report rate setting audit corinthian …€¦ · noncovered services deducted from patient share of...
TRANSCRIPT
REPORT ON THE
RATE SETTING AUDIT
CORINTHIAN GARDENS HEALTHCARE CENTER BAKERSFIELD, CALIFORNIA
PROVIDER NUMBERS: ZZT18066K / NPI 1568677342
FISCAL PERIOD ENDED DECEMBER 31, 2008
Audits Section - Burbank Financial Audits Branch
Audits and Investigations California Department of Health Care Services
Section Chief: Daniel J. Giardinelli Audit Supervisor: Celia Avina Auditor: Amandeep Sodhi
State of California—Health and Human Services Agency
Department of Health Care Services
DAVID MAXWELL-JOLLY ARNOLD SCHWARZENEGGER Director Governor
Financial Audits/Burbank/A & I, MS 2101, 1405 North San Fernando Boulevard, Room 203, Burbank, CA 91504
Telephone (818) 295-2620 FAX: (818) 563-3324 Internet Address: www.dhcs.ca.gov
May 10, 2010 Administrator Corinthian Gardens Healthcare Center 1611 Height Street Bakersfield, California 93309 PROVIDER: CORINTHIAN GARDENS HEALTHCARE CENTER PROVIDER NOS. ZZT18066K / NPI 1568677342 FISCAL PERIOD ENDED DECEMBER 31, 2008 We have examined the facility's Integrated Disclosure and Medi-Cal Cost Report for the above-referenced fiscal period. We also examined the facility's use of and Records of Noncovered Services deducted from patient share of cost. Our examination was made under the authority of Section 14170 of the Welfare and Institutions Code and, accordingly, included such tests of the accounting records and such other auditing procedures as we considered necessary in the circumstances. In our opinion, the data presented in the accompanying Summary of Audited Facility Cost per Patient Day represents a proper determination of the allowable costs, patient days and use of share of cost for the above fiscal period in accordance with Medi-Cal reimbursement principles. This audit report includes the: 1. Summary of Audited Facility Cost per Patient Day and supporting schedules 2. Audit adjustments that include a summary of the total due the State in the
amount of $498, which resulted from Medi-Cal overbillings The audit settlement will be incorporated into a Statement(s) of Account Status, which may reflect tentative retroactive adjustment determinations, payments from the provider, and other financial transactions initiated by the Department. The Statement(s) of Account Status will be forwarded to the provider by the State’s fiscal intermediary. Instructions regarding payment will be included with the Statement(s) of Account Status. Future Medi-Cal long-term care prospective rates may be affected by this examination. The extent to which the rates change will be determined by the Department's Rate Development Branch.
Administrator Page 2
Notwithstanding this audit report, overpayments to the provider are subject to recovery pursuant to Section 51458.1, Article 6 of Division 3, Title 22, California Code of Regulations. If you disagree with the decision of the Department, you may appeal by writing to: Chief Office of Administrative Appeals and Hearings 1029 J Street, Suite 200 Sacramento, CA 95814-2825 (916) 322-5603 The written notice of disagreement must be received by the Department within 60 calendar days from the day you receive this letter. A copy of this notice should be sent to: United States Postal Service (USPS) Courier (UPS, FedEx, etc.) Assistant Chief Counsel Assistant Chief Counsel Department of Health Care Services Department of Health Care Services Office of Legal Services Office of Legal Services MS 0010 MS 0010 PO Box 997413 1501 Capitol Avenue, Suite 71.5001 Sacramento, CA 95899-7413 Sacramento, CA 95814-5005 (916) 440-7700 The procedures that govern an appeal are contained in Welfare and Institutions Code, Section 14171, and California Code of Regulations, Title 22, Section 51016, et seq. If you have questions regarding this report, you may call the Audits Section—Burbank at (818) 295-2620. Original Signed By Daniel J. Giardinelli, Chief Audits Section—Burbank Financial Audits Branch Certified
STATE OF CALIFORNIA SCHEDULE 1
Provider Name: Fiscal Period:CORINTHIAN GARDENS HEALTHCARE CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
Provider Number: Provider NPI: OSHPD Facility No.:ZZT18066K 1568677342 206150698
LineNo.
SKILLED NURSING CARE1 Cost of Direct Care - Labor (Sch. 2, Ln. 105) $ N/A $ 2,021,592 $ 62.26
2 Cost of Indirect Care - Labor (Sch. 3, Ln. 105) $ N/A $ 751,209 $ 23.13
3 Cost of Direct and Indirect NonLabor - Other (Sch. 4, Ln. 105) $ N/A $ 1,251,339 $ 38.54
4 Cost of Capital Related (Sch. 5, Ln. 105) $ N/A $ 1,122,004 $ 34.55
5 Property Taxes (Sch. 5, Ln. 105) $ N/A $ 71,618 $ 2.21
6 Facility License Fees (Sch. 6, Ln. 105) $ N/A $ 54,411 $ 1.68
7 Liability Insurance (Sch. 6, Ln. 105) $ N/A $ 100,200 $ 3.09
8 Caregiver Training (Sch. 6, Ln. 105) $ N/A $ 0 $ 0.00
9 Quality Assurance Fees (Sch. 6, Ln. 105) $ N/A $ 166,954 $ 5.14
10 Cost of Administration (Sch. 6, Ln. 105) $ N/A $ 977,684 $ 30.11
11 Cost of Routine Service/Audited Total Costs $ 7,143,488 $ 6,517,010 $ 200.70
12 Total Patient Days (Adj ) 32,471 32,471
13 Cost Per Patient Day (Cost Divided by Days) $ 220.00 $ 200.70
14 Overpayments (Adj 29) $ 0 $ 498
INTERMEDIATE CARE15 Cost of Routine Service (Sch. 2, 3, 4, 5, 6) $ 0 $ 0
16 Total Patient Days (Adj ) 0 0
17 Cost Per Patient Day (Cost Divided by Days) $ 0.00 $ 0.00
18 Overpayments (Adj ) $ 0 $ 0
MENTALLY DISORDERED19 Cost of Routine Service (Sch. 2, 3, 4, 5, 6) $ 0 $ 0
20 Total Patient Days (Adj ) 0 0
21 Cost Per Patient Day (Cost Divided by Days) $ 0.00 $ 0.00
22 Overpayments (Adj ) $ 0 $ 0
DEVELOPMENTALLY DISABLED23 Cost of Routine Service (Sch. 2, 3, 4, 5, 6) $ 0 $ 0
24 Total Patient Days (Adj ) 0 0
25 Cost Per Patient Day (Cost Divided by Days) $ 0.00 $ 0.00
26 Overpayments (Adj ) $ 0 $ 0
ADULT SUBACUTE27 Cost of Direct Care - Labor (Adult Subacute Sch. 1, Ln. 25) $ N/A $ 0 $ 0.00
28 Cost of Indirect Care - Labor (Adult Subacute Sch. 1, Ln. 26) $ N/A $ 0 $ 0.00
29 Cost of Direct and Indirect NonLabor - Other (Adult SA Sch. 1, Ln. 27) $ N/A $ 0 $ 0.00
30 Cost of Capital Related (Adult Subacute Sch. 1, Ln. 28) $ N/A $ 0 $ 0.00
31 Property Taxes (Adult Subacute Sch. 1, Ln. 29) $ N/A $ 0 $ 0.00
32 Facility License Fees (Adult Subacute Sch. 1, Ln. 30) $ N/A $ 0 $ 0.00
33 Liability Insurance (Adult Subacute Sch. 1, Ln. 31) $ N/A $ 0 $ 0.00
34 Caregiver Training (Adult Subacute Sch. 1, Ln. 32) $ N/A $ 0 $ 0.00
35 Quality Assurance Fees (Adult Subacute Sch. 1, Ln. 33) $ N/A $ 0 $ 0.00
36 Cost of Administration (Adult Subacute Sch., Ln. 34) $ N/A $ 0 $ 0.00
37 Total Cost of Subacute Service (Adult Subacute Sch. 1, Ln. 35) $ 0 $ 0 $ 0.00
38 Total Patient Days (Adult Subacute Sch. 1, Ln. 36) 0 0
39 Cost Per Patient Day (Cost Divided by Days) $ 0.00 $ 0.00
40 Overpayments (Adult Subacute Sch. 1, Ln. 38 + Ln. 39) $ 0 $ 0
SUMMARY OF AUDITED FACILITY COST PER PATIENT DAY
COST PERAUDITED
AS REPORTED AS AUDITED PATIENT DAYPROGRAM DESCRIPTION
STATE OF CALIFORNIA SCHEDULE 1
Provider Name: Fiscal Period:CORINTHIAN GARDENS HEALTHCARE CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
Provider Number: Provider NPI: OSHPD Facility No.:ZZT18066K 1568677342 206150698
LineNo.
