report on the home office audit prime … · report on the home office audit prime healthcare...
TRANSCRIPT
REPORT ON THE
HOME OFFICE AUDIT
PRIME HEALTHCARE SERVICES, INC. CHINO, CALIFORNIA
FISCAL PERIOD ENDED DECEMBER 31, 2008
Audits Section—Rancho Cucamonga Financial Audits Branch
Audits and Investigations Department of Health Care Services
Section Chief: Julio M. Cueto Audit Supervisor: Virat Shah Auditor: Manny Tria
State of California—Health and Human Services Agency
Department of Health Care Services
DAVID MAXWELL-JOLLY ARNOLD SCHWARZENEGGER Director Governor
9439 Archibald Avenue, Suite 107, MS 2105, Rancho Cucamonga, CA 91730
(909) 481-3420 / (909) 481-3442 fax Internet Address: www.dhcs.ca.gov
January 14, 2010 Lex Ready, President Prime Healthcare Management Services, Inc. 3300 E. Guasti Road, 3rd Floor Ontario, CA 91761 PRIME HEALTHCARE SERVICES, INC. FISCAL PERIOD ENDED DECEMBER 31, 2008 We have examined the Provider’s Medi-Cal Home Office Cost Report for the fiscal period ended December 31, 2008. 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 Summary of Audited Home Office Costs to Health Care Facilities represents a proper determination of home office allowable costs for the above fiscal period in accordance with Medi-Cal reimbursement principles. The audited home office cost will be incorporated, by separate adjustment, into each applicable facility audit report. This audit report includes the: 1. Summary of Audited Home Office Costs to Health Care Facilities and Supporting
Schedules 2. Audit Adjustments Schedule If you disagree with the decision of the Department, the results of the home office audit may only be appealed through each individual facility's audit report. Please refer to the appeal instructions in each facility’s audit report.
Lex Ready Page 2
If you have questions regarding this report, you may call the Audits Section—Rancho Cucamonga at (909) 481-3420. Original Signed By Julio M. Cueto, Chief Audits Section—Rancho Cucamonga Financial Audits Branch Certified cc: Michael Bogert Corporate Controller
1 - SUMMARY OF AUDITED HOME OFFICE COSTSTO HEALTH CARE FACILITIES
2 - COMPARISON OF REPORTED AND AUDITED HOME OFFICE COSTS
3 - SUMMARY ALLOCATION OF HOME OFFICE COSTSCAPITAL RELATED
3-1 - SUMMARY ALLOCATION OF HOME OFFICE COSTSNONCAPITAL RELATED
4 - POOLED ALLOCATION OF EXPENSES TO CHAIN COMPONENTS
5 - FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTSCAPITAL AND NONCAPITAL RELATED
6 - FUNCTIONAL ALLOCATION OF EXPENSES TO CHAIN COMPONENTS - STATISTICSCAPITAL AND 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
TABLE OF CONTENTS
SCHEDULES
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 1
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-
CA
LF
ISC
AL
CA
PIT
AL
NO
NC
AP
ITA
LT
OT
AL
AU
DIT
ED
NU
MB
ER
YE
AR
EN
DR
EL
AT
ED
RE
LA
TE
DH
.O. C
OS
T(S
ch. 3
)(S
ch. 3
-1)
(CO
LU
MN
1 +
2)
HE
AL
TH
CA
RE
FA
CIL
ITIE
S1
23
1.C
entin
ela
Hos
pita
l05
-073
912
/31/
08$6
8,85
7$2
,281
,597
$2,3
50,4
54
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
12/3
1/08
24,7
7782
0,99
784
5,77
4
3.D
eser
t Val
ley
Hos
pita
l05
-070
912
/31/
0827
,349
906,
210
933,
559
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
812
/31/
089,
651
319,
786
329,
437
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
12/3
1/08
11,6
7638
6,89
939
8,57
5
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
12/3
1/08
15,3
6850
9,21
952
4,58
7
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
12/3
1/08
11,5
9438
4,17
839
5,77
2
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
12/3
1/08
12,7
5742
2,71
043
5,46
7
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
412
/31/
0835
,074
1,16
2,18
71,
197,
261
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
812
/31/
087,
381
244,
571
251,
952
11.
She
rman
Oak
s H
ospi
tal
05-0
114
12/3
1/08
26,3
0387
1,57
289
7,87
5
12.
Wes
t Ana
heim
Med
ical
Cen
ter
05-0
426
12/3
1/08
25,3
2083
8,98
186
4,30
1
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
12/3
1/08
4,89
916
2,34
516
7,24
4
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
$2
81,0
06$9
,311
,252
$9,5
92,2
58
SU
MM
AR
Y O
F A
UD
ITE
D H
OM
E O
FF
ICE
CO
ST
ST
O H
EA
LT
H C
AR
E F
AC
ILIT
IES
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 2
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
ME
DI-C
AL
FIS
CA
LR
EP
OR
TE
DA
UD
ITE
DV
AR
IAN
CE
NU
MB
ER
YE
AR
EN
DS
UM
MA
RY
OF
H.O
. CO
ST
AL
LO
C. C
OS
T(S
ch. 3
& 3
-1)
(CO
LU
MN
1 -
2)H
EA
LT
H C
AR
E F
AC
ILIT
IES
12
3
1.05
-073
912
/31/
08$3
,160
,000
$2,3
50,4
54($
809,
546)
2.05
-058
612
/31/
081,
137,
076
845,
774
(291
,302
)
3.05
-070
912
/31/
081,
255,
097
933,
559
(321
,538
)
4.05
-015
812
/31/
0844
2,90
232
9,43
7(1
13,4
65)
5.05
-023
012
/31/
0853
5,85
339
8,57
5(1
37,2
78)
6.05
-052
612
/31/
0870
5,26
652
4,58
7(1
80,6
79)
7.05
-058
012
/31/
0853
2,08
639
5,77
2(1
36,3
14)
8.05
-075
812
/31/
0858
5,45
143
5,46
7(1
49,9
84)
9.05
-002
412
/31/
081,
609,
624
1,19
7,26
1(4
12,3
63)
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
812
/31/
0833
8,73
0
25
1,95
2(8
6,77
8)
11.
05-0
114
12/3
1/08
1,20
7,12
4
897,
875
(309
,249
)
12.
05-0
426
12/3
1/08
1,16
1,98
4
864,
301
(297
,683
)
13.
05-0
733
12/3
1/08
224,
848
167,
244
(57,
604)
12,8
96,0
419,
592,
258
(3,3
03,7
83)
25
.
034
7,58
834
7,58
826
.
025
,304
25,3
0427
.P
arad
ise
Val
ley
Med
ical
Gro
up
035
,480
35,4
8028
.P
rime
Hea
lthca
re S
ervi
ces,
LLC
(PH
S)
0
21,5
2621
,526
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC
03,
520
3,52
030
.B
io-M
ed S
ervi
ces,
Inc.
0
42,7
9642
,796
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
0
23,7
5723
,757
32.
00
33.
00
34.
00
35.
