REPORT COST REPORT REVIEW SILVER LAKE ... ON THE COST REPORT REVIEW SILVER LAKE MEDICAL CENTER LOS ANGELES, CALIFORNIA NATIONAL PROVIDER IDENTIFIER: 1427293216 FISCAL PERIOD ENDED

REPORT ON THE

COST REPORT REVIEW

SILVER LAKE MEDICAL CENTER LOS ANGELES CALIFORNIA

NATIONAL PROVIDER IDENTIFIER 1427293216

FISCAL PERIOD ENDED DECEMBER 31 2011

Audits SectionmdashBurbank Financial Audits Branch

Audits and Investigations Department of Health Care Services

Section Chief Daniel J Giardinelli Audit Supervisor Henry Kwan Auditor Jimmy Lee

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

TOOBY DOUGLAS EDMUNDD G BROWN JR DIRECTOR GOVERNOR

Novembber 5 2013

George Koutsakos Chief Finnancial Off icer Silver Laake Medicaal Center 1711 Weest Templee Street Los Anggeles Califoornia 900266

SILVERR LAKE MEDDICAL CENNTER NATIONNAL PROVIDER IDENNTIFIER (NPPI) 14272933216 FISCAL PERIOD EENDED DECEMBER 331 2011

We havee examinedd the Providders Medi-CCal Cost Reeport for th e above-reeferenced fiscals period Our examinnation was made undeer the authoority of Secction 141700 of the Wellfare and Insttitutions Code and wass limited to a review off the cost reeport and aaccompanying financiall statementts Medi-Caal payment ddata reportts prior fisccal periods Medi-Cal programm audit repoort and Meddicare audit report for the currentt fiscal periood if appliccable and available

In our oppinion the audited commbined setttlement for the fiscal pperiod due tthe State inn the amount of $19107 and the audited costts presentedd in the Summary of FFindings represennt a proper determinattion in accoordance with the reimbbursement principlesp oof applicabble programms

This auddit report includes the

1 SSummary off Findings

2 CComputationn of Medi-CCal Reimbursement Seettlement (NNONCONTTRACT SSchedules)

3 CComputationn of Medi-CCal Cost (COONTRACT Scheduless)

4 AAudit Adjusttments Schedule

The auddited settlemment will bee incorporatted into a SStatement(ss) of Accounnt Status which mmay reflect tentative rettroactive addjustment ddeterminatioons paymeents from thhe providerr and otherr financial trransactionss initiated byy the Depaartment Thhe Statement(s)

Financiaal AuditsBurbaankA amp I MS 22101 1405 Norrth San Fernanndo Boulevard Room 203 Buurbank CA 915504 Telepphone (818) 2995-2620 FAX (818) 563-33244

Internet Addrress wwwdhccscagov

George Koutsakos Page 2

of Account Status will be forwarded to the provider by the State fiscal intermediary Instructions regarding payment will be included with the Statement(s) of Account Status

Notwithstanding this audit report overpayments to the provider are subject to recovery pursuant to Section 514581 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 Department of Health Care Services Office of Administrative Hearings and Appeals 1029 J Street Suite 200 Sacramento CA 95814 (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 715001 Sacramento CA 95899 Sacramento CA 95814

(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 SectionmdashBurbank at (818) 295-2620

Original Signed By

Daniel J Giardinelli Chief Audits SectionmdashBurbank Financial Audits Branch

Certified

SUMMARY OF FINDINGS

Provider Name Fiscal Period Ended

SILVER LAKE MEDICAL CENTER DECEMBER 31 2011

SETTLEMENT COST

1 Medi-Cal Noncontract Settlement (SCHEDULE 1) Provider NPI 1427293216 Reported

Net Change

Audited Amount Due Provider (State)

2 Subprovider I (SCHEDULE 1-1) Provider NPI Reported

Net Change

3 Subprovider II (SCHEDULE 1-2) Provider NPI Reported

Net Change

4 Medi-Cal Contract Cost (CONTRACT SCH 1) Provider NPI 1427293216 Reported

Net Change

Audited Cost

25483627

(19962376)

5521251

$ (19107)