SUMMARY OF AUDITED FACILITY COST PER PATIENT DAY
COST PERAUDITED
AS REPORTED AS AUDITED PATIENT DAYPROGRAM DESCRIPTION
PEDIATRIC SUBACUTE41 Cost of Routine Service (Ped-SA, Sch. 1, Ln 3) $ 0 $ 0
42 Cost of Ancillary Service (Ped-SA, Sch. 1, Ln. 1 + Ln. 2) $ 0 $ 0
43 Total Cost of Pediatric Subacute Service (Ln. 42 + Ln. 43) $ 0 $ 0
44 Total Patient Days (Ped-SA, Sch. 1, Ln. 5) 0 0
45 Cost Per Patient Day (Cost Divided by Days) $ 0.00 $ 0.00
46 Overpayments (Ped-SA, Sch. 1, Ln. 7 + Ln. 8) $ 0 $ 0
HOSPICE INPATIENT CARE47 Cost of Routine Service (Sch. 2, 3, 4, 5, 6) $ 0 $ 0
48 Total Patient Days (Adj ) 0 0
49 Cost Per Patient Day (Cost Divided by Days) $ 0.00 $ 0.00
50 Overpayments (Adj ) $ 0 $ 0
OTHER ROUTINE SERVICES51 Cost of Routine Service (Sch. 2, 3, 4, 5, 6) $ 0 $ 0
52 Total Patient Days (Adj ) 0 0
53 Cost Per Patient Day (Cost Divided by Days) $ 0.00 $ 0.00
54 Overpayments (Adj ) $ 0 $ 0
STATE OF CALIFORNIA SCHEDULE 2
Provider Name: Fiscal Period:CORINTHIAN GARDENS HEALTHCARE CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
Provider Number: Provider NPI: OSHPD Facility No.:ZZT18066K 1568677342 206150698
Soc Srvs ActivitiesNet Exp For
Line DESCRIPTION Cost AllocNo. (From Sch 8) 155 160 Total
GENERAL SERVICES5.00 Plant Operations and Maintenance
10.00 Housekeeping60.00 Laundry and Linen65.00 Dietary
155.00 Social Services (Salaries, Fringe Benefits, & Agency Labor) 66,999$ 66,999$ 160.00 Activities (Salaries, Fringe Benefits, & Agency Labor) 97,671 97,671$ 165.00 Administration165.00 Medical Records170.00 Inservice Education - Nursing
ANCILLARY SERVICES75.00 Patient Supplies 17,953 0 0 17,953$ 77.00 Specialized Support Surfaces N/A 0 0 080.00 Physical Therapy 389,279 0 0 389,27981.00 Respiratory Therapy 0 0 0 082.00 Occupational Therapy 93,507 0 0 93,50783.00 Speech Pathology 11,227 0 0 11,22785.00 Pharmacy 84,741 0 0 84,74190.00 Laboratory 2,574 0 0 2,57495.00 Home Health Services 0 0 0 0
100.00 Other Ancillary Services 10,770 0 0 10,770100.06 Subacute Ancillary Services 0 0 0 0100.12 Subacute Pediatrics Ancillary Services 0 0 0 0
ROUTINE SERVICES105.00 Skilled Nursing Care 1,856,922 66,999 97,671 2,021,592 *110.00 Intermediate Care 0 0 0 0 *115.00 Mentally Disordered 0 0 0 0 *120.00 Developmentally Disabled 0 0 0 0 *125.00 Subacute Care 0 0 0 0 *126.00 Subacute Care - Pediatrics 0 0 0 0 *130.00 Hospice Inpatient Care 0 0 0 0 *135.00 Other Routine Services 0 0 0 0 *
NONREIMBURSABLE 136.00 Residential Care 0 0 0 0140.00 Beauty and Barber 3,508 0 0 3,508145.00 Other Nonreimbursable 0 0 0 0
TOTAL 2,635,151$ 66,999$ 97,671$ 2,635,151$
* (To Schedule 1)
ALLOCATION OF GENERAL SERVICES - LABOR (DIRECT CARE)
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STATE OF CALIFORNIA SCHEDULE 5
ALLOCATION OF CAPITAL COSTS
Provider Name: Fiscal Period:CORINTHIAN GARDENS HEALTHCARE CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
Provider Number: Provider NPI: OSHPD Facility Number:ZZT18066K 1568677342 206150698
Capital Plant Ops Hskpng Laundry Dietary Soc Srvs ActivitiesNet Exp For
Line DESCRIPTION Cost AllocNo. (From Sch 8) Ratio Various 5 10 60 65 155 160
GENERAL SERVICESCapital Related (excluding lines 40 & 45) 1,263,631$ 94%
Property Tax (line 40) 80,658 6% 1,344,289$
5.00 Plant Operations and Maintenance 39,941 39,941$
10.00 Housekeeping 16,490 505 16,995$
60.00 Laundry and Linen 29,991 918 396 31,305$
65.00 Dietary 197,702 6,054 2,609 0 206,365$
155.00 Social Services 9,845 301 130 0 0 10,276$
160.00 Activities 42,402 1,298 560 0 0 0 44,260$
165.00 Administration 74,327 2,276 981 0 0 0 0
165.00 Medical Records 6,926 212 91 0 0 0 0
170.00 Inservice Education - Nursing 15,611 478 206 0 0 0 0
ANCILLARY SERVICES75.00 Patient Supplies 10,020 307 132 0 0 0 0
77.00 Specialized Support Surfaces 0 0 0 0 0 0 0
80.00 Physical Therapy 41,137 1,260 543 0 0 0 0
81.00 Respiratory Therapy 0 0 0 0 0 0 0
82.00 Occupational Therapy 18,599 570 245 0 0 0 0
83.00 Speech Pathology 9,317 285 123 0 0 0 0
85.00 Pharmacy 5,731 175 76 0 0 0 0
90.00 Laboratory 0 0 0 0 0 0 0
95.00 Home Health Services 0 0 0 0 0 0 0
100.00 Other Ancillary Services 879 27 12 0 0 0 0
100.06 Subacute Ancillary Services 0 0 0 0 0 0 0
100.12 Subacute Pediatrics Ancillary Services 0 0 0 0 0 0 0
ROUTINE SERVICES105.00 Skilled Nursing Care 778,115 23,827 10,268 31,305 206,365 10,276 44,260
110.00 Intermediate Care 0 0 0 0 0 0 0
115.00 Mentally Disordered 0 0 0 0 0 0 0
120.00 Developmentally Disabled 0 0 0 0 0 0 0
125.00 Subacute Care 0 0 0 0 0 0 0
126.00 Subacute Care - Pediatrics 0 0 0 0 0 0 0
130.00 Hospice Inpatient Care 0 0 0 0 0 0 0
135.00 Other Routine Services 0 0 0 0 0 0 0
NONREIMBURSABLE 136.00 Residential Care 0 0 0 0 0 0 0
140.00 Beauty and Barber 47,254 1,447 624 0 0 0 0
145.00 Other Nonreimbursable 0 0 0 0 0 0 0
TOTAL 1,344,289$ 100% 1,344,289$ 39,941$ 16,995$ 31,305$ 206,365$ 10,276$ 44,260$
* (To Schedule 1)
STATE OF CALIFORNIA
Provider Name:CORINTHIAN GARDENS HEALTHCARE CENTER
Provider Number: Provider NPI:ZZT18066K 1568677342
Net Exp ForLine DESCRIPTION Cost AllocNo. (From Sch 8) Ratio
GENERAL SERVICESCapital Related (excluding lines 40 & 45) 1,263,631$ 94%Property Tax (line 40) 80,658 6%
5.00 Plant Operations and Maintenance10.00 Housekeeping60.00 Laundry and Linen65.00 Dietary
155.00 Social Services160.00 Activities165.00 Administration165.00 Medical Records170.00 Inservice Education - Nursing
ANCILLARY SERVICES75.00 Patient Supplies77.00 Specialized Support Surfaces80.00 Physical Therapy81.00 Respiratory Therapy82.00 Occupational Therapy83.00 Speech Pathology85.00 Pharmacy90.00 Laboratory95.00 Home Health Services
100.00 Other Ancillary Services100.06 Subacute Ancillary Services100.12 Subacute Pediatrics Ancillary Services
ROUTINE SERVICES105.00 Skilled Nursing Care110.00 Intermediate Care115.00 Mentally Disordered120.00 Developmentally Disabled125.00 Subacute Care126.00 Subacute Care - Pediatrics130.00 Hospice Inpatient Care135.00 Other Routine Services