00
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$499
,971
$499
,971
G
RA
ND
TO
TA
L$1
2,89
6,04
1$1
0,09
2,22
9($
2,80
3,81
2)
Hun
tingt
on B
each
Hos
pita
l
Chi
no V
alle
y M
edic
al C
ente
r
Des
ert V
alle
y H
ospi
tal
Enc
ino
Hos
pita
l Med
ical
Cen
ter
Gar
den
Gro
ve H
ospi
tal M
edic
al C
ente
r
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.
CO
MP
AR
ISO
N O
F R
EP
OR
TE
D A
ND
AU
DIT
ED
HO
ME
OF
FIC
E C
OS
TS
Dec
emb
er 3
1, 2
008
Cen
tinel
a H
ospi
tal
La P
alm
a In
terc
omm
unity
Hos
pita
l
Mon
tcla
ir H
ospi
tal M
edic
al C
ente
r
OT
HE
R C
OM
PO
NE
NT
SD
eser
t Val
ley
Med
ical
Gro
upS
herm
an O
aks
Med
ical
Gro
up
She
rman
Oak
s H
ospi
tal
Par
adis
e V
alle
y H
ospi
tal
Wes
t Ana
heim
Med
ical
Cen
ter
Sha
sta
Reg
iona
l Med
ical
Cen
ter
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 3
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-
CA
LF
ISC
AL
DIR
EC
TF
UN
CT
ION
AL
PO
OL
ED
TO
TA
LN
UM
BE
RY
EA
R E
ND
CA
PIT
AL
CA
PIT
AL
CA
PIT
AL
CA
PIT
AL
(Sch
. 7)
(Sch
. 5)
(Sch
. 4)
RE
LA
TE
DH
EA
LT
H C
AR
E F
AC
ILIT
IES
12
34
5
1.C
entin
ela
Hos
pita
l05
-073
912
/31/
08$0
$0$6
8,85
7$6
8,85
7
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
12/3
1/08
00
24,7
7724
,777
3.
Des
ert V
alle
y H
ospi
tal
05-0
709
12/3
1/08
00
27,3
4927
,349
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
812
/31/
080
09,
651
9,65
1
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
12/3
1/08
00
11,6
7611
,676
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
12/3
1/08
00
15,3
6815
,368
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
12/3
1/08
00
11,5
9411
,594
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
12/3
1/08
00
12,7
5712
,757
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
412
/31/
080
035
,074
35,0
74
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
812
/31/
080
07,
381
7,38
1
11.
She
rman
Oak
s H
ospi
tal
05-0
114
12/3
1/08
00
26,3
0326
,303
12.
Wes
t Ana
heim
Med
ical
Cen
ter
05-0
426
12/3
1/08
00
25,3
2025
,320
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
12/3
1/08
00
4,89
94,
899
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
$0
$0$2
81,0
06$2
81,0
06
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t Val
ley
Med
ical
Gro
up
00
10,1
8310
,183
26.
She
rman
Oak
s M
edic
al G
roup
0
074
174
127
.P
arad
ise
Val
ley
Med
ical
Gro
up
00
1,03
91,
039
28.
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)
00
631
631
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC
00
103
103
30.
Bio
-Med
Ser
vice
s, In
c.
00
1,25
41,
254
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
0
069
669
632
.
00
00
33.
0
00
034
.
00
00
35.
0
00
0
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$1
4,64
7$1
4,64
7
G
RA
ND
TO
TA
L$0
$0$2
95,6
53$2
95,6
53(T
o S
ch. 1
& 2
)
SU
MM
AR
Y A
LL
OC
AT
ION
OF
HO
ME
OF
FIC
E C
OS
TS
CA
PIT
AL
RE
LA
TE
D
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 3
-1
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-
CA
LF
ISC
AL
DIR
EC
TF
UN
CT
ION
AL
PO
OL
ED
TO
TA
LN
UM
BE
RY
EA
R E
ND
CO
ST
SC
OS
TS
CO
ST
SN
ON
CA
PIT
AL
(Sch
. 7-1
)(S
ch. 5
)(S
ch. 4
)E
XP
EN
SE
HE
AL
TH
CA
RE
FA
CIL
ITIE
S1
23
45
1.C
entin
ela
Hos
pita
l05
-073
912
/31/
08$0
$0$2
,281
,597
$2,2
81,5
97
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
12/3
1/08
00
820,
997
820,
997
3.
Des
ert V
alle
y H
ospi
tal
05-0
709
12/3
1/08
00
906,
210
906,
210
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
812
/31/
080
031
9,78
631
9,78
6
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
12/3
1/08
00
386,
899
386,
899
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
12/3
1/08
00
509,
219
509,
219
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
12/3
1/08
00
384,
178
384,
178
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
12/3
1/08
00
422,
710
422,
710
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
412
/31/
080
01,
162,
187
1,16
2,18
7
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
812
/31/
080
024
4,57
124
4,57
1
11.
She
rman
Oak
s H
ospi
tal
05-0
114
12/3
1/08
00
871,
572
871,
572
12.
Wes
t Ana
heim
Med
ical
Cen
ter
05-0
426
12/3
1/08
00
838,
981
838,
981
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
12/3
1/08
00
162,
345
162,
345
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
$0
$0$9
,311
,252
$9,3
11,2
52
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t Val
ley
Med
ical
Gro
up
00
337,
405
337,
405
26.
She
rman
Oak
s M
edic
al G
roup
0
024
,563
24,5
6327
.P
arad
ise
Val
ley
Med
ical
Gro
up
00
34,4
4134
,441
28.
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)
00
20,8
9520
,895
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC
00
3,41
73,
417
30.
Bio
-Med
Ser
vice
s, In
c.
00
41,5
4241
,542
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
0
023
,061
23,0
6132
.
00
00
33.
0
00
034
.
00
00
35.
0
00
0
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$4
85,3
24$4
85,3
24
G
RA
ND
TO
TA
L$0
$0$9
,796
,577
$9,7
96,5
77(T
o S
ch. 1
& 2
)
SU
MM
AR
Y A
LL
OC
AT
ION
OF
HO
ME
OF
FIC
E C
OS
TS
NO
NC
AP
ITA
L R
EL
AT
ED
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 4
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-C
AL
TO
TA
L C
OS
TC
AP
ITA
LN
ON
CA
PIT
AL
PO
OL
ED
NU
MB
ER
(SC
H. G
, CO
L. 1
)(S
ch. 8
)(S
ch. 8
)(C
OL
UM
N 2
+ 3
)H
EA
LT
H C
AR
E F
AC
ILIT
IES
12
34
(Adj
.16)
1.C
entin
ela
Hos
pita
l05
-073
9$2
14,1
76,3
79$6
8,85
7$2
,281
,597
$2,3
50,4
54
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
77,0
68,0
0224
,777
820,
997
845,
774
3.D
eser
t Val
ley
Hos
pita
l05
-070
985
,067
,069
27,3
4990
6,21
093
3,55
9
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
830
,018
,698
9,65
131
9,78
632
9,43
7
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
36,3
18,6
6211
,676
386,
899
398,
575
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
47,8
01,0
5815
,368
509,
219
524,
587
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
36,0
63,3
1711
,594
384,
178
395,
772
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
39,6
80,2
8812
,757
422,
710
435,
467
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
410
9,09
5,97
035
,074
1,16
2,18
71,
197,
261
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
822
,958
,221
7,38
124
4,57
125
1,95
2
11.