5 Distinct Part Nursing Facility (DPNF SCH 1) Provider NPI Reported

Net Change

Audited Cost Per Day

6 Distinct Part Nursing Facility (DPNF SCH 1-1) Provider NPI Reported

Net Change

7 Adult Subacute (ADULT SUBACUTE SCH 1) Provider NPI Reported

Net Change

8 Total Medi-Cal Settlement Due Provider (State) - (Lines 1 through 7) $ (19107)

9 Total Medi-Cal Cost $ 5521251

SUMMARY OF FINDINGS

Provider Name Fiscal Period Ended SILVER LAKE MEDICAL CENTER DECEMBER 31 2011

SETTLEMENT COST

10 Subacute (SUBACUTE SCH 1-1) Provider NPI Reported

Net Change

11 Rural Health Clinic (RHC SCH 1) Provider NPI Reported

Net Change

12 Rural Health Clinic (RHC 95-210 SCH 1) Provider NPI Reported

Net Change

13 Rural Health Clinic (RHC 95-210 SCH 1-1) Provider NPI Reported

Net Change

14 County Medical Services Program (CMSP SCH 1) Provider NPI Reported

Net Change

15 Transitional Care (TC SCH 1) Provider NPI Reported

Net Change

16 Total Other Settlement Due Provider (State) - (Lines 10 through 15) $ 0

17 Total Combined Audited Settlement Due Provider (StateCMSPRHC) - (Line 8 + Line 16) $ (19107)

STATE OF CALIFORNIA SCHEDULE 1 PROGRAM NONCONTRACT

COMPUTATION OF MEDI-CAL REIMBURSEMENT SETTLEMENT

Provider NPI 1427293216

REPORTED AUDITED

1 Net Cost of Covered Services Rendered to Medi-Cal Patients (Schedule 3) $ 0 $ 27626

2 Excess Reasonable Cost Over Charges (Schedule 2) $ 0 $ 0

3 Medi-Cal Inpatient Hospital Based Physician Services $ 0 $ 0

4 $ 0 $ 0

5 TOTAL COST-Reimbursable to Provider (Lines 1 through 4) $ 0 $ 27626

6 Interim Payments (Adj 12) $ 0 $ (27626)

7 Balance Due Provider (State) $ 0 $ 0

8 Duplicate Payments (Adj ) $ 0 $ 0

9 $ 0 $ 0

10 $ 0 $ 0

11 TOTAL MEDI-CAL SETTLEMENT Due Provider (State) $ 0 $ 0 (To Summary of Findings)

COMPUTATION OF LESSER OF MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES

REPORTED AUDITED

REASONABLE COST OF MEDI-CAL INPATIENT SERVICES

1 Cost of Covered Services (Schedule 3) $ 0 $ 29075

CHARGES FOR MEDI-CAL INPATIENT SERVICES

2 Inpatient Routine Service Charges (Adj 10) $ 0 $ 153750

3 Inpatient Ancillary Service Charges (Adj ) $ 0 $ 0

4 Total Charges - Medi-Cal Inpatient Services $ 0 $ 153750

5 Excess of Customary Charges Over Reasonable Cost (Line 4 minus Line 1) $ 0 $ 124675

6 Excess of Reasonable Cost Over Customary Charges (Line 1 minus Line 4) $ 0 $ 0

(To Schedule 1)

If charges exceed reasonable cost no further calculation necessary for this schedule

COMPUTATION OF MEDI-CAL NET COSTS OF COVERED SERVICES

REPORTED AUDITED

1 Medi-Cal Inpatient Ancillary Services (Schedule 5) $ 0 $ 0

2 Medi-Cal Inpatient Routine Services (Schedule 4) $ 0 $ 29075

3 Medi-Cal Inpatient Hospital Based Physician for Intern and Resident Services (Sch ) $ 0 $ 0

4 $ 0 $ 0

5 $ 0 $ 0

6 SUBTOTAL (Sum of Lines 1 through 5) $ 0 $ 29075

7 Medi-Cal Inpatient Hospital Based Physician for Acute Care Services (Schedule 7) $ 0 $ 0

8 SUBTOTAL $ 0 $ 29075 (To Schedule 2)

9 Medi-Cal Deductible (Adj ) $ 0 $ 0

10 Medi-Cal Coinsurance (Adj 11) $ 0 $ (1449)

11 Net Cost of Covered Services Rendered to Medi-Cal Inpatients $ 0 $ 27626

(To Schedule 1)

COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST

Provider Name SILVER LAKE MEDICAL CENTER

Fiscal Period Ended DECEMBER 31 2011

GENERAL SERVICE UNIT NET OF SWING-BED COSTS REPORTED AUDITED

INPATIENT DAYS 1 Total Inpatient Days (include private amp swing-bed) (Adj ) 2 Inpatient Days (include private exclude swing-bed) 3 Private Room Days (exclude swing-bed private room) (Adj ) 4 Semi-Private Room Days (exclude swing-bed) (Adj ) 5 Medicare NF Swing-Bed Days through Dec 31 (Adj ) 6 Medicare NF Swing-Bed Days after Dec 31 (Adj ) 7 Medi-Cal NF Swing-Bed Days through July 31 (Adj ) 8 Medi-Cal NF Swing-Bed Days after July 31 (Adj ) 9 Medi-Cal Days (excluding swing-bed) (Adj )

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

SW ING-BED ADJUSTMENT 17 Medicare NF Swing-Bed Rates through Dec 31 (Adj )18 Medicare NF Swing-Bed Rates after Dec 31 (Adj )19 Medi-Cal NF Swing-Bed Rates through July 31 (Adj )20 Medi-Cal NF Swing-Bed Rates after July 31 (Adj )21 Total Routine Serv Cost (Sch 8 Line 30 Col 27)22 Medicare NF Swing-Bed Cost through Dec 31 (L 5 x L 17)23 Medicare NF Swing-Bed Cost after Dec 31 (L 6 x L 18)24 Medi-Cal NF Swing-Bed Cost through July 31 (L 7 x L 19)25 Medi-Cal NF Swing-Bed Cost after July 31 (L 8 x L 20)26 Total Swing-Bed Cost (Sum of Lines 22 to 25)27 Inpatient Routine Cost Net of Swing-Bed (L 21 minus L 26)

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

PRIVATE ROOM DIFFERENTIAL ADJUSTMENT 28 Gen Inpatient Routine Serv Charges (excl swing-bed charges)29 Private Room Charges (excluding swing-bed charges)30 Semi-Private Room Charges (excluding swing-bed charges)31 Gen Inpatient Routine Service CostCharge Ratio (L 27 divide L 28)32 Average Private Room Per Diem Charge (L 29 divide L 3)33 Average Semi-Private Room Per Diem Charge (L 30 divide L 4)34 Avg Per Diem Prvt Room Charge Differential (L 32 minus L 33)35 Average Per Diem Private Room Cost Differential (L 31 x L 34)36 Private Room Cost Differential Adjustment (L 35 x L 3)37 Inpatient Rout Cost Net of Swing-Bed amp Prvt Rm (L 27 minus L 36)

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

PROGRAM INPATIENT OPERATING COST 38 Adjusted General Inpatient Routine Cost Per Diem (L 37 divide L 2)39 Program General Inpatient Routine Service Cost (L 9 x L 38)

611990

54134 0

40 Cost Applicable to Medi-Cal (Sch 4A)41 Cost Applicable to Medi-Cal (Sch 4B)

28137 938

42 TOTAL MEDI-CAL ROUTINE COST (Sum of Lines 3940 amp 41) $ 0 $ 29075 ( To Schedule 3 )

STATE OF CALIFORNIA SCHEDULE 4A PROGRAM NONCONTRACT

SPECIAL CARE ANDOR NURSERY UNITS REPORTED AUDITED

NURSERY 1 Total Inpatient Routine Cost (Sch 8 Line 43 Col 27)

2 Total Inpatient Days (Adj ) 3 Average Per Diem Cost 4 Medi-Cal Inpatient Days (Adj ) 5 Cost Applicable to Medi-Cal

0000 0

INTENSIVE CARE UNIT 6 Total Inpatient Routine Cost (Sch 8 Line 31 Col 27)

7 Total Inpatient Days (Adj ) 8 Average Per Diem Cost

9 Medi-Cal Inpatient Days (Adj ) 10 Cost Applicable to Medi-Cal

$ 39646812434

$ 1628870

35907202434

14752300

CORONARY CARE UNIT 11 Total Inpatient Routine Cost (Sch 8 Line 32 Col 27)

0000 0

BURN INTENSIVE CARE UNIT 16 Total Inpatient Routine Cost (Sch 8 Line 33 Col 27)17 Total Inpatient Days (Adj ) 18 Average Per Diem Cost19 Medi-Cal Inpatient Days (Adj ) 20 Cost Applicable to Medi-Cal