NONREIMBURSABLE 136.00 Residential Care140.00 Beauty and Barber145.00 Other Nonreimbursable
TOTAL 1,344,289$ 100%
* (To Schedule 1)
SCHEDULE 5
ALLOCATION OF CAPITAL COSTS
Fiscal Period:JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
OSHPD Facility Number:206150698
In-serv. Ed Admin Medical Capital PropertyRecords Related Tax
Accumulated 94% 6%170 Costs 165 165 Total Of Total Of Total
77,584$ 77,584$ 7,230 7,230$
16,295$
0 10,460 437 41 10,938$ 10,282$ 656$ 0 0 114 11 125 117 70 42,939 5,975 557 49,471 46,503 2,9680 0 0 0 0 0 00 19,414 1,609 150 21,173 19,903 1,2700 9,726 334 31 10,091 9,486 6050 5,982 1,236 115 7,334 6,894 4400 0 34 3 37 35 20 0 0 0 0 0 00 918 160 15 1,093 1,027 660 0 0 0 0 0 00 0 0 0 0 0 0
16,295 1,120,712 66,695 6,215 1,193,622 1,122,004 71,618 *0 0 0 0 0 0 0 *0 0 0 0 0 0 0 *0 0 0 0 0 0 0 *0 0 0 0 0 0 0 *0 0 0 0 0 0 0 *0 0 0 0 0 0 0 *0 0 0 0 0 0 0 *
0 0 0 0 0 0 00 49,325 988 92 50,405 47,381 3,0240 0 0 0 0 0 0
16,295$ 1,259,475$ 77,584$ 7,230$ 1,344,289$ 1,263,631$ 80,658$
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1234
10
ST
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STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period:CORINTHIAN GARDENS HEALTHCARE CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
Provider Number: Provider NPI: OSHPD Facility Number:ZZT18066K 1568677342 206150698
Line Natural ACCOUNT TITLE AccountNo. Class Number
5.00 Plant Operations and Maintenance 6200 $ 379,074 $ (379,074) $ 0 $ 0 $ 05.01 .01-.19 Salaries and Wages 6200 63,578 63,578 0 63,578 (Sch 3)5.02 .20-.39 Fringe Benefits 6200 9,176 9,176 0 9,176 (Sch 3)5.03 .79 Agency Staff 6200 0 0 0 0 (Sch 3)5.04 .40-.99 Other - Nonlabor 6200 306,320 306,320 (14,554) 291,766 (Sch 4)5.05 Plant Operations and Maintenance - Total 6200 $ 379,074 $ 0 $ 379,074 $ (14,554) $ 364,520
10.00 Housekeeping 6300 $ 229,587 $ (229,587) $ 0 $ 0 $ 010.01 .01-.19 Salaries and Wages 6300 170,865 170,865 0 170,865 (Sch 3)10.02 .20-.39 Fringe Benefits 6300 21,827 21,827 0 21,827 (Sch 3)10.03 .79 Agency Staff 6300 0 0 0 0 (Sch 3)10.04 .40-.99 Other - Nonlabor 6300 36,895 36,895 0 36,895 (Sch 4)10.05 Housekeeping - Total 6300 $ 229,587 $ 0 $ 229,587 $ 0 $ 229,587
15.00 Depreciation: Bldgs and Improvements 7110 - 7120 $ $ 0 $ 0 $ 0 (Sch 5)20.00 Depreciation: Leasehold Improvements 7130 0 0 0 (Sch 5)25.00 Depreciation: Equipment 7140 0 0 0 (Sch 5)30.00 Depreciation and Amortization - Other 7150 - 7160 0 0 0 (Sch 5)35.00 Leases and Rentals 7200 1,145,131 1,145,131 0 1,145,131 (Sch 5)40.00 Property Taxes 7300 80,658 80,658 0 80,658 (Sch 5)45.00 Property Insurance 7400 18,216 18,216 0 18,216 (Sch 6)50.00 Interest-Property, Plant, and Equipment 7500 118,500 118,500 0 118,500 (Sch 5)55.00 Interest-Other 7600 471,935 471,935 0 471,935 (Sch 6)
57.00 Subtotal 005 - 055 $ 2,443,101 $ 0 $ 2,443,101 $ (14,554) $ 2,428,547
60.00 Laundry and Linen 6400 $ 104,806 $ (104,806) $ 0 $ 0 $ 060.01 .01-.19 Salaries and Wages 6400 80,819 80,819 0 80,819 (Sch 3)60.02 .20-.39 Fringe Benefits 6400 8,303 8,303 0 8,303 (Sch 3)60.03 .79 Agency Staff 6400 0 0 0 0 (Sch 3)60.04 .40-.99 Other - Nonlabor 6400 15,684 15,684 0 15,684 (Sch 4)60.05 Laundry and Linen - Total 6400 $ 104,806 $ 0 $ 104,806 $ 0 $ 104,806
65.00 Dietary 6500 $ 596,221 $ (596,221) $ 0 $ 0 $ 065.01 .01-.19 Salaries and Wages 6500 287,832 287,832 0 287,832 (Sch 3)65.02 .20-.39 Fringe Benefits 6500 41,383 41,383 0 41,383 (Sch 3)65.03 .79 Agency Staff 6500 0 0 0 0 (Sch 3)65.04 .40-.99 Other - Nonlabor 6500 267,006 267,006 0 267,006 (Sch 4)65.05 Dietary - Total 6500 $ 596,221 $ 0 $ 596,221 $ 0 $ 596,221
70.00 Provision for Bad Debts 7700 $ $ 0 $ 0 $ 0
Ancillary Services (Note 1)75.00 Patient Supplies 8100 $ 17,953 $ 0 $ 17,953 $ 0 $ 17,953 (Sch 2)75.01 .01-.19 Salaries and Wages 8100 0 0 0 0 (Sch 2)75.02 .20-.39 Fringe Benefits 8100 0 0 0 0 (Sch 2)75.03 .79 Agency Staff 8100 0 0 0 0 (Sch 2)75.04 .40-.99 Other - Nonlabor 8100 0 0 0 0 (Sch 4)75.05 Patient Supplies - Total 8100 $ 17,953 $ 0 $ 17,953 $ 0 $ 17,953
77.00 Specialized Support Surfaces 8150 8,631 $ 8,631 $ 0 $ 8,631 (Sch 4)
80.00 Physical Therapy 8200 $ 389,279 $ 0 $ 389,279 $ 0 $ 389,279 (Sch 2)80.01 .01-.19 Salaries and Wages 8200 0 0 0 0 (Sch 2)80.02 .20-.39 Fringe Benefits 8200 0 0 0 0 (Sch 2)80.03 .79 Agency Staff 8200 0 0 0 0 (Sch 2)80.04 .40-.99 Other - Nonlabor 8200 0 0 0 0 (Sch 4)80.05 Physical Therapy - Total 8200 $ 389,279 $ 0 $ 389,279 $ 0 $ 389,279
81.00 Respiratory Therapy 8220 $ $ 0 $ 0 $ 0 $ 0 (Sch 2)81.01 .01-.19 Salaries and Wages 8220 0 0 0 0 (Sch 2)81.02 .20-.39 Fringe Benefits 8220 0 0 0 0 (Sch 2)81.03 .79 Agency Staff 8220 0 0 0 0 (Sch 2)81.04 .40-.99 Other - Nonlabor 8220 0 0 0 0 (Sch 4)81.05 Respiratory Therapy - Total 8220 $ 0 $ 0 $ 0 $ 0 $ 0
SUMMARY OF AUDITED PROGRAM EXPENSES
AUDIT ADJUSTMENTSREPORTED AUDITED(SCHEDULE 8A-1)
AS ASSUBTOTAL (SCHEDULE 8A-2)
STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period:CORINTHIAN GARDENS HEALTHCARE CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
Provider Number: Provider NPI: OSHPD Facility Number:ZZT18066K 1568677342 206150698
Line Natural ACCOUNT TITLE AccountNo. Class Number
SUMMARY OF AUDITED PROGRAM EXPENSES
AUDIT ADJUSTMENTSREPORTED AUDITED(SCHEDULE 8A-1)
AS ASSUBTOTAL (SCHEDULE 8A-2)
82.00 Occupational Therapy 8250 $ 93,507 $ 0 $ 93,507 $ 0 $ 93,507 (Sch 2)82.01 .01-.19 Salaries and Wages 8250 0 0 0 0 (Sch 2)82.02 .20-.39 Fringe Benefits 8250 0 0 0 0 (Sch 2)82.03 .79 Agency Staff 8250 0 0 0 0 (Sch 2)82.04 .40-.99 Other - Nonlabor 8250 0 0 0 0 (Sch 4)82.05 Occupational Therapy - Total 8250 $ 93,507 $ 0 $ 93,507 $ 0 $ 93,507
83.00 Speech Pathology 8280 $ 11,227 $ 0 $ 11,227 $ 0 $ 11,227 (Sch 2)83.01 .01-.19 Salaries and Wages 8280 0 0 0 0 (Sch 2)83.02 .20-.39 Fringe Benefits 8280 0 0 0 0 (Sch 2)83.03 .79 Agency Staff 8280 0 0 0 0 (Sch 2)83.04 .40-.99 Other - Nonlabor 8280 0 0 0 0 (Sch 4)83.05 Speech Pathology - Total 8280 $ 11,227 $ 0 $ 11,227 $ 0 $ 11,227