She
rman
Oak
s H
ospi
tal
05-0
114
81,8
15,6
0726
,303
871,
572
897,
875
12.
Wes
t Ana
heim
Med
ical
Cen
ter
05-0
426
78,7
56,1
8825
,320
838,
981
864,
301
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
15,2
39,5
734,
899
162,
345
167,
244
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
874,
059,
032
$281
,006
$9,3
11,2
52$9
,592
,258
OT
HE
R C
OM
PO
NE
NT
S
25.
Des
ert V
alle
y M
edic
al G
roup
31
,672
,673
10,1
8333
7,40
534
7,58
826
.S
herm
an O
aks
Med
ical
Gro
up
2,30
5,72
474
124
,563
25,3
0427
.P
arad
ise
Val
ley
Med
ical
Gro
up
3,23
3,04
61,
039
34,4
4135
,480
28.
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)
1,96
1,47
363
120
,895
21,5
2629
.P
rime
Hea
lthca
re S
ervi
ces,
Los
Ang
eles
, LLC
32
0,77
610
33,
417
3,52
030
.B
io-M
ed S
ervi
ces,
Inc.
3,
899,
612
1,25
441
,542
42,7
9631
.H
ospi
tal B
usin
ess
Ser
vice
s, In
c.
2,16
4,78
769
623
,061
23,7
5732
.
33
.
34
.
35
.
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$4
5,55
8,09
1$1
4,64
7$4
85,3
24$4
99,9
71
G
RA
ND
TO
TA
L$9
19,6
17,1
23$2
95,6
53$9
,796
,577
$10,
092,
230
MU
LTIP
LIE
R0.
0003
210.
0106
53
PO
OL
ED
AL
LO
CA
TIO
N O
F E
XP
EN
SE
S T
O C
HA
IN C
OM
PO
NE
NT
S
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 5
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-C
AL
AU
DIT
ED
NU
MB
ER
TO
TA
LH
EA
LT
H C
AR
E F
AC
ILIT
IES
12
45
CA
PIT
AL
1.C
entin
ela
Hos
pita
l05
-073
9$0
$0$0
$0$0
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
00
00
0
3.D
eser
t V
alle
y H
ospi
tal
05-0
709
00
00
0
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
80
00
00
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
00
00
0
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
00
00
0
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
00
00
0
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
00
00
0
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
40
00
00
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
80
00
00
11.
She
rman
Oak
s H
ospi
tal
05-0
114
00
00
0
12.
Wes
t A
nahe
im M
edic
al C
ente
r05
-042
60
00
00
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
00
00
0
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
$0$0
$0$0
$0
OT
HE
R C
OM
PO
NE
NT
S
00
00
025
.D
eser
t V
alle
y M
edic
al G
roup
0
00
00
26.
She
rman
Oak
s M
edic
al G
roup
0
00
00
27.
Par
adis
e V
alle
y M
edic
al G
roup
0
00
00
28.
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)
00
00
029
.P
rime
Hea
lthca
re S
ervi
ces,
Los
Ang
eles
, LL
C
00
00
030
.B
io-M
ed S
ervi
ces,
Inc
.
00
00
031
.H
ospi
tal B
usin
ess
Ser
vice
s, I
nc.
0
00
00
32.
00
00
033
.
0
00
00
34.
00
00
035
.
0
00
00
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
(To
Sch
. 3)
Mov
able
E
qu
ipm
ent
- B
uild
ing
an
d
Fix
ture
s -
Old
Mov
able
E
qu
ipm
ent
- O
ldB
uild
ing
an
d
Fix
ture
s -
New
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
CA
PIT
AL
RE
LA
TE
D
Pag
e 1
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 5
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
HE
AL
TH
CA
RE
FA
CIL
ITIE
S11
1213
1415
1617
1.C
entin
ela
Hos
pita
l$0
$0$0
$0$0
$0$0
2.C
hino
Val
ley
Med
ical
Cen
ter
00
00
00
0
3.D
eser
t V
alle
y H
ospi
tal
00
00
00
0
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r0
00
00
00
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
00
00
00
0
6.H
untin
gton
Bea
ch H
ospi
tal
00
00
00
0
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
00
00
00
0
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
00
00
00
0
9.P
arad
ise
Val
ley
Hos
pita
l0
00
00
00
10.
San
Dim
as C
omm
unity
Hos
pita
l0
00
00
00
11.
She
rman
Oak
s H
ospi
tal
00
00
00
0
12.
Wes
t A
nahe
im M
edic
al C
ente
r0
00
00
00
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
00
00
00
0
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S0
00
00
00
25.
Des
ert
Val
ley
Med
ical
Gro
up0
00
00
00
26.
She
rman
Oak
s M
edic
al G
roup
00
00
00
027
.P
arad
ise
Val
ley
Med
ical
Gro
up0
00
00
00
28.
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)0
00
00
00
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es,
LLC
00
00
00
030
.B
io-M
ed S
ervi
ces,
Inc
.0
00
00
00
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc
.0
00
00
00
32.
0
00
00
00
33.
0
00
00
00
34.
0
00
00
00
35.
0
00
00
00
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0$0
$0$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
Leg
al F
ees
Sal
arie
s of
O
ffic
ers
Sal
arie
s &
Wag
es
of O
ther
sP
ayro
ll T
axes
Em
p B
ene-
Pay
roll
Rel
ated
Em
p B
ene-
Non
pay
roll
Pro
fit
Sh
arin
g/P
ensi
o
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
NO
NC
AP
ITA
L R
EL
AT
ED
Pag
e 2
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 5
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
HE
AL
TH
CA
RE
FA
CIL
ITIE
S18
1920
2122
2324
1.C
entin
ela
Hos
pita
l$0
$0$0
$0$0
$0$0
2.C
hino
Val
ley
Med
ical
Cen
ter
00
00
00
0
3.D
eser
t V
alle
y H
ospi
tal
00
00
00
0
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r0
00
00
00
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
00
00
00
0
6.H
untin
gton
Bea
ch H
ospi
tal
00
00
00
0
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
00
00
00
0
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
00
00
00
0
9.P
arad
ise
Val
ley
Hos
pita
l0
00
00
00
10.
San
Dim
as C
omm
unity
Hos
pita
l0
00
00
00
11.
She
rman
Oak
s H
ospi
tal
00
00
00
0
12.
Wes
t A
nahe
im M
edic
al C
ente
r0
00
00
00
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
00
00
00
0
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S0
00
00
00
25.
Des
ert
Val
ley
Med
ical
Gro
up0
00
00
00
26.
She
rman
Oak
s M
edic
al G
roup
00
00
00
027
.P
arad
ise
Val
ley
Med
ical
Gro
up0
00
00
00
28.