0000 0

000 0 0

SURGICAL INTENSIVE CARE UNIT 21 Total Inpatient Routine Cost (Sch 8 Line 34 Col 27)22 Total Inpatient Days (Adj ) 23 Average Per Diem Cost24 Medi-Cal Inpatient Days (Adj ) 25 Cost Applicable to Medi-Cal

0000 0

000 0 0

OTHER SPECIAL CARE (SPECIFY) 26 Total Inpatient Routine Cost (Sch 8 Line 35 Col 27)27 Total Inpatient Days (Adj ) 28 Average Per Diem Cost29 Medi-Cal Inpatient Days (Adj ) 30 Cost Applicable to Medi-Cal

0000 0

000 0 0

ADMINISTRATIVE DAYS (JANUARY 2011 amp MARCH 2011-MAY 2011) 31 Per Diem Rate (Adj 7)32 Medi-Cal Inpatient Days (Adj 7) 33 Cost Applicable to Medi-Cal

0000 0

40948 55

ADMINISTRATIVE DAYS (JUNE 2011) 34 Per Diem Rate (Adj 8)35 Medi-Cal Inpatient Days (Adj 8) 36 Cost Applicable to Medi-Cal

0000 0

40116 14

37 Medi-Cal Routine Cost (Sum of Lines 510152025303336) $ 0 $ 28137 (To Schedule 4)

STATE OF CALIFORNIA SCHEDULE 4B PROGRAM NONCONTRACT

ADMINISTRATIVE DAYS (AUGUST 2011) 1 na 2 na 3 Per Diem Rate (Adj 9) 4 Medi-Cal Inpatient Days (Adj 9) 5 Cost Applicable to Medi-Cal

PORTED

0000 0

AUDITED

312713

6 Total Inpatient Routine Cost (Sch 8 Line ___ Col 27) 7 Total Inpatient Days (Adj ) 8 Average Per Diem Cost 9 Medi-Cal Inpatient Days (Adj ) 10 Cost Applicable to Medi-Cal

0000 0

11 Total Inpatient Routine Cost (Sch 8 Line ___ Col 27)12 Total Inpatient Days (Adj ) 13 Average Per Diem Cost14 Medi-Cal Inpatient Days (Adj ) 15 Cost Applicable to Medi-Cal

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

SCHEDULE OF MEDI-CAL ANCILLARY COSTS

TOTAL ANCILLARY

TOTAL ANCILLARY CHARGES

(Adj )

RATIO COST TO CHARGES (From Schedule 6)

MEDI-CAL CHARGES COST

MEDI-CAL

ANCILLARY COST CENTERS 5000 Operating Room $ 2044615 $ 9149585 0223465 $ 0 $ 0 5100 Recovery Room 0 0 0000000 0 0 5200 Labor Room and Delivery Room 0 0 0000000 0 0 5300 Anesthesiology 0 0 0000000 0 0 5400 Radiology-Diagnostic 1537951 5097795 0301690 0 0 5500 Radiology-Therapeutic 0 0 0000000 0 0 5600 Radioisotope 0 0 0000000 0 0 5700 Computed Tomography (CT) Scan 0 0 0000000 0 0 5800 Magnetic Resonance Imaging (MRI) 0 0 0000000 0 0 5900 Cardiac Catheterization 0 0 0000000 0 0 6000 Laboratory 2897941 22111822 0131058 0 0 6100 PBP Clinical Laboratory Services-Program Only 0 0 0000000 0 0 6200 W hole Blood amp Packed Red Blood Cells 0 0 0000000 0 0 6300 Blood Storing Processing amp Trans 0 0 0000000 0 0 6400 Intravenous Therapy 0 0 0000000 0 0 6500 Respiratory Therapy 1457819 12182434 0119666 0 0 6600 Physical Therapy 424920 466078 0911694 0 0 6700 Occupational Therapy 0 0 0000000 0 0 6800 PsychiatricPsychological 4054146 42469195 0095461 0 0 6900 Electrocardiology 188812 1827744 0103303 0 0 7000 Electroencephalography 0 0 0000000 0 0 7100 Medical Supplies Charged to Patients 2742483 15096631 0181662 0 0 7200 Implantable Devices Charged to Patients 1189992 2592908 0458941 0 0 7300 Drugs Charged to Patients 3921416 22381305 0175209 0 0 7400 Renal Dialysis 0 0 0000000 0 0 7500 ASC (Non-Distinct Part) 0 0 0000000 0 0 7600 Other Ancillary (specify) 0 0 0000000 0 0 7700 0 0 0000000 0 0 7800 0 0 0000000 0 0 7900 0 0 0000000 0 0 8000 0 0 0000000 0 0 8100 0 0 0000000 0 0 8200 0 0 0000000 0 0 8300 0 0 0000000 0 0 8400 0 0 0000000 0 0 8500 0 0 0000000 0 0 8600 0 0 0000000 0 0 8700 0 0 0000000 0 0 8701 0 0 0000000 0 0 8800 Rural Health Clinic (RHC) 0 0 0000000 0 0 8900 Federally Qualified Health Center (FQHC) 0 0 0000000 0 0 9000 Clinic 3508835 2849185 1231522 0 0 9100 Emergency 0 0 0000000 0 0 9200 Observation Beds 0 0 0000000 0 0 9300 Other Outpatient Services (Specify) 0 0 0000000 0 0 9301 0 0 0000000 0 0 9302 0 0 0000000 0 0 9303 0 0 0000000 0 0 9304 0 0 0000000 0 0 9305 0 0 0000000 0 0