85.00 Pharmacy 8300 $ 84,741 $ 0 $ 84,741 $ 0 $ 84,741 (Sch 2)85.01 .01-.19 Salaries and Wages 8300 0 0 0 0 (Sch 2)85.02 .20-.39 Fringe Benefits 8300 0 0 0 0 (Sch 2)85.03 .79 Agency Staff 8300 0 0 0 0 (Sch 2)85.04 .40-.99 Other - Nonlabor 8300 0 0 0 0 (Sch 4)85.05 Pharmacy - Total 8300 $ 84,741 $ 0 $ 84,741 $ 0 $ 84,741
90.00 Laboratory 8400 $ 2,574 $ 0 $ 2,574 $ 0 $ 2,574 (Sch 2)90.01 .01-.19 Salaries and Wages 8400 0 0 0 0 (Sch 2)90.02 .20-.39 Fringe Benefits 8400 0 0 0 0 (Sch 2)90.03 .79 Agency Staff 8400 0 0 0 0 (Sch 2)90.04 .40-.99 Other - Nonlabor 8400 0 0 0 0 (Sch 4)90.05 Laboratory - Total 8400 $ 2,574 $ 0 $ 2,574 $ 0 $ 2,574
95.00 Home Health Services 8800 $ $ 0 $ 0 $ 0 $ 0 (Sch 2)95.01 .01-.19 Salaries and Wages 8800 0 0 0 0 (Sch 2)95.02 .20-.39 Fringe Benefits 8800 0 0 0 0 (Sch 2)95.03 .79 Agency Staff 8800 0 0 0 0 (Sch 2)95.04 .40-.99 Other - Nonlabor 8800 0 0 0 0 (Sch 4)95.05 Home Health Services - Total 8800 $ 0 $ 0 $ 0 $ 0 $ 0
100.00 Other Ancillary Services 8900 $ 10,770 $ 0 $ 10,770 $ 0 $ 10,770 (Sch 2)100.01 .01-.19 Salaries and Wages 8900 0 0 0 0 (Sch 2)100.02 .20-.39 Fringe Benefits 8900 0 0 0 0 (Sch 2)100.03 .79 Agency Staff 8900 0 0 0 0 (Sch 2)100.04 .40-.99 Other - Nonlabor 8900 0 0 0 0 (Sch 4)100.05 Other Ancillary Services - Total 8900 $ 10,770 $ 0 $ 10,770 $ 0 $ 10,770
100.06 Subacute Ancillary Services $ $ 0 $ 0 $ 0 $ 0 (Sch 2)100.07 .01-.19 Salaries and Wages 0 0 0 0 (Sch 2)100.08 .20-.39 Fringe Benefits 0 0 0 0 (Sch 2)100.09 .79 Agency Staff 0 0 0 0 (Sch 2)100.10 .40-.99 Other - Nonlabor 0 0 0 0 (Sch 4)100.11 Subacute Ancillary Services - Total $ 0 $ 0 $ 0 $ 0 $ 0
100.12 Subacute Pediatrics Ancillary Services $ $ 0 $ 0 $ 0 (Sch 2)
101.00 Subtotal 075 - 100.12 $ 618,682 $ 0 $ 618,682 $ 0 $ 618,682
Routine Services105.00 Skilled Nursing Care 6110 $ 2,533,910 $ (2,533,910) $ 0 $ 0 $ 0105.01 .01-.19 Salaries and Wages 6110 1,630,840 1,630,840 0 1,630,840 (Sch 2)105.02 .20-.39 Fringe Benefits 6110 226,082 226,082 0 226,082 (Sch 2)105.03 .49 Agency Staff 6110 0 0 0 0 (Sch 2)105.04 .40-.99 Other - Nonlabor 6110 676,988 676,988 (47,373) 629,615 (Sch 4)105.05 Skilled Nursing Care - Total 6110 $ 2,533,910 $ 0 $ 2,533,910 $ (47,373) $ 2,486,537
110.00 Intermediate Care 6120 $ $ 0 $ 0 $ 0 (Sch 2)115.00 Mentally Disordered 6130 0 0 0 (Sch 2)120.00 Developmentally Disabled 6140 0 0 0 (Sch 2)
STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period:CORINTHIAN GARDENS HEALTHCARE CENTER JANUARY 1, 2008 THROUGH DECEMBER 31, 2008
Provider Number: Provider NPI: OSHPD Facility Number:ZZT18066K 1568677342 206150698
Line Natural ACCOUNT TITLE AccountNo. Class Number
SUMMARY OF AUDITED PROGRAM EXPENSES
AUDIT ADJUSTMENTSREPORTED AUDITED(SCHEDULE 8A-1)
AS ASSUBTOTAL (SCHEDULE 8A-2)
125.00 Subacute Care 6150 $ $ 0 $ 0 $ 0 $ 0125.01 .01-.19 Salaries and Wages 6150 0 0 0 0 (Sch 2)125.02 .20-.39 Fringe Benefits 6150 0 0 0 0 (Sch 2)125.03 .49 Agency Staff 6150 0 0 0 0 (Sch 2)125.04 .40-.99 Other - Nonlabor 6150 0 0 0 0 (Sch 4)125.05 Subacute Care - Total 6150 $ 0 $ 0 $ 0 $ 0 $ 0
126.00 Subacute Care - Pediatrics 6160 $ $ 0 $ 0 $ 0 (Sch 2)130.00 Hospice Inpatient Care 6180 0 0 0 (Sch 2)135.00 Other Routine Services 6190 0 0 0 (Sch 2)
Other Nonreimbursable136.00 Residential Care 9100 $ $ 0 $ 0 $ 0 (Sch 2)140.00 Beauty and Barber 8900 3,508 3,508 0 3,508 (Sch 2)145.00 Other Nonreimbursable 9100 0 0 0 (Sch 2)
146.00 Subtotal 105 - 145 $ 2,537,418 $ 0 $ 2,537,418 $ (47,373) $ 2,490,045
155.00 Social Services 6600 $ 67,470 $ (67,470) $ 0 $ 0 $ 0155.01 .01-.19 Salaries and Wages 6600 58,398 58,398 0 58,398 (Sch 2)155.02 .20-.39 Fringe Benefits 6600 8,601 8,601 0 8,601 (Sch 2)155.03 .79 Agency Staff 6600 0 0 0 0 (Sch 2)155.04 .40-.99 Other - Nonlabor 6600 471 471 0 471 (Sch 4)155.05 Social Services - Total 6600 $ 67,470 $ 0 $ 67,470 $ 0 $ 67,470
160.00 Activities 6700 $ 111,994 $ (111,994) $ 0 $ 0 $ 0160.01 .01-.19 Salaries and Wages 6700 83,453 83,453 0 83,453 (Sch 2)160.02 .20-.39 Fringe Benefits 6700 14,218 14,218 0 14,218 (Sch 2)160.03 .79 Agency Staff 6700 0 0 0 0 (Sch 2)160.04 .40-.99 Other - Nonlabor 6700 14,323 14,323 (749) 13,574 (Sch 4)160.05 Activities - Total 6700 $ 111,994 $ 0 $ 111,994 $ (749) $ 111,245
165.00 Administration 6900 $ 1,552,352 $ (1,552,352) $ 0 $ 0 $ 0165.01 .01-.19 Salaries and Wages 6900 456,594 456,594 (47,137) 409,457 (Sch 6)165.02 .20-.39 Fringe Benefits 6900 57,735 57,735 13,973 71,708 (Sch 6)165.03 .01-.19 Medical Records - Salaries and Wages 6900 0 0 47,137 47,137 (Sch 3)165.04 .20-.39 Medical Records - Fringe Benefits 6900 0 0 3,214 3,214 (Sch 3)165.05 .79 Medical Records - Agency Staff 6900 0 0 0 0 (Sch 3)165.06 .40-.99 Medical Records - Other - Nonlabor 6900 0 0 38,579 38,579 (Sch 4)165.07 Facility License Fees 6900 0 0 63,295 63,295 (Sch 6)165.08 Liability Insurance 6900 0 0 116,560 116,560 (Sch 6)165.09 Caregiver Training 6900 0 0 0 0 (Sch 6)165.10 Quality Assurance Fees 6900 0 0 194,213 194,213 (Sch 6)165.11 .40-.99 Other - Nonlabor 6900 1,038,023 1,038,023 (872,024) 165,999 (Sch 6)165.12 Administration - Total 6900 $ 1,552,352 $ 0 $ 1,552,352 $ (442,190) $ 1,110,162
170.00 Inservice Education - Nursing 6800 $ 53,893 $ (53,893) $ 0 $ 0 $ 0170.01 .01-.19 Salaries and Wages 6800 49,635 49,635 0 49,635 (Sch 3)170.02 .20-.39 Fringe Benefits 6800 4,258 4,258 0 4,258 (Sch 3)170.03 .79 Agency Staff 6800 0 0 0 0 (Sch 3)170.04 .40-.99 Other - Nonlabor 6800 0 0 0 0 (Sch 4)170.05 Inservice Education - Nursing - Total 6800 $ 53,893 $ 0 $ 53,893 $ 0 $ 53,893
171.00 Subtotal 155 - 170.05 $ 1,785,709 $ 0 $ 1,785,709 $ (442,939) $ 1,342,770
175.00 Total $ 8,085,937 $ 0 $ 8,085,937 $ (504,866) $ 7,581,071
NOTE 1: Ancillary service costs are reclassified only if the facility has an Adult Subacute unit.