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)0
00
00
00
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es,
LLC
00
00
00
030
.B
io-M
ed S
ervi
ces,
Inc
.0
00
00
00
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc
.0
00
00
00
32.
0
00
00
00
33.
0
00
00
00
34.
0
00
00
00
35.
0
00
00
00
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0$0
$0$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
Au
diti
ng
&
Acc
oun
ting
Fee
sU
tiliti
esC
omm
un
icat
ion
sT
rave
l &
En
tert
ain
men
tT
ran
spor
tatio
nC
lnin
g O
ffic
e &
A
dm
in S
up
plie
sM
inor
E
qu
ipm
ent
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
NO
NC
AP
ITA
L R
EL
AT
ED
Pag
e 3
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 5
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
HE
AL
TH
CA
RE
FA
CIL
ITIE
S25
2627
2829
3031
1.C
entin
ela
Hos
pita
l$0
$0$0
$0$0
$0$0
2.C
hino
Val
ley
Med
ical
Cen
ter
00
00
00
0
3.D
eser
t V
alle
y H
ospi
tal
00
00
00
0
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r0
00
00
00
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
00
00
00
0
6.H
untin
gton
Bea
ch H
ospi
tal
00
00
00
0
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
00
00
00
0
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
00
00
00
0
9.P
arad
ise
Val
ley
Hos
pita
l0
00
00
00
10.
San
Dim
as C
omm
unity
Hos
pita
l0
00
00
00
11.
She
rman
Oak
s H
ospi
tal
00
00
00
0
12.
Wes
t A
nahe
im M
edic
al C
ente
r0
00
00
00
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
00
00
00
0
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t V
alle
y M
edic
al G
roup
00
00
00
026
.S
herm
an O
aks
Med
ical
Gro
up0
00
00
00
27.
Par
adis
e V
alle
y M
edic
al G
roup
00
00
00
028
.P
rime
Hea
lthca
re S
ervi
ces,
LLC
(PH
S)
00
00
00
029
.P
rime
Hea
lthca
re S
ervi
ces,
Los
Ang
eles
, LL
C0
00
00
00
30.
Bio
-Med
Ser
vice
s, I
nc.
00
00
00
031
.H
ospi
tal B
usin
ess
Ser
vice
s, I
nc.
00
00
00
032
.
00
00
00
033
.
00
00
00
034
.
00
00
00
035
.
00
00
00
0
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0$0
$0$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
Tax
es &
L
icen
ses
- In
tere
st
Exp
ense
Tem
por
ary
Lab
orR
epai
rs &
M
ain
ten
ance
Du
es &
S
ub
scri
ptio
ns
Con
trib
utio
ns
Insu
rnc
Pre
m-
Non
cap
Rel
ated
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
NO
NC
AP
ITA
L R
EL
AT
ED
Pag
e 4
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 5
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
AU
DIT
ED
TO
TA
LH
EA
LT
H C
AR
E F
AC
ILIT
IES
3233
3435
N
ON
CA
PIT
AL
1.C
entin
ela
Hos
pita
l$0
$0$0
$0$0
$0$0
$0
2.C
hino
Val
ley
Med
ical
Cen
ter
00
00
00
00
3.D
eser
t V
alle
y H
ospi
tal
00
00
00
00
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r0
00
00
00
0
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
00
00
00
00
6.H
untin
gton
Bea
ch H
ospi
tal
00
00
00
00
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
00
00
00
00
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
00
00
00
00
9.P
arad
ise
Val
ley
Hos
pita
l0
00
00
00
0
10.
San
Dim
as C
omm
unity
Hos
pita
l0
00
00
00
0
11.
She
rman
Oak
s H
ospi
tal
00
00
00
00
12.
Wes
t A
nahe
im M
edic
al C
ente
r0
00
00
00
0
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
00
00
00
00
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
$0
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t V
alle
y M
edic
al G
roup
00
00
00
00
26.
She
rman
Oak
s M
edic
al G
roup
00
00
00
00
27.
Par
adis
e V
alle
y M
edic
al G
roup
00
00
00
00
28.
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)0
00
00
00
029
.P
rime
Hea
lthca
re S
ervi
ces,
Los
Ang
eles
, LL
C0
00
00
00
030
.B
io-M
ed S
ervi
ces,
Inc
.0
00
00
00
031
.H
ospi
tal B
usin
ess
Ser
vice
s, I
nc.
00
00
00
00
32.
0
00
00
00
033
.
00
00
00
00
34.
0
00
00
00
035
.
00
00
00
00
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
$0(T
o S
ch.
3-1)
Ad
vert
isin
gO
uts
ide
Ser
vice
sT
rain
ing
/Em
plo
yee
Pro
gra
ms
Oth
er -
Ban
k F
es
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
NO
NC
AP
ITA
L R
EL
AT
ED
Pag
e 5
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 6
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-
CA
LN
UM
BE
R(
stat
)(
stat
)(
stat
)(
stat
)H
EA
LT
H C
AR
E F
AC
ILIT
IES
12
45
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
1.C
entin
ela
Hos
pita
l05
-073
9
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
3.D
eser
t Val
ley
Hos
pita
l05
-070
9
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
8
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
4
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
8
11.
She
rman
Oak
s H
ospi
tal
05-0
114
12.
Wes
t Ana
heim
Med
ical
Cen
ter
05-0
426
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S
25.
Des
ert V
alle
y M
edic
al G
roup
26
.S
herm
an O
aks
Med
ical
Gro
up
27.
Par
adis
e V
alle
y M
edic
al G
roup
28
.P
rime
Hea
lthca
re S
ervi
ces,
LLC
(PH
S)
29
.P
rime
Hea
lthca
re S
ervi
ces,
Los
Ang
eles
, LLC
30
.B
io-M
ed S
ervi
ces,
Inc.
31
.H
ospi
tal B
usin
ess
Ser
vice
s, In
c.
32.
33.
34.
35.
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0
TO
TA
L S
TA
TIS
TIC
S0
00
0C
OS
T T
O B
E A
LLO
CA
TE
D (
Fro
m S
ch. 8
)$0
$0$0
$0U
NIT
CO
ST
MU
LTIP
LIE
R0.
0000
000.
0000
000.
0000
000.
0000
00
Bu
ildin
g a
nd
F
ixtu
res
- O
ldM
ova
ble
E
qu
ipm
ent
- O
ldB
uild
ing
an
d
Fix
ture
s -
New
Mo
vab
le
Eq
uip
men
t -
New
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
- S
TA
TIS
TIC
SC
AP
ITA
L R
EL
AT
ED
Pag
e 1
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 6
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
HE
AL
TH
CA
RE
FA
CIL
ITIE
S11
1213
1415
1617
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
1.C
entin
ela
Hos
pita
l
2.C
hino
Val
ley
Med
ical
Cen
ter
3.D
eser
t Val
ley
Hos
pita
l
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
6.H
untin
gton
Bea
ch H
ospi
tal
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
9.P
arad
ise
Val
ley
Hos
pita
l
10.
San
Dim
as C
omm
unity
Hos
pita
l
11.