TOTAL $ 23968930 $ 136224682 $ 0 $ 0 (To Schedule 3)

From Schedule 8 Column 26

ADJUSTMENTS TO MEDI-CAL CHARGES

ANCILLARY CHARGES REPORTED

(Adj ) ADJUSTMENTS AUDITED

5000 Operating Room $ 0 $ $ 0 5100 Recovery Room 0 0 5200 Labor Room and Delivery Room 0 0 5300 Anesthesiology 0 0 5400 Radiology-Diagnostic 0 0 5500 Radiology-Therapeutic 0 0 5600 Radioisotope 0 0 5700 Computed Tomography (CT) Scan 0 0 5800 Magnetic Resonance Imaging (MRI) 0 0 5900 Cardiac Catheterization 0 0 6000 Laboratory 0 0 6100 PBP Clinical Laboratory Services-Program Only 0 0 6200 W hole Blood amp Packed Red Blood Cells 0 0 6300 Blood Storing Processing amp Trans 0 0 6400 Intravenous Therapy 0 0 6500 Respiratory Therapy 0 0 6600 Physical Therapy 0 0 6700 Occupational Therapy 0 0 6800 PsychiatricPsychological 0 0 6900 Electrocardiology 0 0 7000 Electroencephalography 0 0 7100 Medical Supplies Charged to Patients 0 0 7200 Implantable Devices Charged to Patients 0 0 7300 Drugs Charged to Patients 0 0 7400 Renal Dialysis 0 0 7500 ASC (Non-Distinct Part) 0 0 7600 Other Ancillary (specify) 0 0 7700 0 0 7800 0 0 7900 0 0 8000 0 0 8100 0 0 8200 0 0 8300 0 0 8400 0 0 8500 0 0 8600 0 0 8700 0 0 8701 0 0 8800 Rural Health Clinic (RHC) 0 0 8900 Federally Qualified Health Center (FQHC) 0 0 9000 Clinic 0 0 9100 Emergency 0 0 9200 Observation Beds 0 0 9300 Other Outpatient Services (Specify) 0 0 9301 0 0 9302 0 0 9303 0 0 9304 0 0 9305 0 0

TOTAL MEDI-CAL ANCILLARY CHARGES $ 0 $ 0 $ 0 (To Schedule 5)

COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED

PHYSICIANS REMUNERATION

PROFESSIONAL SERVICE

COST CENTERS REMUNERATION

(Adj )

TOTAL CHARGES TO ALL PATIENTS

(Adj ) TO CHARGES

RATIO OF REMUNERATION CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

5300 Anesthesiology $ 0 $ 0 0000000 $ $ 0 5400 Radiology - Diagnostic 0 0 0000000 0 5500 Radioisotope 0 0 0000000 0 6000 Laboratory 0 0 0000000 0 6900 Electrocardiology 0 0 0000000 0 7000 Electroencephalography 0 0 0000000 0 9100 Emergency 0 0 0000000 0

