000 0000000 0000000 0000000 0000000


FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS STATISTICS - NONCAPITAL RELATED



PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900

Taxes amp Licenses - Non

(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507

(Statistics) 3508HEALTH CARE FACILITIES

(Adj ) (Adj ) (Adj )

1 Monterey Palms Health Care Center 1982676524 0 0 0 2 Autumn Hills Health Care Center 1659343192 0 0 0 3 Fremont Health Care Center 1366414906 0 0 0 4 Driftwood Health Care - Hayward 1487627725 0 0 0 5 Almaden Health and Rehab Center 1548232184 0 0 0 6 Driftwood Healthcare Santa Cruz 1548232150 0 0 0 7 Florin Healthcare Center 1538131032 0 0 0 8 Hayward Hills Healthcare Center 1801868302 0 0 0 9 Inglewood Healthcare Center 1013989656 0 0 0 10 Parkview Healthcare Center 1609840115 0 0 0 11 Santa Monica Health Care Center 1720051295 0 0 0 12 Skyline Healthcare - San Jose 1902879471 0 0 0 13 Verdugo Vista Healthcare Center 1851364194 0 0 0 14 Vale Healthcare Center 1932172491 0 0 0 15 Palm Springs Health amp Rehab 1699747659 0 0 0 16 Creekside Health Care Center 1811969355 0 0 0 17 Pine Ridge Care Center 1376515817 0 0 0 18 Rehab Center of Santa Monica 1083687560 0 0 0 19 0 0 0 0 20 All Other Facilities Various 0 0 0

SUBTOTAL (LINES 1 THROUGH 20) 0 0 0

OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0

TOTAL STATISTICS 0 0 0 COST TO BE ALLOCATED (FROM SCHEDULE 8) $0 $0 $0 UNIT COST MULTIPLIER 0000000 0000000 0000000


DIRECT ALLOCATION OF CAPITAL COSTS TO CHAIN COMPONENTS


PROVIDER REPORTED AUDITED NPI TOTAL TOTAL

HEALTH CARE FACILITIES (SCH E) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0 (To Schedule 3)

0 0 0 0 0 0


DIRECT ALLOCATION OF NONCAPITAL COSTS TO CHAIN COMPONENTS



PROVIDER NPI

REPORTED TOTAL

(SCH E-1)

Legal Fees Legal Fees Legal Fees Contracted Professional

Services


Services (Adj 2 ) (Adj 3 ) (Adj 4 ) (Adj 5 ) (Adj 6 ) (Adj ) (Adj )

1 Monterey Palms Health Care Center 1982676524 $500 $0 $0 $0 $0 $0 $0 $0 2 Autumn Hills Health Care Center 1659343192 750 0 0 0 0 0 0 0 3 Fremont Health Care Center 1366414906 0 0 0 0 0 0 0 0 4 Driftwood Health Care - Hayward 1487627725 13853 0 0 0 0 0 0 0 5 Almaden Health and Rehab Center 1548232184 16290 0 0 0 0 0 0 0 6 Driftwood Healthcare Santa Cruz 1548232150 26492 0 0 0 0 0 0 0 7 Florin Healthcare Center 1538131032 6149 0 0 0 0 0 0 0 8 Hayward Hills Healthcare Center 1801868302 1500 0 0 0 0 0 0 0 9 Inglewood Healthcare Center 1013989656 500 0 0 0 0 0 0 0 10 Parkview Healthcare Center 1609840115 996 0 0 0 0 0 0 0 11 Santa Monica Health Care Center 1720051295 5888 0 0 0 0 0 0 0 12 Skyline Healthcare - San Jose 1902879471 10671 0 0 0 0 0 0 0 13 Verdugo Vista Healthcare Center 1851364194 1278 0 0 0 0 0 0 0 14 Vale Healthcare Center 1932172491 11869 0 0 0 0 0 0 0 15 Palm Springs Health amp Rehab 1699747659 0 0 0 0 0 0 0 0 16 Creekside Health Care Center 1811969355 0 0 0 0 0 0 0 0 17 Pine Ridge Care Center 1376515817 500 0 0 0 0 0 0 0 18 Rehab Center of Santa Monica 1083687560 0 0 0 0 0 0 0 0 19 0 0 0 0 0 0 0 0 0 20 All Other Facilities Various 0 68352 10215 1336 46736 9940 0 0