She
rman
Oak
s H
ospi
tal
12.
Wes
t Ana
heim
Med
ical
Cen
ter
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t Val
ley
Med
ical
Gro
up26
.S
herm
an O
aks
Med
ical
Gro
up27
.P
arad
ise
Val
ley
Med
ical
Gro
up28
.P
rime
Hea
lthca
re S
ervi
ces,
LLC
(PH
S)
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC30
.B
io-M
ed S
ervi
ces,
Inc.
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
32.
33
.
34.
35
.
SU
BT
OT
AL
(SU
M O
F L
INE
S 2
5 -
35)
$0$0
$0$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
TO
TA
L S
TA
TIS
TIC
S0
00
00
00
CO
ST
TO
BE
ALL
OC
AT
ED
(F
rom
Sch
. 8)
$0$0
$0$0
$0$0
$0U
NIT
CO
ST
MU
LTIP
LIE
R0.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
00
Sal
arie
s o
f O
ffic
ers
Em
p B
ene-
No
np
ayro
ll R
elat
edP
rofi
t S
har
ing
/Pen
sio
n
Pla
n
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
- S
TA
TIS
TIC
SN
ON
CA
PIT
AL
RE
LA
TE
D
Leg
al F
ees
Pay
roll
Tax
esE
mp
Ben
e-P
ayro
ll R
elat
edS
alar
ies
& W
ages
o
f O
ther
s
Pag
e 2
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 6
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
HE
AL
TH
CA
RE
FA
CIL
ITIE
S18
1920
2122
2324
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
1.C
entin
ela
Hos
pita
l
2.C
hino
Val
ley
Med
ical
Cen
ter
3.D
eser
t Val
ley
Hos
pita
l
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
6.H
untin
gton
Bea
ch H
ospi
tal
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
9.P
arad
ise
Val
ley
Hos
pita
l
10.
San
Dim
as C
omm
unity
Hos
pita
l
11.
She
rman
Oak
s H
ospi
tal
12.
Wes
t Ana
heim
Med
ical
Cen
ter
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t Val
ley
Med
ical
Gro
up26
.S
herm
an O
aks
Med
ical
Gro
up27
.P
arad
ise
Val
ley
Med
ical
Gro
up28
.P
rime
Hea
lthca
re S
ervi
ces,
LLC
(PH
S)
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC30
.B
io-M
ed S
ervi
ces,
Inc.
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
32.
33
.
34.
35
.
SU
BT
OT
AL
(SU
M O
F L
INE
S 2
5 -
35)
$0$0
$0$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
TO
TA
L S
TA
TIS
TIC
S0
00
00
00
CO
ST
TO
BE
ALL
OC
AT
ED
(F
rom
Sch
. 8)
$0$0
$0$0
$0$0
$0U
NIT
CO
ST
MU
LTIP
LIE
R0.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
00
Tra
nsp
ort
atio
nC
lnin
g O
ffic
e &
A
dm
in S
up
plie
sM
ino
r E
qu
ipm
ent
Exp
ense
dU
tilit
ies
Co
mm
un
icat
ion
sT
rave
l &
En
tert
ain
men
tA
ud
itin
g &
A
cco
un
tin
g F
ees
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
- S
TA
TIS
TIC
SN
ON
CA
PIT
AL
RE
LA
TE
D
Pag
e 3
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 6
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
HE
AL
TH
CA
RE
FA
CIL
ITIE
S25
2627
2829
3031
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
1.C
entin
ela
Hos
pita
l
2.C
hino
Val
ley
Med
ical
Cen
ter
3.D
eser
t Val
ley
Hos
pita
l
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
6.H
untin
gton
Bea
ch H
ospi
tal
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
9.P
arad
ise
Val
ley
Hos
pita
l
10.
San
Dim
as C
omm
unity
Hos
pita
l
11.
She
rman
Oak
s H
ospi
tal
12.
Wes
t Ana
heim
Med
ical
Cen
ter
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t Val
ley
Med
ical
Gro
up26
.S
herm
an O
aks
Med
ical
Gro
up27
.P
arad
ise
Val
ley
Med
ical
Gro
up28
.P
rime
Hea
lthca
re S
ervi
ces,
LLC
(PH
S)
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC30
.B
io-M
ed S
ervi
ces,
Inc.
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
32.
33
.
34.
35
.
SU
BT
OT
AL
(SU
M O
F L
INE
S 2
5 -
35)
$0$0
$0$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
TO
TA
L S
TA
TIS
TIC
S0
00
00
00
CO
ST
TO
BE
ALL
OC
AT
ED
(F
rom
Sch
. 8)
$0$0
$0$0
$0$0
$0U
NIT
CO
ST
MU
LTIP
LIE
R0.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
00
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
- S
TA
TIS
TIC
SN
ON
CA
PIT
AL
RE
LA
TE
D
Tax
es &
Lic
ense
s -
No
nca
p R
elat
edIn
tere
st E
xpen
seT
emp
ora
ry L
abo
rR
epai
rs &
M
ain
ten
ance
Du
es &
S
ub
scri
pti
on
sC
on
trib
uti
on
sIn
surn
c P
rem
-N
on
cap
Rel
ated
Pag
e 4
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 6
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
( st
at )
HE
AL
TH
CA
RE
FA
CIL
ITIE
S32
3334
35
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
1.C
entin
ela
Hos
pita
l
2.C
hino
Val
ley
Med
ical
Cen
ter
3.D
eser
t Val
ley
Hos
pita
l
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
6.H
untin
gton
Bea
ch H
ospi
tal
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
9.P
arad
ise
Val
ley
Hos
pita
l
10.
San
Dim
as C
omm
unity
Hos
pita
l
11.
She
rman
Oak
s H
ospi
tal
12.
Wes
t Ana
heim
Med
ical
Cen
ter
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S25
.D
eser
t Val
ley
Med
ical
Gro
up26
.S
herm
an O
aks
Med
ical
Gro
up27
.P
arad
ise
Val
ley
Med
ical
Gro
up28
.P
rime
Hea
lthca
re S
ervi
ces,
LLC
(PH
S)
29.
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC30
.B
io-M
ed S
ervi
ces,
Inc.
31.
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
32.
33
.
34.
35
.
SU
BT
OT
AL
(SU
M O
F L
INE
S 2
5 -
35)
$0$0
$0$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
TO
TA
L S
TA
TIS
TIC
S0
00
00
00
CO
ST
TO
BE
ALL
OC
AT
ED
(F
rom
Sch
. 8)
$0$0
$0$0
$0$0
$0U
NIT
CO
ST
MU
LTIP
LIE
R0.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
000.