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

STATE OF CALIFORNIA CONTRACT SCH 1

COMPUTATION OF MEDI-CAL CONTRACT COST

REPORTED AUDITED

1 Net Cost of Covered Services Rendered to Medi-Cal Patients (Contract Sch 3) $ 25483627 $ 5521251

2 Excess Reasonable Cost Over Charges (Contract Sch 2) $ 0 $ 0

4 $ 0 $ 0

5 Subtotal (Sum of Lines 1 through 4) $ 25483627 $ 5521251

6 $ 0 $ 0

7 $ 0 $ 0

8 Total Medi-Cal Cost (Sum of Lines 5 through 7) $ 25483627 $ 5521251 (To Summary of Findings)

9 Medi-Cal Overpayments (Adj ) $ 0 $ 0

10 Medi-Cal Credit Balances (Adj 17) $ 0 $ (19107)

11 $ 0 $ 0

12 $ 0 $ 0

13 TOTAL MEDI-CAL SETTLEMENT Due Provider (State) $ 0 $ (19107) (To Summary of Findings)

REPORTED AUDITED

1 Cost of Covered Services (Contract Sch 3) $ 25483627 $ 5670987

3 Inpatient Ancillary Service Charges (Adj 15) $ 48745717 $ 17567507

(To Contract Sch 1)

COMPUTATION OF MEDI-CAL NET COST OF COVERED SERVICES

REPORTED AUDITED

1 Medi-Cal Inpatient Ancillary Services (Contract Sch 5) $ 8607229 $ 2885841

2 Medi-Cal Inpatient Routine Services (Contract Sch 4) $ 16876398 $ 2785146

4 Medical and Other Services $ 0 $ 0

5 $ 0 $ 0

7 Medi-Cal Inpatient Hospital Based Physician for Acute Care Services (Contract Sch 7) $ 0 $ 0

8 SUBTOTAL $ 25483627 $ 5670987 (To Contract Sch 2)

9 Medi-Cal Deductibles (Adj 16) $ 0 $ (1485)

(To Contract Sch 1)

GENERAL SERVICE UNIT NET OF SWING-BEDS COSTS REPORTED AUDITED

INPATIENT DAYS 1 Total Inpatient Days (include private amp swing-bed) (Adj ) 2 Inpatient Days (include private exclude swing-bed) 3 Private Room Days (exclude swing-bed private room) (Adj ) 4 Semi-Private Room Days (exclude swing-bed) (Adj ) 5 Medicare NF Swing-Bed Days through Dec 31 (Adj ) 6 Medicare NF Swing-Bed Days after Dec 31 (Adj ) 7 Medi-Cal NF Swing-Bed Days through July 31 (Adj ) 8 Medi-Cal NF Swing-Bed Days after July 31 (Adj ) 9 Medi-Cal Days (excluding swing-bed) (Adj 13)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

PRIVATE ROOM DIFFERENTIAL ADJUSTMENT 28 Gen Inpatient Routine Serv Charges (excl swing-bed charges) (Adj )29 Private Room Charges (excluding swing-bed charges) (Adj )30 Semi-Private Room Charges (excluding swing-bed charges) (Adj )31 Gen Inpatient Routine Service CostCharge Ratio (L 27 divide L 28)32 Average Private Room Per Diem Charge (L 29 divide L 3)33 Average Semi-Private Room Per Diem Charge (L 30 divide L 4)34 Avg Per Diem Prvt Room Charge Differential (L 32 minus L 33)35 Average Per Diem Private Room Cost Differential (L 31 x L 34)36 Private Room Cost Differential Adjustment (L 35 x L 3)37 Inpatient Rout Cost Net of Swing-Bed amp Prvt Rm (L 27 minus L 36)

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

40 Cost Applicable to Medi-Cal (Contract Sch 4A)41 Cost Applicable to Medi-Cal (Contract Sch 4B)

18422520

1385241 0

42 TOTAL MEDI-CAL ROUTINE COST (Sum of Lines 39 40 amp 41) $ 16876398 $ (To Contract Sch 3)

2785146

STATE OF CALIFORNIA CONTRACT SCH 4A

NURSERY 1 Total Inpatient Routine Cost (Sch 8 Line 43 Col 27) 2 Total Inpatient Days (Adj ) 3 Average Per Diem Cost 4 Medi-Cal Inpatient Days (Adj ) 5 Cost Applicable to Medi-Cal

