STATE OF CALIFORNIA RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS_part1 pptx
STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS _part1 ppt
... 416(772,791)(65,365)(22,203)(12,668)(8,420)(3,510)93,569(93,569) (11,945) (16,188) ADJUSTMENTS TO REPORTED COSTS This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider Name Fiscal Period ... 43 44-47 ADJUSTMENTS TO REPORTED COSTS 160,272(25,903)(6,049)(11,361)160,272 (57) (25,006) (18,948) (31,952) (1,401) (11,361) 0 0 0This is trial versionwww.adultpdf.com STATE OF CALIFORNIA ... ADJ AUDIT ADJ34-36 37 38-40 41 42 43 44-47(57)(1,401) ADJUSTMENTS TO REPORTED COSTS This is trial versionwww.adultpdf.com STATE OF CALIFORNIA Provider Name:HOLLENBECK PALMS5.00 Plant Operations...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS _part2 pptx
... ReportAudit ReportExplanation of Audit Adjustments AdjustmentsHOLLENBECK PALMS JULY 1, 2007 THROUGH JUNE 30, 2008 ZZT05115F ADJUSTMENTS TO REPORTED COSTS 37 Not Reported 8A-2 5.04 Plant Operations ... ReportExplanation of Audit Adjustments AdjustmentsHOLLENBECK PALMS JULY 1, 2007 THROUGH JUNE 30, 2008 ZZT05115F ADJUSTMENTS TO REPORTED COSTS 10.1(4) 55 14 8A-2 55.00 Interest - Other * $773,84026 To adjust ... ReportAudit ReportExplanation of Audit Adjustments AdjustmentsHOLLENBECK PALMS JULY 1, 2007 THROUGH JUNE 30, 2008 ZZT05115FRECLASSIFICATIONS OF REPORTED COSTS 16 Not Reported 8A-2 165.07 Administration...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS pdf
... Report ADJUSTMENTS TO REPORTED COSTS 10.5 165 4 8A-2 165 4 Administration - Other - Nonlabor * $76,67424 To adjust reported home office costs to agree with the Centurion, Inc. $8,982Home Office ... and 2304*Balance carried forward from prior /to subsequent adjustments PageThis is trial versionwww.adultpdf.com State of California Department of Health Care ServProvider Name Fiscal Period ... and 2302.8*Balance carried forward from prior /to subsequent adjustments PageThis is trial versionwww.adultpdf.com State of California Department of Health Care ServProvider Name Fiscal Period...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS_part2 docx
... ReportExplanation of Audit Adjustments AdjustmentsVILLA GARDENS HEALTH CARE UNIT APRIL 1, 2006 THROUGH MARCH 31, 2007 LTC55429HADJUSTMENT TO REPORTED STATISTICS16 Not Reported 7 5.00 Plant ... 60011.1(1 of 3) 85 2 7 N/A Total Statistics - Square Feet 18,798 (1,167) 17,63111.1(1 of 3) 85 2 7 N/A Total Statistics - Square Feet 18,798 (3,323) 15,475 To adjust square footage statistics to agree ... and 2304*Balance carried forward from prior /to subsequent adjustments Page 2This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider Name Fiscal...
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STATE OF CALIFORNIA RECONCILIATION OF THE PROVIDER''''S ADJUSTMENTS TO THE AUDIT REPORT_part1 pdf
... AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ10 RECONCILIATION OF THE PROVIDER'S ADJUSTMENTS TO THE AUDIT REPORT23,396(23,396)000000000000This ... 31, 2007TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ(Page 1) 11 12 13 14 15 16 17 ADJUSTMENTS TO REPORTED COSTS82.02 Occupational Therapy ... THROUGH DECEMBER 31, 2007TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ(Page 1) 11 12 13 14 15 16 17 ADJUSTMENTS TO REPORTED COSTS130.00...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS_part3 potx
... Audit Adjustments ADJUSTMENTS TO REPORTED COSTS17 Not Reported 40 14 8A-2 40.00 Property Taxes $21,883 $5,883 $27,766 To reflect the proper accrual of real property taxes applicable to theaudit ... and 2302.8*Balance carried forward from prior /to subsequent adjustments Page 4This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider Name Fiscal ... and 2304*Balance carried forward from prior /to subsequent adjustments Page 5This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider Name Fiscal...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS_part4 potx
... Nursing - Other - Nonlabor 0175.00 Total $74,302000(4,652) 184,449 (105,000) (495) 0 0 (To Sch 8)This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider ... prior /to subsequent adjustments Page 1 Adjustments VILLA SCALABRINI JANUARY 1, 2008 THROUGH DECEMBER 31, 2008 LTC90058FReport ReferencesCost ReportAudit ReportExplanation of Audit Adjustments This ... versionwww.adultpdf.com State of California Department of Health Care ServicesProvider Name Fiscal Period Provider Number17MC530Adj. Page or As Increase AsNo. Exhibit Line Col. Sch Line Reported (Decrease)...