SUBTOTAL (LINES 1 THROUGH 20) $97236 $68352 $10215 $1336 $46736 $9940 $0 $0

OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0




PROVIDER AUDITED NPI TOTAL

HEALTH CARE FACILITIES (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $233815 (To Schedule 3-1)

REPORTED ADJ ADJUSTMENT AUDITED POOLED ALLOC NO AMOUNT(S) POOLED (SCH B COL 8) COSTS


TRIAL BALANCE OF EXPENSES


LINE NO COST CENTER DESCRIPTION

CAPITAL-RELATED COSTS - OLD 100 Old Cap Related-Buildings amp Fixtures $0 101 0 0 0 200 Old Cap Related-Movable Equipment 0 0 0 201 0 0 0 300 SUBTOTAL (sum of lines 1 through 201) $0 $0 $0

CAPITAL-RELATED COSTS - NEW 400 New Cap Related-Buildings amp Fixtures $0 $0 $0 401 0 0 0 500 New Cap Related-Movable Equipment 209509 1 (12172) 197337 501 0 0 0 600 SUBTOTAL (sum of lines 4 through 501) $209509 ($12172) $197337

OTHER CAPITAL-RELATED COSTS 700 Insurance Premiums $0 $0 $0 800 Taxes and Licenses - Not INCM 0 0 0 900 Other 0 0 0

1000 SUBTOTAL (sum of lines 7 through 9) $0 $0 $0

NON CAPITAL-RELATED COSTS 1100 Salaries of Officers $0 $0 $0 1200 Salaries and Temporary Labor 3333308 7 (1462305) 1871003 1300 Payroll Taxes 204993 0 204993 1400 Employee Benefits-Payroll Related 185003 0 185003 1500 Employee Benefits-Nonpayroll Related 0 0 0 1600 Profit SharingPension Plans 0 0 0 1700 Legal Fees 222812 2348 (83224) 139588 1800 Auditing amp Accounting Fees 0 0 0 1900 Utilities (13606) 0 (13606) 2000 Communications 109563 0 109563 2100 Travel amp Entertainment 293523 0 293523 2200 Automobile 140924 0 140924 2300 Supplies 31946 0 31946 2400 Minor Equipment Expensed 0 0 0 2500 Repairs amp Maintenance 1147 0 1147 2600 Dues amp Subscriptions 16132 0 16132 2700 Contributions 0 0 0 2800 Insurance Premium-Non Capital Related 0 0 0 2900 Taxes amp Licenses - Non Capital Related 130915 0 130915 3000 Interest Expense 318909 119 (318909) 0 3100 Temporary Labor 0 0 0 3200 Forms amp Printing 3026 0 3026 3300 Meetings amp Conferences 20519 0 20519 3400 Contracted Professional Services 1562875 569-18 (1063251) 499624 3500 Bank Charges 288911 0 288911 3501 0 0 0 3502 Clinical 1438305 0 1438305 3503 0 0 0 3504 0 0 0 3505 0 0 0 3506 0 0 0 3507 0 0 0 3508 0 0 0 3600 SUBTOTAL (sum of lines 11 through 3508) $8289205 ($2927689) $5361516

3700 TOTAL ALLOWABLE EXPENSES $8498714 ($2939861) $5558853 (To Sch 4)

3800 NONREIMBURSABLE EXPENSES $0 $0 $0

TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA

HOME OFFICE NAME MARINER HEALTH CARE INC


SCHEDULE 8



CAPITAL-RELATED COSTS - OLD 100 Old Cap Related-Buildings amp Fixtures 101 200 Old Cap Related-Movable Equipment 201 300 SUBTOTAL (sum of lines 1 through 201)

CAPITAL-RELATED COSTS - NEW 400 New Cap Related-Buildings amp Fixtures 401 500 New Cap Related-Movable Equipment 501 600 SUBTOTAL (sum of lines 4 through 501)

OTHER CAPITAL-RELATED COSTS 700 Insurance Premiums 800 Taxes and Licenses - Not INCM 900 Other