0000
00
FU
NC
TIO
NA
L A
LL
OC
AT
ION
OF
EX
PE
NS
ES
TO
CH
AIN
CO
MP
ON
EN
TS
- S
TA
TIS
TIC
S
Ad
vert
isin
gO
uts
ide
Ser
vice
sT
rain
ing
/Em
plo
yee
Pro
gra
ms
Oth
er -
Ban
k F
es
NO
NC
AP
ITA
L R
EL
AT
ED
Pag
e 5
of 5
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 7
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-
CA
LR
EP
OR
TE
DE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seA
UD
ITE
DN
UM
BE
RT
OT
AL
Cat
ego
ryC
ateg
ory
Cat
ego
ryC
ateg
ory
Cat
ego
ryC
ateg
ory
TO
TA
LH
EA
LT
H C
AR
E F
AC
ILIT
IES
12
34
56
78
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
1.C
entin
ela
Hos
pita
l05
-073
9$0
$0$0
$0$0
$0$0
$0
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
00
00
00
00
3.D
eser
t Val
ley
Hos
pita
l05
-070
90
00
00
00
0
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
80
00
00
00
0
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
00
00
00
00
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
00
00
00
00
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
00
00
00
00
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
00
00
00
00
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
40
00
00
00
0
10.
San
Dim
as C
omm
unity
Hos
pita
l05
-058
80
00
00
00
0
11.
She
rman
Oak
s H
ospi
tal
05-0
114
00
00
00
00
12.
Wes
t Ana
heim
Med
ical
Cen
ter
05-0
426
00
00
00
00
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
00
00
00
00
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
$0$0
$0$0
$0$0
$0$0
OT
HE
R C
OM
PO
NE
NT
S
00
00
00
00
25.
Des
ert V
alle
y M
edic
al G
roup
0
00
00
00
026
.S
herm
an O
aks
Med
ical
Gro
up
00
00
00
00
27.
Par
adis
e V
alle
y M
edic
al G
roup
0
00
00
00
028
.P
rim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)
00
00
00
00
29.
Pri
me
Hea
lthca
re S
ervi
ces,
Los
Ang
eles
, LLC
0
00
00
00
030
.B
io-M
ed S
ervi
ces,
Inc.
0
00
00
00
031
.H
ospi
tal B
usin
ess
Ser
vice
s, In
c.
00
00
00
00
32.
00
00
00
00
33.
00
00
00
00
34.
00
00
00
00
35.
00
00
00
00
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
$0(T
o S
ch. 3
)
DIR
EC
T A
LL
OC
AT
ION
OF
CA
PIT
AL
CO
ST
S T
O C
HA
IN C
OM
PO
NE
NT
S
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 7
-1
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
ME
DI-
CA
LR
EP
OR
TE
DE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seE
nte
r E
xpen
seA
UD
ITE
DN
UM
BE
RT
OT
AL
Cat
ego
ryC
ateg
ory
Cat
ego
ryC
ateg
ory
Cat
ego
ryC
ateg
ory
TO
TA
LH
EA
LT
H C
AR
E F
AC
ILIT
IES
12
34
56
78
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
(Adj
. )
1.C
entin
ela
Hos
pita
l05
-073
9$0
$0$0
$0$0
$0$0
$0
2.C
hino
Val
ley
Med
ical
Cen
ter
05-0
586
00
00
00
00
3.D
eser
t Val
ley
Hos
pita
l05
-070
90
00
00
00
0
4.E
ncin
o H
ospi
tal M
edic
al C
ente
r05
-015
80
00
00
00
0
5.G
arde
n G
rove
Hos
pita
l Med
ical
Cen
ter
05-0
230
00
00
00
00
6.H
untin
gton
Bea
ch H
ospi
tal
05-0
526
00
00
00
00
7.La
Pal
ma
Inte
rcom
mun
ity H
ospi
tal
05-0
580
00
00
00
00
8.M
ontc
lair
Hos
pita
l Med
ical
Cen
ter
05-0
758
00
00
00
00
9.P
arad
ise
Val
ley
Hos
pita
l05
-002
40
00
00
00
0 010
.S
an D
imas
Com
mun
ity H
ospi
tal
05-0
588
00
00
00
00 0
11.
She
rman
Oak
s H
ospi
tal
05-0
114
00
00
00
00 0
12.
Wes
t Ana
heim
Med
ical
Cen
ter
05-0
426
00
00
00
00 0
13.
Sha
sta
Reg
iona
l Med
ical
Cen
ter
05-0
733
00
00
00
00 0
SU
BT
OT
AL
(SU
M O
F L
INE
S 1
- 1
3)
00
00
00
00
OT
HE
R C
OM
PO
NE
NT
S
00
00
00
00
25.
Des
ert V
alle
y M
edic
al G
roup
0
00
00
00
026
.S
herm
an O
aks
Med
ical
Gro
up
00
00
00
00
27.
Par
adis
e V
alle
y M
edic
al G
roup
0
00
00
00
028
.P
rim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)
00
00
00
00
29.
Pri
me
Hea
lthca
re S
ervi
ces,
Los
Ang
eles
, LLC
0
00
00
00
030
.B
io-M
ed S
ervi
ces,
Inc.
0
00
00
00
031
.H
ospi
tal B
usin
ess
Ser
vice
s, In
c.
00
00
00
00
32.
00
00
00
00
33.
00
00
00
00
34.
00
00
00
00
35.
00
00
00
00
S
UB
TO
TA
L (S
UM
OF
LIN
ES
25
- 35
)$0
$0$0
$0$0
$0$0
$0
G
RA
ND
TO
TA
L$0
$0$0
$0$0
$0$0
$0(T
o S
ch. 3
-1)
DIR
EC
T A
LL
OC
AT
ION
OF
NO
NC
AP
ITA
L C
OS
TS
TO
CH
AIN
CO
MP
ON
EN
TS
ST
AT
E O
F C
AL
IFO
RN
IAS
CH
ED
UL
E 8
HO
ME
OF
FIC
E N
AM
E:
FIS
CA
L P
ER
IOD
EN
DE
D:
PR
IME
HE
AL
TH
CA
RE
SE
RV
ICE
S, I
NC
.D
ecem
ber
31,
200
8
RE
PO
RT
ED
AD
JUS
TM
EN
TA
DJU
ST
ME
NT
AU
DIT
ED
DIR
EC
TF
UN
CT
ION
AL
PO
OL
ED
AL
LO
C.
NU
MB
ER
(S)
AM
OU
NT
(S)
PO
OL
ED
AL
LO
CA
TIO
NA
LL
OC
AT
ION
CO
ST
CE
NT
ER
DE
SC
RIP
TIO
N(S
CH
. B, C
OL
8)
CO
ST
(SC
H. B
, CO
L 6
)(S
CH
. B, C
OL
7)
CA
PIT
AL
-RE
LA
TE
D C
OS
TS
- O
LD
(Adj
. )
(Adj
. )
1.00
Bui
ldin
g an
d F
ixtu
res
- O
ld$0
2.00
Mov
able
Equ
ipm
ent -
Old
03.