ST
AT
E O
F C
ALI
FOR
NIA
Sch
edul
e 8A
-1
Pag
e 1
Pro
vide
r N
ame:
Pro
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r N
umbe
r:P
rovi
der
NP
I:O
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Fac
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Num
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CO
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EN
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ZZ
T18
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1568
6773
4220
6150
698
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1, 2
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(Pag
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67
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Pla
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and
Mai
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Mai
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63,5
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9,17
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21,8
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8,30
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287,
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287,
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65.0
2D
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41,3
83
65.0
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267,
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Sch
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Pag
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Pro
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Pro
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der
NP
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PD
Fac
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Num
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T18
066K
1568
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kille
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ursi
ng C
are
- S
alar
ies
and
Wag
es1,
630,
840
1,63
0,84
0
105.
02S
kille
d N
ursi
ng C
are
- F
ringe
Ben
efits
226,
082
226,
082
105.
03S
kille
d N
ursi
ng C
are
- A
genc
y S
taff
00
105.
04S
kille
d N
ursi
ng C
are
- O
ther
- N
onl
abo
r67
6,98
867
6,98
8
125.
00S
ubac
ute
Car
e0
125.
01S
ubac
ute
Car
e -
Sal
arie
s an
d W
ages
0
125.
02S
ubac
ute
Car
e -
Frin
ge B
enef
its0
125.
03S
ubac
ute
Car
e -
Age
ncy
Sta
ff0
125.
04S
ubac
ute
Car
e -
Oth
er -
No
nlab
or
0
155.
00S
oci
al S
ervi
ces
(67,
470)
(67,
470)
155.
01S
oci
al S
ervi
ces
- S
alar
ies
and
Wag
es58
,398
58,3
98
ST
AT
E O
F C
ALI
FOR
NIA
Sch
edul
e 8A
-1
Pag
e 1
Pro
vide
r N
ame:
Pro
vide
r N
umbe
r:P
rovi
der
NP
I:O
SH
PD
Fac
ility
Num
ber:
Fisc
al P
erio
d:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
TO
TA
L A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
J
(Pag
es 1
& 2
)1
23
45
67
89
RE
CO
NC
ILIA
TIO
N O
F T
HE
PR
OV
IDE
R'S
RE
CO
RD
S T
O T
HE
AU
DIT
RE
PO
RT
155.
02S
oci
al S
ervi
ces
- F
ringe
Ben
efits
8,60
18,
601
155.
03S
oci
al S
ervi
ces
- A
genc
y S
taff
00
155.
04S
oci
al S
ervi
ces
- O
ther
- N
onl
abo
r47
147
1
160.
00A
ctiv
ities
(111
,994
)(1
11,9
94)
160.
01A
ctiv
ities
- S
alar
ies
and
Wag
es83
,453
83,4
53
160.
02A
ctiv
ities
- F
ringe
Ben
efits
14,2
1814
,218
160.
03A
ctiv
ities
- A
genc
y S
taff
00
160.
04A
ctiv
ities
- O
ther
- N
onl
abo
r14
,323
14,3
23
165.
00A
dmin
istr
atio
n(1
,552
,352
)(1
,636
,421
)
165.
01A
dmin
istr
atio
n -
Sal
arie
s an
d W
ages
456,
594
456,
594
165.
02A
dmin
istr
atio
n -
Frin
ge B
enef
its57
,735
57,7
35
165.
03A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Sal
arie
s an
d W
ages
00
165.
04A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Frin
ge B
enef
its0
0
165.
05A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Age
ncy
Sta
ff0
0
165.
06A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Oth
er -
No
nlab
or
00
165.
07A
dmin
istr
atio
n -
Fac
ility
Lic
ense
Fee
s0
0
165.
08A
dmin
istr
atio
n -
Liab
ility
Insu
ranc
e0
0
165.
09A
dmin
istr
atio
n -
Car
egiv
er T
rain
ing
00
165.
10A
dmin
istr
atio
n -
Qua
lity
Ass
uran
ce F
ees
00
165.
11A
dmin
istr
atio
n -
Oth
er -
No
nlab
or
1,03
8,02
31,
122,
092
170.
00In
serv
ice
Edu
catio
n -
Nur
sing
(53,
893)
(53,
893)
170.
01In
serv
ice
Edu
catio
n -
Nur
sing
- S
alar
ies
and
Wag
es49
,635
49,6
35
170.
02In
serv
ice
Edu
catio
n -
Nur
sing
- F
ringe
Ben
efits
4,25
84,
258
170.
03In
serv
ice
Edu
catio
n -
Nur
sing
- A
genc
y S
taff
00
170.
04In
serv
ice
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catio
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sing
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ther
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onl
abo
r0
0
175.
00
To
tal
$00
00
00
00
00
(To
Sch
8)
ST
AT
E O
F C
ALI
FOR
NIA
Pro
vide
r N
ame:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
5.00
Pla
nt O
pera
tions
and
Mai
nten
ance
5.01
Pla
nt O
pera
tions
and
Mai
nten
ance
- S
alar
ies
and
Wag
es
5.02
Pla
nt O
pera
tions
and
Mai
nten
ance
- F
ringe
Ben
efits
5.03
Pla
nt O
pera
tions
and
Mai
nten
ance
- A
genc
y S
taff
5.04
Pla
nt O
pera
tions
and
Mai
nten
ance
- O
ther
- N
onl
abo
r
10.0
0H
ous
ekee
ping
10.0
1H
ous
ekee
ping
- S
alar
ies
and
Wag
es
10.0
2H
ous
ekee
ping
- F
ringe
Ben
efits
10.0
3H
ous
ekee
ping
- A
genc
y S
taff
10.0
4H
ous
ekee
ping
- O
ther
- N
onl
abo
r
60.0
0La
undr
y an
d Li
nen
60.0
1La
undr
y an
d Li
nen
- S
alar
ies
and
Wag
es
60.0
2La
undr
y an
d Li
nen
- F
ringe
Ben
efits
60.0
3La
undr
y an
d Li
nen
- A
genc
y S
taff
60.0
4La
undr
y an
d Li
nen
- O
ther
- N
onl
abo
r
65.0
0D
ieta
ry
65.0
1D
ieta
ry -
Sal
arie
s an
d W
ages
65.0
2D
ieta
ry -
Frin
ge B
enef
its
65.0
3D
ieta
ry -
Age
ncy
Sta
ff
65.0
4D
ieta
ry -
Oth
er -
No
nlab
or
75.0
0P
atie
nt S
uppl
ies
75.0
1P
atie
nt S
uppl
ies
- S
alar
ies
and
Wag
es
75.0
2P
atie
nt S
uppl
ies
- F
ringe
Ben
efits
75.0
3P
atie
nt S
uppl
ies
- A
genc
y S
taff
75.0
4P
atie
nt S
uppl
ies
- O
ther
- N
onl
abo
r
80.0
0P
hysi
cal T
hera
py
80.0
1P
hysi
cal T
hera
py -
Sal
arie
s an
d W
ages
80.0
2P
hysi
cal T
hera
py -
Frin
ge B
enef
its
80.0
3P
hysi
cal T
hera
py -
Age
ncy
Sta
ff
80.0
4P
hysi
cal T
hera
py -
Oth
er -
No
nlab
or
81.0
0R
espi
rato
ry T
hera
py
81.0
1R
espi
rato
ry T
hera
py -
Sal
arie
s an
d W
ages
81.0
2R
espi
rato
ry T
hera
py -
Frin
ge B
enef
its
81.0
3R
espi
rato
ry T
hera
py -
Age
ncy
Sta
ff
81.0
4R
espi
rato
ry T
hera
py -
Oth
er -
No
nlab
or
82.0
0O
ccup
atio
nal T
hera
py
82.0
1O
ccup
atio
nal T
hera
py -
Sal
arie
s an
d W
ages
82.0
2O
ccup
atio
nal T
hera
py -
Frin
ge B
enef
its
82.0
3O
ccup
atio
nal T
hera
py -
Age
ncy
Sta
ff
82.0
4O
ccup
atio
nal T
hera
py -
Oth
er -
No
nlab
or
83.0
0S
peec
h P
atho
logy
Sch
edul
e 8A
-1
Pag
e 2
Pro
vide
r N
umbe
r:P
rovi
der
NP
I:O
SH
PD
Fac
ility
Num
ber:
Fisc
al P
erio
d:
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
1011
365 0 0 0
(365
)
RE
CO
NC
ILIA
TIO
N O
F T
HE
PR
OV
IDE
R'S
AD
JUS
TM
EN
TS
TO
TH
E A
UD
IT R
EP
OR
T
ST
AT
E O
F C
ALI
FOR
NIA
Pro
vide
r N
ame:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
83.0
1S
peec
h P
atho
logy
- S
alar
ies
and
Wag
es
83.0
2S
peec
h P
atho
logy
- F
ringe
Ben
efits
83.0
3S
peec
h P
atho
logy
- A
genc
y S
taff
83.0
4S
peec
h P
atho
logy
- O
ther
- N
onl
abo
r
85.0
0P
harm
acy
85.0
1P
harm
acy
- S
alar
ies
and
Wag
es
85.0
2P
harm
acy
- F
ringe
Ben
efits
85.0
3P
harm
acy
- A
genc
y S
taff
85.0
4P
harm
acy
- O
ther
- N
onl
abo
r
90.0
0La
bora
tory
90.0
1La
bora
tory
- S
alar
ies
and
Wag
es
90.0
2La
bora
tory
- F
ringe
Ben
efits
90.0
3La
bora
tory
- A
genc
y S
taff
90.0
4La
bora
tory
- O
ther
- N
onl
abo
r
95.0
0H
om
e H
ealth
Ser
vice
s
95.0
1H
om
e H
ealth
Ser
vice
s -
Sal
arie
s an
d W
ages
95.0
2H
om
e H
ealth
Ser
vice
s -
Frin
ge B
enef
its
95.0
3H
om
e H
ealth
Ser
vice
s -
Age
ncy
Sta
ff
95.0
4H
om
e H
ealth
Ser
vice
s -
Oth
er -
No
nlab
or
100.