1000 SUBTOTAL (sum of lines 7 through 9)

NON CAPITAL-RELATED COSTS 1100 Salaries of Officers 1200 Salaries and Temporary Labor 1300 Payroll Taxes 1400 Employee Benefits-Payroll Related 1500 Employee Benefits-Nonpayroll Related 1600 Profit SharingPension Plans 1700 Legal Fees 1800 Auditing amp Accounting Fees 1900 Utilities 2000 Communications 2100 Travel amp Entertainment 2200 Automobile 2300 Supplies 2400 Minor Equipment Expensed 2500 Repairs amp Maintenance 2600 Dues amp Subscriptions 2700 Contributions 2800 Insurance Premium-Non Capital Related 2900 Taxes amp Licenses - Non Capital Related 3000 Interest Expense 3100 Temporary Labor 3200 Forms amp Printing 3300 Meetings amp Conferences 3400 Contracted Professional Services 3500 Bank Charges 3501 3502 Clinical 3503 3504 3505 3506 3507 3508 3600 SUBTOTAL (sum of lines 11 through 3508)

3700 TOTAL ALLOWABLE EXPENSES

3800 NONREIMBURSABLE EXPENSES

TOTAL EXPENSES

REPORTED ADJ ADJUSTMENT AUDITED DIRECT ALLOC NO AMOUNT(S) DIRECT (SCH B COL 6) COSTS

$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES

REPORTED ADJ ADJUSTMENT AUDITED FUNCTIONAL COSTS NO AMOUNT(S) FUNCTIONAL

(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0


REPORTED HOME OFFICE COSTS



PROVIDER NPI

FISCAL YEAR


DIRECT ALLOCATION FUNCTIONAL ALLOCATION POOLED ALLOCATION TOTAL ALLOCATION HOME OFFICE

COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED

COSTS (SCH G)FROM TO

1 Monterey Palms Health Care Center 1982676524 010111 123111 $500 $10547 $417280 $428327 2 Autumn Hills Health Care Center 1659343192 010111 123111 750 10486 414892 426128 3 Fremont Health Care Center 1366414906 010111 123111 0 13236 523698 536934 4 Driftwood Health Care - Hayward 1487627725 010111 123111 13853 9890 391291 415034 5 Almaden Health and Rehab Center 1548232184 010111 123111 16290 9404 372086 397780 6 Driftwood Healthcare Santa Cruz 1548232150 010111 123111 26492 9513 376380 412385 7 Florin Healthcare Center 1538131032 010111 123111 6149 12321 487469 505939 8 Hayward Hills Healthcare Center 1801868302 010111 123111 1500 8864 350689 361053 9 Inglewood Healthcare Center 1013989656 010111 123111 500 8608 340566 349674

10 Parkview Healthcare Center 1609840115 010111 123111 996 11733 464222 476951 11 Santa Monica Health Care Center 1720051295 010111 123111 5888 7129 282040 295057 12 Skyline Healthcare - San Jose 1902879471 010111 123111 10671 23891 945261 979823 13 Verdugo Vista Healthcare Center 1851364194 010111 123111 1278 9057 358356 368691 14 Vale Healthcare Center 1932172491 010111 123111 11869 21271 841576 874716 15 Palm Springs Health amp Rehab 1699747659 010111 123111 0 8734 345546 354280 16 Creekside Health Care Center 1811969355 010111 123111 0 10372 410365 420737 17 Pine Ridge Care Center 1376515817 010111 123111 500 9991 395284 405775 18 Rehab Center of Santa Monica 1083687560 010111 123111 0 14462 572201 586663 19 0 20 All Other Facilities Various 0


OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0


GRAND TOTAL $0 $97236 $0 $0 $209509 $8289202 $8595947 (To Sch 2 Col 1)

State of California Department of Health Care Services

Provider Name MARINER HEALTH CARE INC

Fiscal Period JANUARY 1 2011 THROUGH DECEMBER 31 2011

Provider Number NA 20

Adjustments

Report References

Explanation of Audit Adjustments As

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

Cost Report Work Sheet Part Title Line Col

RECLASSIFICATIONS OF REPORTED COSTS

1 8 B 500 8 Capital Related Costs $209509 ($12172) $197337 8 B 3000 8 Interest Expense 318909 12172 331081

To reverse providers reclassification of interest expense to capital related costs due to insufficient supporting documentation that the borrowing was necessary proper reasonable and related to patient care in conjunction with adjustment 19 42 CFR 4139 41320 41324 and 413153 CMS Pub 15-1 Sections 202 2021 2022 2300 and 2304