00
SU
BT
OT
AL
(sum
of l
ines
1 a
nd 2
)$0
$0$0
$0$0
CA
PIT
AL
-RE
LA
TE
D C
OS
TS
- N
EW
4.00
Bui
ldin
g an
d F
ixtu
res
- N
ew$9
67,7
961,
2,3,
4($
838,
724)
$129
,072
5.00
Mov
able
Equ
ipm
ent -
New
469,
458
5(3
02,8
77)
166,
581
6.00
S
UB
TO
TA
L (s
um o
f lin
es 4
and
5)
$1,4
37,2
54($
1,14
1,60
1)$2
95,6
53$0
$0O
TH
ER
CA
PIT
AL
-RE
LA
TE
D C
OS
TS
7.00
Insu
ranc
e P
rem
ium
s$0
8.00
Tax
es a
nd L
icen
ses
- O
ther
than
INC
M0
9.00
Oth
er0
10.0
0
SU
BT
OT
AL
(sum
of l
ines
7 th
roug
h 9)
$0$0
$0$0
$0N
ON
CA
PIT
AL
-RE
LA
TE
D C
OS
TS
11.0
0S
alar
ies
of O
ffice
rs$0
12.0
0S
alar
ies
& W
ages
of O
ther
s5,
910,
075
5,91
0,07
513
.00
Pay
roll
Tax
es36
2,75
836
2,75
814
.00
Em
p B
ene-
Pay
roll
Rel
ated
510,
804
510,
804
15.0
0E
mp
Ben
e-N
onpa
yrol
l Rel
ated
17,5
666
(11,
134)
6,43
216
.00
Pro
fit S
hari
ng/P
ensi
on P
lan
017
.00
Lega
l Fee
s1,
347,
278
1,34
7,27
818
.00
Aud
iting
& A
ccou
ntin
g F
ees
1,82
3,08
27,
8,9,
10(1
,242
,376
)58
0,70
619
.00
Util
ities
63,4
6663
,466
20.0
0C
omm
unic
atio
ns0
21.0
0T
rave
l & E
nter
tain
men
t51
7,02
911
,12
(196
,747
)32
0,28
222
.00
Tra
nspo
rtat
ion
023
.00
Cln
ing
Offi
ce &
Adm
in S
uppl
ies
63,8
3663
,836
24.0
0M
inor
Equ
ipm
ent E
xpen
sed
025
.00
Rep
airs
& M
aint
enan
ce93
,994
93,9
9426
.00
Due
s &
Sub
scri
ptio
ns44
,185
13,1
4(2
7,94
9)16
,236
27.0
0C
ontr
ibut
ions
028
.00
Insu
rnc
Pre
m-N
onca
p R
elat
ed20
,640
20,6
4029
.00
Tax
es &
Lic
ense
s -
Non
cap
Rel
ated
196,
049
196,
049
30.0
0In
tere
st E
xpen
se18
4,00
215
(184
,002
)0
31.0
0T
empo
rary
Lab
or0
32.0
0A
dver
tisin
g0
33.0
0O
utsi
de S
ervi
ces
034
.00
Tra
inin
g/E
mpl
oyee
Pro
gram
s0
35.0
0O
ther
- B
ank
Fes
304,
021
304,
021
0
0
036
.00
S
UB
TO
TA
L (s
um o
f lin
es 1
1 th
roug
h 35
)$1
1,45
8,78
5($
1,66
2,20
8)$9
,796
,577
$0$0
37.0
0T
OT
AL
ALL
OW
AB
LE E
XP
EN
SE
S$1
2,89
6,03
9($
2,80
3,80
9)$1
0,09
2,23
0$0
$0(T
o S
ch. 4
)(T
o S
ch. 7
, 7-1
)(T
o S
ch. 5
)
38.0
0N
ON
RE
IMB
UR
SA
BLE
EX
PE
NS
ES
$0$0
TO
TA
L E
XP
EN
SE
S$1
2,89
6,03
9($
2,80
3,80
9)$1
0,09
2,23
0
TR
IAL
BA
LA
NC
E O
F E
XP
EN
SE
S
Sta
te o
f C
alif
orn
iaD
epar
tmen
t o
f H
ealt
h C
are
Ser
vice
s
Pro
vid
er N
ame
Fis
cal P
erio
dP
rovi
der
Nu
mb
er16
Adj
.A
udit
Wor
kA
sIn
crea
seA
sN
o.R
epor
tS
heet
Par
tT
itle
Line
Col
.R
epor
ted
(Dec
reas
e)A
djus
ted
AD
JUS
TM
EN
TS
TO
RE
PO
RT
ED
CO
ST
S
Sch
edul
e 8
B4.
008
New
Cap
ital R
elat
ed C
osts
- B
uild
ing
and
Fix
ture
s$9
67,7
96
1T
o el
imin
ate
prop
erty
taxe
s fo
r a
luxu
ry h
ouse
loca
ted
in B
ever
ly H
ills.
($10
3,72
2)42
CF
R 4
13.9
(c)(
3) /
CM
S P
ub. 1
5-1,
Sec
tion
2122
.2F
2T
o el
imin
ate
leas
e ex
pens
es d
ue to
insu
ffici
ent d
ocum
enta
tion.
(7,2
24)
42 C
FR
413
.20
and
413.
24
CM
S P
ub. 1
5-1,
Sec
tions
230
0 an
d 23
04
3T
o el
imin
ate
leas
e fo
r a
luxu
ry fa
mily
hou
se lo
cate
d in
Bev
erly
Hill
s.(7
20,0
00)
42 C
FR
413
.9(c
)(3)
/ C
MS
Pub
. 15-
1, S
ectio
n 21
02.3
4T
o el
imin
ate
leas
e ex
pens
es d
ue to
insu
ffici
ent d
ocum
enta
tion.
(7,7
78)
42 C
FR
413
.20
and
413.
24
($83
8,72
4)$1
29,0
72C
MS
Pub
. 15-
1, S
ectio
ns 2
300
and
2304
5S
ched
ule
8B
5.00
8N
ew C
apita
l Rel
ated
Cos
ts -
Mov
able
Equ
ipm
ent
$469
,458
($30
2,87
7)$1
66,5
81T
o el
imin
ate
depr
ecia
tion
for
luxu
ry it
ems,
hel
icop
ter
and
Ben
tley
car.
42 C
FR
413
.9(c
)(3)
/ C
MS
Pub
. 15-
1, S
ectio
ns 2
102.
3 an
d 21
04.3
6S
ched
ule
8B
15.0
08
Em
ploy
ee B
enef
its -
Non
-Pay
roll
Rel
ated
$17,
566
($11
,134
)$6
,432
To
elim
inat
e ap
prec
iatio
n ex
pens
es n
ot r
elat
ed to
pat
ient
car
e.42
CF
R 4
13.9
(c)(
3) a
nd 4
13.2
4 C
MS
Pub
. 15-
1, S
ectio
n 21
02.3
Pag
e1
Rep
ort R
efer
ence
sP
RIM
E H
EA
LTH
CA
RE
SE
RV
ICE
S, I
NC
.