00O
ther
Anc
illar
y S
ervi
ces
100.
01O
ther
Anc
illar
y S
ervi
ces
- S
alar
ies
and
Wag
es
100.
02O
ther
Anc
illar
y S
ervi
ces
- F
ringe
Ben
efits
100.
03O
ther
Anc
illar
y S
ervi
ces
- A
genc
y S
taff
100.
04O
ther
Anc
illar
y S
ervi
ces
- O
ther
- N
onl
abo
r
100.
06S
ubac
ute
Anc
illar
y S
ervi
ces
100.
07S
ubac
ute
Anc
illar
y S
ervi
ces
- S
alar
ies
and
Wag
es
100.
08S
ubac
ute
Anc
illar
y S
ervi
ces
- F
ringe
Ben
efits
100.
09S
ubac
ute
Anc
illar
y S
ervi
ces
- A
genc
y S
taff
100.
10S
ubac
ute
Anc
illar
y S
ervi
ces
- O
ther
- N
onl
abo
r
105.
00S
kille
d N
ursi
ng C
are
105.
01S
kille
d N
ursi
ng C
are
- S
alar
ies
and
Wag
es
105.
02S
kille
d N
ursi
ng C
are
- F
ringe
Ben
efits
105.
03S
kille
d N
ursi
ng C
are
- A
genc
y S
taff
105.
04S
kille
d N
ursi
ng C
are
- O
ther
- N
onl
abo
r
125.
00S
ubac
ute
Car
e
125.
01S
ubac
ute
Car
e -
Sal
arie
s an
d W
ages
125.
02S
ubac
ute
Car
e -
Frin
ge B
enef
its
125.
03S
ubac
ute
Car
e -
Age
ncy
Sta
ff
125.
04S
ubac
ute
Car
e -
Oth
er -
No
nlab
or
155.
00S
oci
al S
ervi
ces
155.
01S
oci
al S
ervi
ces
- S
alar
ies
and
Wag
es
Sch
edul
e 8A
-1
Pag
e 2
Pro
vide
r N
umbe
r:P
rovi
der
NP
I:O
SH
PD
Fac
ility
Num
ber:
Fisc
al P
erio
d:
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
1011
RE
CO
NC
ILIA
TIO
N O
F T
HE
PR
OV
IDE
R'S
AD
JUS
TM
EN
TS
TO
TH
E A
UD
IT R
EP
OR
T
ST
AT
E O
F C
ALI
FOR
NIA
Pro
vide
r N
ame:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
155.
02S
oci
al S
ervi
ces
- F
ringe
Ben
efits
155.
03S
oci
al S
ervi
ces
- A
genc
y S
taff
155.
04S
oci
al S
ervi
ces
- O
ther
- N
onl
abo
r
160.
00A
ctiv
ities
160.
01A
ctiv
ities
- S
alar
ies
and
Wag
es
160.
02A
ctiv
ities
- F
ringe
Ben
efits
160.
03A
ctiv
ities
- A
genc
y S
taff
160.
04A
ctiv
ities
- O
ther
- N
onl
abo
r
165.
00A
dmin
istr
atio
n
165.
01A
dmin
istr
atio
n -
Sal
arie
s an
d W
ages
165.
02A
dmin
istr
atio
n -
Frin
ge B
enef
its
165.
03A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Sal
arie
s an
d W
ages
165.
04A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Frin
ge B
enef
its
165.
05A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Age
ncy
Sta
ff
165.
06A
dmin
istr
atio
n -
Med
ical
Rec
ord
s -
Oth
er -
No
nlab
or
165.
07A
dmin
istr
atio
n -
Fac
ility
Lic
ense
Fee
s
165.
08A
dmin
istr
atio
n -
Liab
ility
Insu
ranc
e
165.
09A
dmin
istr
atio
n -
Car
egiv
er T
rain
ing
165.
10A
dmin
istr
atio
n -
Qua
lity
Ass
uran
ce F
ees
165.
11A
dmin
istr
atio
n -
Oth
er -
No
nlab
or
170.
00In
serv
ice
Edu
catio
n -
Nur
sing
170.
01In
serv
ice
Edu
catio
n -
Nur
sing
- S
alar
ies
and
Wag
es
170.
02In
serv
ice
Edu
catio
n -
Nur
sing
- F
ringe
Ben
efits
170.
03In
serv
ice
Edu
catio
n -
Nur
sing
- A
genc
y S
taff
170.
04In
serv
ice
Edu
catio
n -
Nur
sing
- O
ther
- N
onl
abo
r
175.
00
To
tal
Sch
edul
e 8A
-1
Pag
e 2
Pro
vide
r N
umbe
r:P
rovi
der
NP
I:O
SH
PD
Fac
ility
Num
ber:
Fisc
al P
erio
d:
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
1011
RE
CO
NC
ILIA
TIO
N O
F T
HE
PR
OV
IDE
R'S
AD
JUS
TM
EN
TS
TO
TH
E A
UD
IT R
EP
OR
T
84,0
69
(84,
069)
00
00
00
00
00
00
ST
AT
E O
F C
AL
IFO
RN
IAS
ched
ule
8A
-2
Pag
e 1
Pro
vid
er N
ame:
Pro
vid
er N
um
ber
:P
rovi
der
NP
I:O
SH
PD
Fac
ilit
y N
um
ber
:F
isca
l Per
iod
:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
TO
TA
L A
DJ
AU
DIT
AD
JA
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IT A
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AU
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AD
JA
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IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
J
(Pag
es 1
& 2
)12
1314
1516
1718
1920
5.00
Pla
nt O
pera
tions
and
Mai
nten
ance
0
5.01
Pla
nt O
pera
tions
and
Mai
nten
ance
- S
alar
ies
and
Wag
es0
5.02
Pla
nt O
pera
tions
and
Mai
nten
ance
- F
ringe
Ben
efits
0
5.03
Pla
nt O
pera
tions
and
Mai
nten
ance
- A
genc
y S
taff
0
5.04
Pla
nt O
pera
tions
and
Mai
nten
ance
- O
ther
- N
onla
bor
(14,
554)
(13,
520)
(1,0
34)
10.0
0H
ouse
keep
ing
0
10.0
1H
ouse
keep
ing
- S
alar
ies
and
Wag
es0
10.0
2H
ouse
keep
ing
- F
ringe
Ben
efits
0
10.0
3H
ouse
keep
ing
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genc
y S
taff
0
10.0
4H
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keep
ing
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ther
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onla
bor
0
15.0
0D
epre
ciat
ion:
Bld
gs a
nd Im
prov
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ts0
20.0
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epre
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seho
ld Im
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25.0
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epre
ciat
ion:
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ipm
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0
30.0
0D
epre
ciat
ion
and
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ortiz
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n -
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er0
35.0
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ases
and
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tals
0
40.0
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rty
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es0
45.0
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ranc
e0
50.0
0In
tere
st-P
rope
rty,
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nt, a
nd E
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men
t0
55.0
0In
tere
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0
60.0
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undr
y an
d Li
nen
0
60.0
1La
undr
y an
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nen
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alar
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es0
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nen
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ringe
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efits
0
60.0
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undr
y an
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nen
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genc
y S
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0
60.0
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y an
d Li
nen
- O
ther
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onla
bor
0
65.0
0D
ieta
ry0
65.0
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ieta
ry -
Sal
arie
s an
d W
ages
0
65.0
2D
ieta
ry -
Frin
ge B
enef
its0
65.0
3D
ieta
ry -
Age
ncy
Sta
ff0
65.0
4D
ieta
ry -
Oth
er -
Non
labo
r0
70.0
0P
rovi
sion
for
Bad
Deb
ts0
75.0
0P
atie
nt S
uppl
ies
0
75.0
1P
atie
nt S
uppl
ies
- S
alar
ies
and
Wag
es0
75.0
2P
atie
nt S
uppl
ies
- F
ringe
Ben
efits
0
75.0
3P
atie
nt S
uppl
ies
- A
genc
y S
taff
0
75.0
4P
atie
nt S
uppl
ies
- O
ther
- N
onla
bor
0
77.0
0S
peci
aliz
ed S
uppo
rt S
urfa
ces
0
80.0
0P
hysi
cal T
hera
py0
80.0
1P
hysi
cal T
hera
py -
Sal
arie
s an
d W
ages
0
80.0
2P
hysi
cal T
hera
py -
Frin
ge B
enef
its0
80.0
3P
hysi
cal T
hera
py -
Age
ncy
Sta
ff0
80.0
4P
hysi
cal T
hera
py -
Oth
er -
Non
labo
r0
81.0
0R
espi
rato
ry T
hera
py0
81.0
1R
espi
rato
ry T
hera
py -
Sal
arie
s an
d W
ages
0
81.0
2R
espi
rato
ry T
hera
py -
Frin
ge B
enef
its0
81.0
3R
espi
rato
ry T
hera
py -
Age
ncy
Sta
ff0
81.0
4R
espi
rato
ry T
hera
py -
Oth
er -
Non
labo
r0
82.0
0O
ccup
atio
nal T
hera
py0
82.0
1O
ccup
atio
nal T
hera
py -
Sal
arie
s an
d W
ages
0
AD
JUS
TM
EN
TS
TO
RE
PO
RT
ED
CO
ST
S
ST
AT
E O
F C
AL
IFO
RN
IAS
ched
ule
8A
-2
Pag
e 1
Pro
vid
er N
ame:
Pro
vid
er N
um
ber
:P
rovi
der
NP
I:O
SH
PD
Fac
ilit
y N
um
ber
:F
isca
l Per
iod
:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
TO
TA
L A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
J
(Pag
es 1
& 2
)12
1314
1516
1718
1920
AD
JUS
TM
EN
TS
TO
RE
PO
RT
ED
CO
ST
S
82.0
2O
ccup
atio
nal T
hera
py -
Frin
ge B
enef
its0
82.0
3O
ccup
atio
nal T
hera
py -
Age
ncy
Sta
ff0
82.0
4O
ccup
atio
nal T
hera
py -
Oth
er -
Non
labo
r0
83.0
0S
peec
h P
atho
logy
0
83.0
1S
peec
h P
atho
logy
- S
alar
ies
and
Wag
es0
83.0
2S
peec
h P
atho
logy
- F
ringe
Ben
efits
0
83.0
3S
peec
h P
atho
logy
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genc
y S
taff
0
83.0
4S
peec
h P
atho
logy
- O
ther
- N
onla
bor