2 7-1 E 2000 6 All Other Facilities $0 $68352 $68352 8 B 1700 8 Legal Fees 222812 (68352) 154460 8 B 1700 6 Legal Fees 97236 68352 165588

To directly allocate the Abelson Herron LLP legal expense for landlord dispute during divestiture of facilities not related to patient care 42 CFR 4139(c)(3) 41320 and 41324 CMS Pub 15-1 Sections 21023 2183 2300 2304 and 23041


To directly allocate the Beach Whitman Cowdrey LLP legal expense for landlord dispute during divestiture of facilities not related to patient care 42 CFR 4139(c)(3) 41320 and 41324 CMS Pub 15-1 Sections 21023 2183 2300 2304 and 23041

Balance carried forward from priorto subsequent adjustments





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report




To directly allocate the Driftwood Torrance legal expense after divestiture of the facility not related to patient care 42 CFR 4139(c)(3) 41320 and 41324 CMS Pub 15-1 Sections 21023 2183 2300 2304 and 23041

5 7-1 E 2000 6 All Other Facilities $79903 $46736 $126639 8 B 3400 8 Contracted Professional Services 1562875 (46736) 1516139 8 B 3400 6 Contracted Professional Services 0 46736 46736

To directly allocate the IKON copy expense for the Heavy litigation in La Salle facility not related to patient care 42 CFR 4139(c)(3) 41320 and 41324 CMS Pub 15-1 Sections 21023 2183 2300 2304 and 23041


To directly allocate the DataLok box destruction expense after the divestiture of Driftwood Torrance not related to patient care 42 CFR 4139(c)(3) Sections CMS Pub 15-1 Sections 10021 21023 and 213410

Balance carried forward from priorto subsequent adjustments Page 2





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report


ADJUSTMENTS TO REPORTED POOLED COSTS

7 8 B 1200 8 Salaries and Temporary Labor $3333308 ($1462305) $1871003 To eliminate bonus expense due to insufficient documentation of the criteria for granting the bonus and the relationship to patient care 42 CFR 41320 and 41324 CMS Pub 15-1 Sections 904 21021 2103 21362 2300 2304 and 2305

8 8 B 1700 8 Legal Fees $142909 ($3321) $139588 To eliminate the FMSC name change legal expenses not related to patient care 42 CFR 4139(c)(3) Sections CMS Pub 15-1 Sections 10021 21023 and 213410

9 8 B 3400 8 Contracted Professional Services $1506199

To eliminate the income tax services for National Senior Care ($250640) not related to patient care 42 CFR 4139(c)(3) Sections CMS Pub 15-1 Sections 10021 21023 and 28062

10 To eliminate related party restructuring cost expenses not (233732) related to patient care 42 CFR 4139(c)(3) Sections CMS Pub 15-1 Sections 10021 21023 and 213410

11 To eliminate consultant expense due to insufficient documentation (201154) that shows the expenses are related to patient care ($685526) $820673 42 CFR 41320 and 41324 CMS Pub 15-1 Sections 2183 2300 and 2304






Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report




To eliminate consulting expense due to lack of documentation ($165000) the expenses are related to patient care 42 CFR 41320 41324 and 431107 CMS Pub 15-1 Sections 2300 and 2304 WampI Code 141242(b)

13 To eliminate reorganization accounting expense performed (89483) by Sava Healthcare not related to patient care 42 CFR 4139(c)(3) CMS Pub 15-1 Sections 21023 and 213410


15 To eliminate related party restructuring costs expense not (11859) related to patient care 42 CFR 4139(c)(3) CMS Pub 15-1 Sections 10021 21023 and 213410

16 To eliminate data entry expense due to insufficient (5000) documentation that shows the expenses are related to patient care 42 CFR 41320 41324 and 431107 CMS Pub 15-1 Sections 2300 and 2304 WampI Code 141242(b)

17 To eliminate PineBridge Investments management fee expense (3795) due to insufficient documentation that shows the expenses are ($319419) $501254 related to patient care 42 CFR 41320 41324 and 431107 CMS Pub 15-1 Sections 2300 and 2304 WampI Code 141242(b)






Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report



18 8 B 3400 8 Contracted Professional Services $501254 ($1630) $499624 To eliminate the geoscientist travel expense due to insufficient documentation that shows the expenses are related to patient care 42 CFR 41320 41324 and 431107 CMS Pub 15-1 Sections 2300 and 2304 WampI Code 141242(b)

19 8 B 3000 8 Interest Expense $331081 ($331081) $0 To eliminate interest expense at the Home Office due to insufficient supporting documentation that the borrowing was necessary proper reasonable and that shows the expenses are related to patient care in conjunction with adjustment 1 42 CFR 4139 41320 41324 and 413153 CMS Pub 15-1 Sections 202 2021 2022 2300 and 2304






Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report


ADJUSTMENT TO REPORTED STATISTICS

20 4 G 2000 3 All Other Facilities (Total Cost) 0 95055 95055 4 G 3 Total - Total Costs 171325638 95055 171420693

To include the sold facilities costs in the pooled allocation statistics to agree with providers Profit and Loss statements 42 CFR 41324 and 41350 CMS Pub 15-1 Sections 2304 and 2306

Page 6

Sttate of CalifoorniamdashHealth and Humman Servicees Agency DDepartmment of HHealth CCare Seervices

TOOBY DOUGLAS EDMUNDD G BROWN JR DIRECTOR GOVERNOR

June 4 2013

Brian Kaarpodinis Director Consolidattion Accounnting Fundammental Admiinistrative SServices LLLC 920 Ridggebrook Rooad Sparks MD 21152

MARINEER HEALTHH CARE INNC FISCAL PERIOD EENDED DECEMBER 331 2011

We havee examinedd the Medi-CCal Home OOffice Costt Report forr the fiscal pperiod endeed Decembber 31 2011 Our exaamination wwas made under the auuthority of SSection 141170 of the WWelfare and Institutionss Code and accordinggly includedd such testss of the accounting recordss and such other auditing proceduures as we consideredd necessaryy in the circuumstances

In our oppinion the data presented in the Summary oof Audited Home Officce Costs to Health CCare Facilitiies represeents a propeer determinnation of home office aallowable coosts for the aabove fiscall period in aaccordancee with Medi--Cal reimbuursement principles TThe audited home officee cost will bbe incorporaated by seeparate adjuustment intto each applicabble facility aaudit report

This auddit report includes the

1 SSummary off Audited Home Officee Costs to HHealth Caree Facilities aand Supporrting SSchedules

2 AAudit Adjusttments Schedule

If you disagree withh the decision of the DDepartment the resultss of the homme office auudit may onlyy be appeaaled throughh each indivvidual facili tys audit reeport Pleaase refer to the appeal instructions in each faccilityrsquos auditt report

Financi al Audits BrancchAudits SectiionmdashSacramennto MS 2106 PO Box 9974413 Sacramennto CA 95899--7413

(916) 650-69994 (916) 650--6990 fax Internet Addrress wwwdhccscagov

Brian Karpodinis


Original Signed By


Certified

TABLE OF CONTENTS

SCHEDULES


















PROVIDER NPI


FISCAL YEAR

CAPITAL RELATED

(SCHEDULE 3) 1

NONCAPITAL RELATED

(SCHEDULE 3-1) 2





OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $197337 $5595331 $5792668





PROVIDER NPI


FISCAL YEAR


COSTS (SCH 9) 1

AUDITED HO COSTS

(SCH 3 amp 3-1) 2

VARIANCE




OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $8595947 $5792668 ($2803279)





PROVIDER NPI


FISCAL YEAR

DIRECT

(SCHEDULE 7) 1


(SCHEDULE 5) 2



3

TOTAL CAPITAL COSTS

(COL 1 TO 3)FROM TO



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0







PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2


3

TOTAL NONCAPITAL




OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0








1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6

Brian Karpodinis Page 2


Original Signed By


Certified

TABLE OF CONTENTS

SCHEDULES


















PROVIDER NPI


FISCAL YEAR

CAPITAL RELATED

(SCHEDULE 3) 1

NONCAPITAL RELATED

(SCHEDULE 3-1) 2





OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $197337 $5595331 $5792668





PROVIDER NPI


FISCAL YEAR


COSTS (SCH 9) 1

AUDITED HO COSTS

(SCH 3 amp 3-1) 2

VARIANCE




OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $8595947 $5792668 ($2803279)