Ad
just
men
ts
Exp
lana
tion
of A
udit
Adj
ustm
ents
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
HO
ME
OF
FIC
E
Cos
t Rep
ort
Sta
te o
f C
alif
orn
iaD
epar
tmen
t o
f H
ealt
h C
are
Ser
vice
s
Pro
vid
er N
ame
Fis
cal P
erio
dP
rovi
der
Nu
mb
er16
Adj
.A
udit
Wor
kA
sIn
crea
seA
sN
o.R
epor
tS
heet
Par
tT
itle
Line
Col
.R
epor
ted
(Dec
reas
e)A
djus
ted
Rep
ort R
efer
ence
sP
RIM
E H
EA
LTH
CA
RE
SE
RV
ICE
S, I
NC
.
Ad
just
men
ts
Exp
lana
tion
of A
udit
Adj
ustm
ents
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
HO
ME
OF
FIC
E
Cos
t Rep
ort
AD
JUS
TM
EN
TS
TO
RE
PO
RT
ED
CO
ST
S
Sch
edul
e 8
B18
.00
8A
uditi
ng a
nd A
ccou
ntin
g F
ees
$1,8
23,0
82
7T
o el
imin
ate
helic
opte
r se
rvic
e co
sts
not r
elat
ed to
pat
ient
car
e.($
491,
110)
42 C
FR
413
.9(c
)(3)
/ C
MS
Pub
. 15-
1, S
ectio
ns 2
102.
3 an
d 21
04.3
8T
o el
imin
ate
lobb
ying
fees
not
rel
ated
to p
atie
nt c
are.
(436
,266
)42
CF
R 4
13.9
(c)(
3)C
MS
Pub
. 15-
1, S
ectio
ns 2
102.
2, 2
104,
and
213
9
9T
o el
imin
ate
prof
esss
iona
l fee
s no
t rel
ated
to p
atie
nt c
are.
(300
,000
)
42 C
FR
413
.9(c
)(3)
C
MS
Pub
. 15-
1, S
ectio
n 21
02.3
10T
o el
imin
ate
frin
ge b
enef
its (
bonu
s) n
ot r
elat
ed to
pat
ient
car
e.(1
5,00
0)42
CF
R 4
13.9
(c)(
3)
($1,
242,
376)
$580
,706
CM
S P
ub. 1
5-1,
Sec
tions
210
2.3
and
2144
.3
Sch
edul
e 8
B21
.00
8T
rave
l and
Ent
erta
inm
ent
$517
,029
11T
o el
imin
ate
trav
el e
xpen
ses
not r
elat
ed to
pat
ient
car
e.($
81,7
20)
42 C
FR
413
.9(c
)(3)
/ C
MS
Pub
. 15-
1, S
ectio
n 21
02.3
12T
o el
imin
ate
luxu
ry L
as V
egas
hot
el a
ccom
odat
ions
not
rel
ated
to
patie
nt c
are.
($11
5,02
7)42
CF
R 4
13.9
(c)(
3) /
CM
S P
ub. 1
5-1,
Sec
tion
2102
.3
(196
,747
)32
0,28
2
Pag
e2
Sta
te o
f C
alif
orn
iaD
epar
tmen
t o
f H
ealt
h C
are
Ser
vice
s
Pro
vid
er N
ame
Fis
cal P
erio
dP
rovi
der
Nu
mb
er16
Adj
.A
udit
Wor
kA
sIn
crea
seA
sN
o.R
epor
tS
heet
Par
tT
itle
Line
Col
.R
epor
ted
(Dec
reas
e)A
djus
ted
Rep
ort R
efer
ence
sP
RIM
E H
EA
LTH
CA
RE
SE
RV
ICE
S, I
NC
.
Ad
just
men
ts
Exp
lana
tion
of A
udit
Adj
ustm
ents
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
HO
ME
OF
FIC
E
Cos
t Rep
ort
AD
JUS
TM
EN
TS
TO
RE
PO
RT
ED
CO
ST
S
Sch
edul
e 8
B26
.00
8D
ues
and
Sub
scrip
tions
$44,
185
13T
o el
imin
ate
dues
and
sub
scrip
tion
expe
nses
not
rel
ated
to p
atie
nt c
are.
($22
,406
)42
CF
R 4
13.9
(c)(
3) /
CM
S P
ub. 1
5-1,
Sec
tion
2102
.3
14T
o el
imin
ate
dues
and
sub
scrip
tions
exp
ense
s du
e to
insu
ffici
ent
(5,5
43)
docu
men
tatio
n.($
27,9
49)
$16,
236
42 C
FR
413
.20
and
413.
24 /
CM
S P
ub. 1
5-1,
Sec
tions
230
0 an
d 23
04
15S
ched
ule
8B
30.0
08
Inte
rest
Exp
ense
$184
,002
($18
4,00
2)$0
To
elim
inat
e th
e in
tere
st e
xpen
se p
aid
to th
e ow
ner.
42 C
FR
413
.153
/ C
MS
15-
1, S
ectio
n 21
8
Pag
e3
Sta
te o
f C
alif
orn
iaD
epar
tmen
t o
f H
ealt
h C
are
Ser
vice
s
Pro
vid
er N
ame
Fis
cal P
erio
dP
rovi
der
Nu
mb
er16
Adj
.A
udit
Wor
kA
sIn
crea
seA
sN
o.R
epor
tS
heet
Par
tT
itle
Line
Col
.R
epor
ted
(Dec
reas
e)A
djus
ted
Rep
ort R
efer
ence
sP
RIM
E H
EA
LTH
CA
RE
SE
RV
ICE
S, I
NC
.
Ad
just
men
ts
Exp
lana
tion
of A
udit
Adj
ustm
ents
JAN
UA
RY
1, 2
008
TH
RO
UG
H D
EC
EM
BE
R 3
1, 2
008
HO
ME
OF
FIC
E
Cos
t Rep
ort
AD
JUS
TM
EN
T T
O R
EP
OR
TE
D S
TA
TIS
TIC
S
16S
ched
ule
425
.00
1D
eser
t Val
ley
Med
ical
Gro
up0
31,6
72,6
7331
,672
,673
Sch
edul
e 4
26.0
01
She
rman
Oak
s M
edic
al G
roup
02,
305,
724
2,30
5,72
4S
ched
ule
427
.00
1P
arad
ise
Val
ley
Med
ical
Gro
up0
3,23
3,04
63,
233,
046
Sch
edul
e 4
28.0
01
Prim
e H
ealth
care
Ser
vice
s, L
LC(P
HS
)0
1,96
1,47
31,
961,
473
Sch
edul
e 4
29.0
01
Prim
e H
ealth
care
Ser
vice
s, L
os A
ngel
es, L
LC0
320,
776
320,
776
Sch
edul
e 4
30.0
01
Bio
-Med
Ser
vice
s, In
c.0
3,89
9,61
23,
899,
612
Sch
edul
e 4
31.0
01
Hos
pita
l Bus
ines
s S
ervi
ces,
Inc.
02,
164,
787
2,16
4,78
7T
o es
tabl
ish
the
tota
l cos
t sta
tistic
s to
oth
er c
ompo
nent
s fo
r pr
oper
hom
e of
fice
cost
allo
catio
n.42
CF
R 4
13.2
4 an
d 41
3.50
CM
S P
ub. 1
5-1,
Sec
tions
230
4, 2
306
and
2328
Pag
e4