0
85.0
0P
harm
acy
0
85.0
1P
harm
acy
- S
alar
ies
and
Wag
es0
85.0
2P
harm
acy
- F
ringe
Ben
efits
0
85.0
3P
harm
acy
- A
genc
y S
taff
0
85.0
4P
harm
acy
- O
ther
- N
onla
bor
0
90.0
0La
bora
tory
0
90.0
1La
bora
tory
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alar
ies
and
Wag
es0
90.0
2La
bora
tory
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ringe
Ben
efits
0
90.0
3La
bora
tory
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genc
y S
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0
90.0
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0
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ome
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lth S
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0
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0
95.0
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ome
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0
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onla
bor
0
100.
00O
ther
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illary
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vice
s0
100.
01O
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vice
s -
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arie
s an
d W
ages
0
100.
02O
ther
Anc
illary
Ser
vice
s -
Frin
ge B
enef
its0
100.
03O
ther
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illary
Ser
vice
s -
Age
ncy
Sta
ff0
100.
04O
ther
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illary
Ser
vice
s -
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er -
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labo
r0
100.
06S
ubac
ute
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illary
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vice
s0
100.
07S
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ute
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illary
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vice
s -
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arie
s an
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0
100.
08S
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illary
Ser
vice
s -
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ge B
enef
its0
100.
09S
ubac
ute
Anc
illary
Ser
vice
s -
Age
ncy
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ff0
100.
10S
ubac
ute
Anc
illary
Ser
vice
s -
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er -
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labo
r0
100.
12S
ubac
ute
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iatr
ics
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illary
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vice
s0
105.
00S
kille
d N
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are
0
105.
01S
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are
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105.
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0
105.
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d N
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0
125.
02S
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125.
03S
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ncy
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ff0
125.
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Car
e -
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er -
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labo
r0
126.
00S
ubac
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e -
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iatr
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0
ST
AT
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F C
AL
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RN
IAS
ched
ule
8A
-2
Pag
e 1
Pro
vid
er N
ame:
Pro
vid
er N
um
ber
:P
rovi
der
NP
I:O
SH
PD
Fac
ilit
y N
um
ber
:F
isca
l Per
iod
:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
TO
TA
L A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
J
(Pag
es 1
& 2
)12
1314
1516
1718
1920
AD
JUS
TM
EN
TS
TO
RE
PO
RT
ED
CO
ST
S
130.
00H
ospi
ce In
patie
nt C
are
0
135.
00O
ther
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tine
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vice
s0
136.
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esid
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e0
140.
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r0
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ther
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able
0
155.
00S
ocia
l Ser
vice
s0
155.
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ocia
l Ser
vice
s -
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arie
s an
d W
ages
0
155.
02S
ocia
l Ser
vice
s -
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ge B
enef
its0
155.
03S
ocia
l Ser
vice
s -
Age
ncy
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ff0
155.
04S
ocia
l Ser
vice
s -
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er -
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labo
r0
160.
00A
ctiv
ities
0
160.
01A
ctiv
ities
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alar
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and
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es0
160.
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ctiv
ities
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ringe
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efits
0
160.
03A
ctiv
ities
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genc
y S
taff
0
160.
04A
ctiv
ities
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ther
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onla
bor
(749
)
165.
00
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dmin
istr
atio
n0
165.
01
A
dmin
istr
atio
n -
Sal
arie
s an
d W
ages
(47,
137)
(47,
137)
165.
02
A
dmin
istr
atio
n -
Frin
ge B
enef
its13
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13,9
73
165.
03
A
dmin
istr
atio
n -
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ical
Rec
ords
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alar
ies
and
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es47
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47,1
37
165.
04
A
dmin
istr
atio
n -
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ords
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ringe
Ben
efits
3,21
43,
214
165.
05
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dmin
istr
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ords
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genc
y S
taff
00
165.
06
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dmin
istr
atio
n -
Med
ical
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ords
- O
ther
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onla
bor
38,5
7938
,579
165.
07
A
dmin
istr
atio
n -
Fac
ility
Lic
ense
Fee
s63
,295
66,8
62
165.
08
A
dmin
istr
atio
n -
Liab
ility
Insu
ranc
e11
6,56
011
6,56
00
165.
09
A
dmin
istr
atio
n -
Car
egiv
er T
rain
ing
00
165.
10
A
dmin
istr
atio
n -
Qua
lity
Ass
uran
ce F
ees
194,
213
194,
213
165.
11
A
dmin
istr
atio
n -
Oth
er -
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labo
r(8
72,0
24)
(116
,560
)13
,520
1,03
4(3
16,8
39)
(600
)(4
,324
)(4
,655
)(3
1,60
0)(3
3,21
1)
170.
00
In
serv
ice
Edu
catio
n -
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sing
0
170.
01
In
serv
ice
Edu
catio
n -
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sing
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alar
ies
and
Wag
es0
170.
02
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serv
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catio
n -
Nur
sing
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ringe
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0
170.
03
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serv
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catio
n -
Nur
sing
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taff
0
170.
04
In
serv
ice
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catio
n -
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sing
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ther
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onla
bor
0
175.