PROVIDER NPI


FISCAL YEAR

DIRECT

(SCHEDULE 7) 1


(SCHEDULE 5) 2



3

TOTAL CAPITAL COSTS

(COL 1 TO 3)FROM TO



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0







PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2


3

TOTAL NONCAPITAL




OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0








1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

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Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

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(Decrease) As

Adjusted Adj No

Audit Report










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Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6

TABLE OF CONTENTS

SCHEDULES


















PROVIDER NPI


FISCAL YEAR

CAPITAL RELATED

(SCHEDULE 3) 1

NONCAPITAL RELATED

(SCHEDULE 3-1) 2





OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $197337 $5595331 $5792668





PROVIDER NPI


FISCAL YEAR


COSTS (SCH 9) 1

AUDITED HO COSTS

(SCH 3 amp 3-1) 2

VARIANCE




OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $8595947 $5792668 ($2803279)





PROVIDER NPI


FISCAL YEAR

DIRECT

(SCHEDULE 7) 1


(SCHEDULE 5) 2



3

TOTAL CAPITAL COSTS

(COL 1 TO 3)FROM TO



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0







PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2


3

TOTAL NONCAPITAL




OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0








1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

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Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

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Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI


FISCAL YEAR

CAPITAL RELATED

(SCHEDULE 3) 1

NONCAPITAL RELATED

(SCHEDULE 3-1) 2





OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $197337 $5595331 $5792668





PROVIDER NPI


FISCAL YEAR


COSTS (SCH 9) 1

AUDITED HO COSTS

(SCH 3 amp 3-1) 2

VARIANCE




OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $8595947 $5792668 ($2803279)





PROVIDER NPI


FISCAL YEAR

DIRECT

(SCHEDULE 7) 1


(SCHEDULE 5) 2



3

TOTAL CAPITAL COSTS

(COL 1 TO 3)FROM TO



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0







PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2


3

TOTAL NONCAPITAL




OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0








1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI


FISCAL YEAR


COSTS (SCH 9) 1

AUDITED HO COSTS

(SCH 3 amp 3-1) 2

VARIANCE




OTHER COMPONENTS

21 0 $0 $0 $0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL $8595947 $5792668 ($2803279)





PROVIDER NPI


FISCAL YEAR

DIRECT

(SCHEDULE 7) 1


(SCHEDULE 5) 2



3

TOTAL CAPITAL COSTS

(COL 1 TO 3)FROM TO



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0







PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2


3

TOTAL NONCAPITAL




OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0








1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report









PROVIDER NPI


FISCAL YEAR

DIRECT

(SCHEDULE 7) 1


(SCHEDULE 5) 2



3

TOTAL CAPITAL COSTS

(COL 1 TO 3)FROM TO



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0







PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2


3

TOTAL NONCAPITAL




OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0








1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

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Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI


FISCAL YEAR

DIRECT COSTS

(SCH 7-1) 1

FUNCTIONAL COSTS

(SCH 5-1) 2


3

TOTAL NONCAPITAL




OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0








1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6






1 2 3 4 (Adj 20)



OTHER COMPONENTS

21 0 $0 $0 $0 $0 22 0 0 0 0 0 23 0 0 0 0 0 24 0 0 0 0 0 25 0 0 0 0 0 26 0 0 0 0 0 27 0 0 0 0 0 28 0 0 0 0 0 29 0 0 0 0 0 30 0 0 0 0 0 31 0 0 0 0 0 32 0 0 0 0 0 33 0 0 0 0 0 34 0 0 0 0 0 35 0 0 0 0 0