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STATE OF CALIFORNIA RECONCILIATION OF THE PROVIDER''''S ADJUSTMENTS TO THE AUDIT REPORT _part2 pdf
... 2008 AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ10 11 12 13 14 RECONCILIATION OF THE PROVIDER'S ADJUSTMENTS TO THE ... 2008 AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ24 25 ADJUSTMENTS TO REPORTED COSTSThis is trial versionwww.adultpdf.com STATE OF CALIFORNIA Provider ... 2008 AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ24 25 ADJUSTMENTS TO REPORTED COSTSThis is trial versionwww.adultpdf.com STATE OF CALIFORNIA...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS docx
... AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ ADJUSTMENTS TO REPORTED COSTS 0000000000000This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider Name Fiscal ... HOSPITAL Adjustments Explanation of Audit Adjustments JULY 1, 2007 THROUGH JUNE 30, 2008 HSC 30056FCost Report ADJUSTMENTS TO REPORTED MEDI-CAL SETTLEMENT DATA - NONCONTRACT10 4A Not Reported ... ReferencesANTELOPE VALLEY HOSPITAL Adjustments Explanation of Audit Adjustments JULY 1, 2007 THROUGH JUNE 30, 2008 HSC 30056FCost ReportRECLASSIFICATIONS OF REPORTED COSTS 5 10A A 6.04 7 Administrative...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS Page 1 _part1 potx
... 0 42,0 91 42,0 91 Not Reported 8A -1 65.04 Dietary - Other - Nonlabor 0 257, 611 257, 611 5 10 .1( 4) 10 5 14 8A -1 105.00 Skilled Nursing Care $3, 619 ,594 ($3, 619 ,594) $0Not Reported 8A -1 105. 01 Skilled ... 19 ,825 19 ,825 *8 10 .1( 4) 16 5 14 8A -1 165.00 Administration $1, 682,4 91 ( $1, 682,4 91) $0Not Reported 8A -1 165. 01 Administration - Salaries and Wages 0 586,680 586,680 *Not Reported 8A -1 165.02 ... 248,787 248,787 *6 10 .1( 4) 15 5 14 8A -1 155.00 Social Services $14 5,538 ( $14 5,538) $0Not Reported 8A -1 155. 01 Social Services - Salaries and Wages 0 12 7,699 12 7,699Not Reported 8A -1 155.02 Social...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS Page 1 _part2 pdf
... 2,0 41 2,0 41 11. 1 (1 of 3) 10 2 7 75.00 Patient Supplies 225 (19 ) 206 11 .1 (1 of 3) 35 2 7 10 0.00 Other Ancillary Services 2 31 (18 1) 50Not Reported 7 16 0.00 Activities 0 14 0 14 0Not Reported 7 16 5.00 ... Reported 7 17 0.00 Inservice Education - Nursing 0 395 395 11 .1 (1 of 3) 85 2 7 N/A Total Statistics - Square Feet 15 ,605 3,872 19 ,477 11 .1 (1 of 3) 85 2 7 N/A Total Statistics - Square Feet 15 ,605 ... 3,6 41 19,246 11 .1 (1 of 3) 85 2 7 N/A Total Statistics - Square Feet 15 ,605 3, 410 19 , 015 To adjust square footage to agree with the provider's square footage workpaper.42 CFR 413 .24 and 413 .50...
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STATE OF CALIFORNIA RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS_part1 pptx
... 12 13 14 15 16 17 18 19 RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS(89,119)(2,365) (8,469) (4,170) (24,313)This is trial versionwww.adultpdf.com STATE OF CALIFORNIA Schedule 8A-2Page ... Occupational Therapy - Other - Nonlabor 2,989 2,989 RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTSThis is trial versionwww.adultpdf.com STATE OF CALIFORNIA Provider Name:SEAPORT 17TH CARE ... ADJ11 12 13 14 15 16 17 18 19(1,910)(35,567) RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTSThis is trial versionwww.adultpdf.com STATE OF CALIFORNIA Schedule 8A-2Page 1Provider Name:...
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STATE OF CALIFORNIA RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS_part2 potx
... AUDIT ADJ AUDIT ADJ20 RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS(3,425)(85,627) 00000000This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider ... 51511.5*Balance carried forward from prior /to subsequent adjustments Page 2This is trial versionwww.adultpdf.com State of California Department of Health Care ServicesProvider Name Fiscal ... Adjusted Adjustments SEAPORT 17TH CARE CENTER JANUARY 1, 2009 THROUGH DECEMBER 31, 2009 ZZT05155ICost ReportExplanation of Audit Adjustments Report ReferencesAudit Report RECLASSIFICATIONS OF REPORTED...
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STATE OF CALIFORNIARECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS Page 1 Provider Number: pot
... provider& apos;s costs on page 10 .1, column 14 .42 CFR 413 .20 and 413 .24 / CMS Pub. 15 -1, Sections 2300 and 23042 To reconcile provider& apos;s reported statistics on page 10 .7 to provider& apos;s reported ... 262 10 .7 010 1, 2 7 010 Housekeeping 06262 10 .7 060 1, 2,3 7 060 Laundry and Linen 0 480 480 10 .7 065 1, 2,3 7 065 Dietary 0 1, 963 1, 963 10 .7 15 5 1, 2,3 7 15 5 Social Services 04747 10 .7 16 5 1, 2,3 ... statistics on page 11 .1. 42 CFR 413 .20 and 413 .24 / CMS Pub. 15 -1, Sections 2300 and 2304 Page 1 Adjustments JANUARY 1, 2009 THROUGH DECEMBER 31, 2009 ZZT05 617 JCost ReportExplanation of Audit Adjustments Report...
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STATE OF CARECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS Page 1Schedule 8A-2Provider doc
... ReportExplanation of Audit Adjustments Report ReferencesAudit Report ADJUSTMENTS TO REPORTED COSTS 10.5 165 4 8A-2 165 4 Administration - Other - Nonlabor * $76,67424 To adjust reported home office costs to ... ReferencesAudit Report ADJUSTMENTS TO REPORTED COSTS 10.5 165 2 8A-2 165 2 Administration - Fringe Benefits * $71,94616 To eliminate retirement expense due to lack of documentation. ($714)42 ... AUDIT ADJ AUDIT ADJ(Pages 1, 2, & 3) 45678910RECLASSIFICATIONS AND/OR ADJUSTMENTS TO REPORTED COSTS 0(6,447)00000000000000000($164,664) 0000000 (To Sch 8)This is trial...
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