00
Tot
al
($50
4,86
6)0
00
2(6
00)
(4,3
24)
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55)
(31,
600)
(33,
211)
(To
Sch
8)
ST
AT
E O
F C
AL
IFO
RN
IA
Pro
vid
er N
ame:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
5.00
Pla
nt O
pera
tions
and
Mai
nten
ance
5.01
Pla
nt O
pera
tions
and
Mai
nten
ance
- S
alar
ies
and
Wag
es
5.02
Pla
nt O
pera
tions
and
Mai
nten
ance
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ringe
Ben
efits
5.03
Pla
nt O
pera
tions
and
Mai
nten
ance
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genc
y S
taff
5.04
Pla
nt O
pera
tions
and
Mai
nten
ance
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ther
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onla
bor
10.0
0H
ouse
keep
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10.0
1H
ouse
keep
ing
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alar
ies
and
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10.0
2H
ouse
keep
ing
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ringe
Ben
efits
10.0
3H
ouse
keep
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genc
y S
taff
10.0
4H
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keep
ing
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ther
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onla
bor
15.0
0D
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ciat
ion:
Bld
gs a
nd Im
prov
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ts
20.0
0D
epre
ciat
ion:
Lea
seho
ld Im
prov
emen
ts
25.0
0D
epre
ciat
ion:
Equ
ipm
ent
30.0
0D
epre
ciat
ion
and
Am
ortiz
atio
n -
Oth
er
35.0
0Le
ases
and
Ren
tals
40.0
0P
rope
rty
Tax
es
45.0
0P
rope
rty
Insu
ranc
e
50.0
0In
tere
st-P
rope
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Pla
nt, a
nd E
quip
men
t
55.0
0In
tere
st-O
ther
60.0
0La
undr
y an
d Li
nen
60.0
1La
undr
y an
d Li
nen
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alar
ies
and
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60.0
2La
undr
y an
d Li
nen
- F
ringe
Ben
efits
60.0
3La
undr
y an
d Li
nen
- A
genc
y S
taff
60.0
4La
undr
y an
d Li
nen
- O
ther
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onla
bor
65.0
0D
ieta
ry
65.0
1D
ieta
ry -
Sal
arie
s an
d W
ages
65.0
2D
ieta
ry -
Frin
ge B
enef
its
65.0
3D
ieta
ry -
Age
ncy
Sta
ff
65.0
4D
ieta
ry -
Oth
er -
Non
labo
r
70.0
0P
rovi
sion
for
Bad
Deb
ts
75.0
0P
atie
nt S
uppl
ies
75.0
1P
atie
nt S
uppl
ies
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alar
ies
and
Wag
es
75.0
2P
atie
nt S
uppl
ies
- F
ringe
Ben
efits
75.0
3P
atie
nt S
uppl
ies
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genc
y S
taff
75.0
4P
atie
nt S
uppl
ies
- O
ther
- N
onla
bor
77.0
0S
peci
aliz
ed S
uppo
rt S
urfa
ces
80.0
0P
hysi
cal T
hera
py
80.0
1P
hysi
cal T
hera
py -
Sal
arie
s an
d W
ages
80.0
2P
hysi
cal T
hera
py -
Frin
ge B
enef
its
80.0
3P
hysi
cal T
hera
py -
Age
ncy
Sta
ff
80.0
4P
hysi
cal T
hera
py -
Oth
er -
Non
labo
r
81.0
0R
espi
rato
ry T
hera
py
81.0
1R
espi
rato
ry T
hera
py -
Sal
arie
s an
d W
ages
81.0
2R
espi
rato
ry T
hera
py -
Frin
ge B
enef
its
81.0
3R
espi
rato
ry T
hera
py -
Age
ncy
Sta
ff
81.0
4R
espi
rato
ry T
hera
py -
Oth
er -
Non
labo
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82.0
0O
ccup
atio
nal T
hera
py
82.0
1O
ccup
atio
nal T
hera
py -
Sal
arie
s an
d W
ages
Sch
edu
le 8
A-2
Pag
e 2
Pro
vid
er N
um
ber
:P
rovi
der
NP
I:O
SH
PD
Fac
ilit
y N
um
ber
:F
isca
l Per
iod
:
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
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BE
R 3
1, 2
008
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
AU
DIT
AD
JA
UD
IT A
DJ
2122
2324
2526
27
AD
JUS
TM
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TO
RE
PO
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CO
ST
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ST
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F C
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Pro
vid
er N
ame:
CO
RIN
TH
IAN
GA
RD
EN
S H
EA
LTH
CA
RE
CE
NT
ER
82.0
2O
ccup
atio
nal T
hera
py -
Frin
ge B
enef
its
82.0
3O
ccup
atio
nal T
hera
py -
Age
ncy
Sta
ff
82.0
4O
ccup
atio
nal T
hera
py -
Oth
er -
Non
labo
r
83.0
0S
peec
h P
atho
logy
83.0
1S
peec
h P
atho
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alar
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and
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83.0
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peec
h P
atho
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ringe
Ben
efits
83.0
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peec
h P
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genc
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taff
83.0
4S
peec
h P
atho
logy
- O
ther
- N
onla
bor
85.0
0P
harm
acy
85.0
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acy
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alar
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and
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85.0
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harm
acy
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ringe
Ben
efits
85.0
3P
harm
acy
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genc
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taff
85.0
4P
harm
acy
- O
ther
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onla
bor
90.0
0La
bora
tory
90.0
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bora
tory
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alar
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and
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90.0
2La
bora
tory
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ringe
Ben
efits
90.0
3La
bora
tory
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genc
y S
taff
90.0
4La
bora
tory
- O
ther
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onla
bor
95.0
0H
ome
Hea
lth S
ervi
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95.0
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ome
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and
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95.0
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95.0
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ome
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95.0
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onla
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100.
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ther
Anc
illary
Ser
vice
s
100.
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illary
Ser
vice
s -
Sal
arie
s an
d W
ages
100.
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ther
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illary
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vice
s -
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ge B
enef
its
100.
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ther
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illary
Ser
vice
s -
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ncy
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ff
100.
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vice
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100.
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vice
s
100.
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100.
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vice
s -
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its
100.
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illary
Ser
vice
s -
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ncy
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ff
100.
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vice
s -
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labo
r
100.
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Anc
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s
105.
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kille
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are
105.
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kille
d N
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are
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alar
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and
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105.
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kille
d N
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are
- F
ringe
Ben
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105.
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kille
d N
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are
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genc
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105.
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kille
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110.
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term
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115.
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120.
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125.
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125.
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Car
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s an
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ages
125.
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125.
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125.
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Oth
er -
Non
labo
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126.
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Ped
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ics
Sch
edu
le 8
A-2
Pag
e 2
Pro
vid
er N
um
ber
:P
rovi
der
NP
I:O
SH
PD
Fac
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y N
um
ber
:F
isca
l Per
iod
:
ZZ
T18
066K
1568
6773
4220
6150
698
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
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BE
R 3
1, 2
008
AU
DIT
AD
JA
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DJ
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AD
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DIT
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2122
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2526
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JUS
TM
EN
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TO
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PO
RT
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ST
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(1,8
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(170
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9)
ST
AT
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F C
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Pro
vid
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136.
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140.
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145.
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155.
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155.
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155.
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155.
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160.
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ctiv
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160.
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160.
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160.
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ctiv
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genc
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160.
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ctiv
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ther
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onla
bor
165.
00
A
dmin
istr
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n
165.
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165.
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dmin
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165.
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165.
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165.
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dmin
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165.
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dmin
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165.
09
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dmin
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n -
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165.
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dmin
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dmin
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labo
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170.
00
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serv
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n -
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sing
170.
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serv
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175.
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Tot
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Sch
edu
le 8
A-2
Pag
e 2
Pro
vid
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um
ber
:P
rovi
der
NP
I:O
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PD
Fac
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y N
um
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:F
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:
ZZ
T18
066K
1568
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tion
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Frin
ge B
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258
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ncile
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exp
ense
s w
ith p
rovi
der's
gen
eral
ledg
eran
d fo
r pr
oper
cos
t det
erm
inat
ion.
42 C
FR
413
.20
and
413.
24 /
CM
S P
ub. 1
5-1,
Sec
tions
230
0 an
d 23
04
*Bal
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car
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from
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ost d
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42 C
FR
413
.20
and
413.
24 /
CM
S P
ub. 1
5-1,
Sec
tions
230
0 an
d 23
04
11N
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-allo
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djus
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t for
pr
oper
cos
t det
erm
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ion.
42
CF
R 4
13.2
0 an
d 41
3.24
/ C
MS
Pub
. 15-
1, S
ectio
ns 2
300
and
2304
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ort R
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42
CF
R 4
13.2
0 an
d 41
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/ C
MS
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. 15-
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R 4
13.2
0 an
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MS
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. 15-
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42 C
FR
413
.20
and
413.
24 /
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S P
ub. 1
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tions
230
0 an
d 23
04
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42
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R 4
13.2
0 an
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42 C
FR
413
.20
and
413.
24 /
CM
S P
ub. 1
5-1,
Sec
tions
230
0 an
d 23
04
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42
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0 an
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MS
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1, S
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42 C
FR
413
.9(c
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MS
Pub
. 15-
1, S
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ns 2
102.
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42 C
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413
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230
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42 C
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413
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230
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413
.17
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413.
20 /
CM
S P
ub. 1
5-1,
Sec
tions
215
0 an
d 21
53
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42 C
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413
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413.
24 /
CM
S P
ub. 1
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Sec
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230
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d 23
04
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42 C
FR
413
.20
and
413.
24 /
CM
S P
ub. 1
5-1,
Sec
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230
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42
CF
R 4
13.2
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3.24
CM
S P
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42 C
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413
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413.
24 /
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230
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42 C
FR
413
.9 /
CM
S P
ub. 1
5-1,
Sec
tion
2104
.1C
CR
, Titl
e 22
, Sec
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511
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42 C
FR
413
.20
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413.
24 /
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S P
ub. 1
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Sec
tions
230
0 an
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04
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MS
Pub
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09
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