MULTIPLIER 0001151 0031277





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

100

Old Cap Related-



201 400

New Cap Related-

Buildings amp 401



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

500


501 700

Insurance Premiums

800


INCM 900

Other AUDITED TOTAL

CAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

11


12


Labor 13

Payroll Taxes

14


Related 15

Employee Benefits-

Nonpayroll 16


n Plans 17

Legal Fees



OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

18


Fees 19

Utilities

20

Communication s

21


22

Automobile

23

Supplies

24




OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

25


26


27

Contributions

28


Capital Related 29


30

Interest Expense

31

Temporary Labor



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

32

Forms amp Printing

33


34


Services 35

Bank Charges

3501 3502

Clinical

3503



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0 $0

0 0 0 0 0 0 0





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

3504 3505 3506 3507 3508

AUDITED TOTAL

NONCAPITAL



OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0


GRAND TOTAL $0 $0 $0 $0 $0 $0





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

(Statistics) 100

Old Cap Related-

(Statistics) 101

(Statistics) 200

Old Cap Related-

(Statistics) 201

(Statistics) 400

New Cap Related-

(Statistics) 401




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

(Statistics) 500

New Cap Related-

(Statistics) 501

(Statistics) 700

Insurance Premiums

(Statistics) 800


(Statistics) 900

Other




OTHER COMPONENTS

21 0 0 0 0 0 0 22 0 0 0 0 0 0 23 0 0 0 0 0 0 24 0 0 0 0 0 0 25 0 0 0 0 0 0 26 0 0 0 0 0 0 27 0 0 0 0 0 0 28 0 0 0 0 0 0 29 0 0 0 0 0 0 30 0 0 0 0 0 0 31 0 0 0 0 0 0 32 0 0 0 0 0 0 33 0 0 0 0 0 0 34 0 0 0 0 0 0 35 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

(Statistics) 1100


(Statistics) 1200


(Statistics) 1300

Payroll Taxes

(Statistics) 1400


(Statistics) 1500

Employee Benefits-

(Statistics) 1600





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

(Statistics) 1700

Legal Fees

(Statistics) 1800


(Statistics) 1900

Utilities

(Statistics) 2000

Communication s

(Statistics) 2100


(Statistics) 2200

Automobile




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

(Statistics) 2300

Supplies

(Statistics) 2400

Minor Equipment

(Statistics) 2500


(Statistics) 2600


(Statistics) 2700

Contributions

(Statistics) 2800





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

(Statistics) 2900


(Statistics) 3000

Interest Expense

(Statistics) 3100

Temporary Labor

(Statistics) 3200

Forms amp Printing

(Statistics) 3300


(Statistics) 3400





OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0








PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

(Statistics) 3500

Bank Charges

(Statistics) 3501

(Statistics) 3502

Clinical

(Statistics) 3503

(Statistics) 3504

(Statistics) 3505




OTHER COMPONENTS

21 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0







PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6




PROVIDER NPI

(Statistics) 3506

(Statistics) 3507





OTHER COMPONENTS

21 0 0 0 0 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 0 0 0 0 27 0 0 0 0 28 0 0 0 0 29 0 0 0 0 30 0 0 0 0 31 0 0 0 0 32 0 0 0 0 33 0 0 0 0 34 0 0 0 0 35 0 0 0 0


GRAND TOTAL 0 0 0









OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6








OTHER COMPONENTS

21 0 $0 $0 $0 $0 $0 $0 $0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0



0 0 0 0 0 0





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

REPORTED TOTAL

(SCH E-1)


Services





OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0 0


GRAND TOTAL $97236 $68352 $10215 $1336 $46736 $9940 $0 $0








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6








OTHER COMPONENTS

21 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 24 0 0 0 0 0 0 0 0 25 0 0 0 0 0 0 0 0 26 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 32 0 0 0 0 0 0 0 0 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 35 0 0 0 0 0 0 0 0















TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6













TOTAL EXPENSES $8498714 ($2939861) $5558853

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


$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

97236 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

$97236

$97236

$0

$97236

234

56

$0 $0

$0 $0

$0 $0

$0 $0 0 0 0 0 0 0 0 0 0 0

79903 177139 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

56676 56676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$136579 $233815

$136579 $233815 (To Sch 7 7-1)

$0 $0

$136579 $233815

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6

STATE OF CALIFORNIA



SCHEDULE 8










TOTAL EXPENSES


(SCH B COL 7) COSTS

$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 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 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

$0 $0 $0 (To Sch 6 6-1)

$0 $0 $0

$0 $0 $0





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





PROVIDER NPI

FISCAL YEAR



COSTS

CAPITAL RELATED

COSTS (SCH E)

NON-CAPITAL RELATED

COSTS (SCH E-1)

CAPITAL RELATED

COSTS (SCH F)

NON-CAPITAL RELATED

COSTS (SCH F-1)

CAPITAL RELATED

COSTS (SCH G)

NON-CAPITAL RELATED





OTHER COMPONENTS

21 $0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0







Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report














Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report















Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report










Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6





Adjustments

Report References


Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report





Page 6

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