0000 0

INTENSIVE CARE UNIT 6 Total Inpatient Routine Cost (Sch 8 Line 31 Col 27) 7 Total Inpatient Days (Adj ) 8 Average Per Diem Cost 9 Medi-Cal Inpatient Days (Adj 13) 10 Cost Applicable to Medi-Cal

39646812434

1628871131

1842252

35907202434

147523939

1385241

CORONARY CARE UNIT 11 Total Inpatient Routine Cost (Sch 8 Line 32 Col 27) 12 Total Inpatient Days (Adj ) 13 Average Per Diem Cost 14 Medi-Cal Inpatient Days (Adj ) 15 Cost Applicable to Medi-Cal

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

31 Medi-Cal Routine Cost (Sum of Lines 51015202530) $ 1842252 $ 1385241 (To Contract Sch 4)

STATE OF CALIFORNIA CONTRACT SCH 4B

SPECIAL CARE UNITS REPORTED AUDITED

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

26 Total Inpatient Routine Cost (Sch 8 Line 35 Col 27)27 Total Inpatient Days (Adj ) 28 Average Per Diem Cost29 Medi-Cal Inpatient Days (Adj ) 30 Cost Applicable to Medi-Cal

0000 0

000 0 0

31 Medi-Cal Routine Cost (Sum of Lines 51015202530) $ 0 $ (To Contract Sch 4)

TOTAL ANCILLARY

TOTAL ANCILLARYCHARGES

(Adj )

RATIO COST TO CHARGES

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

TOTAL $ 23968930 $ 136224682 $ 17567507 $ 2885841 (To Contract Sch 3)

ANCILLARY CHARGES REPORTED ADJUSTMENTS

(Adj 14) AUDITED

5000 Operating Room $ 854684 $ 296748 $ 1151432 5100 Recovery Room 0 0 0 5200 Labor Room and Delivery Room 0 0 0 5300 Anesthesiology 0 0 0 5400 Radiology-Diagnostic 1407277 (642093) 765184 5500 Radiology-Therapeutic 0 0 0 5600 Radioisotope 0 0 0 5700 Computed Tomography (CT) Scan 0 0 0 5800 Magnetic Resonance Imaging (MRI) 0 0 0 5900 Cardiac Catheterization 0 0 0 6000 Laboratory 7620289 (4174049) 3446240 6100 PBP Clinical Laboratory Services-Program Only 0 0 0 6200 W hole Blood amp Packed Red Blood Cells 0 0 0 6300 Blood Storing Processing amp Trans 0 0 0 6400 Intravenous Therapy 0 0 0 6500 Respiratory Therapy 5354917 (1413273) 3941644 6600 Physical Therapy 58000 (27409) 30591 6700 Occupational Therapy 0 0 0 6800 PsychiatricPsychological 17663250 (17663250) 0 6900 Electrocardiology 431562 (106261) 325301 7000 Electroencephalography 0 0 0 7100 Medical Supplies Charged to Patients 4631885 (377208) 4254677 7200 Implantable Devices Charged to Patients 68419 (68419) 0 7300 Drugs Charged to Patients 9844191 (6191753) 3652438 7400 Renal Dialysis 0 0 0 7500 ASC (Non-Distinct Part) 0 0 0 7600 Other Ancillary (specify) 0 0 0 7700 0 0 0 7800 0 0 0 7900 0 0 0 8000 0 0 0 8100 0 0 0 8200 0 0 0 8300 0 0 0 8400 0 0 0 8500 0 0 0 8600 0 0 0 8700 0 0 0 8701 0 0 0 8800 Rural Health Clinic (RHC) 0 0 0 8900 Federally Qualified Health Center (FQHC) 0 0 0 9000 Clinic 811243 (811243) 0 9100 Emergency 0 0 0 9200 Observation Beds 0 0 0 9300 Other Outpatient Services (Specify) 0 0 0 9301 0 0 0 9302 0 0 0 9303 0 0 0 9304 0 0 0 9305 0 0 0

TOTAL MEDI-CAL ANCILLARY CHARGES $ 48745717 $ (31178210) $ 17567507 (To Contract Sch 5)

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO ALL PATIENTS TOTAL CHARGES

TO CHARGES

RATIO OF REMUNERATION

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

STATE OF CALIFORNIA COMPUTATION OF COST ALLOCATION (WS B) SCHEDULE 8

NET EXP FOR CAPITAL CAPITAL OTHER CAP TRIAL BALANCE COST ALLOC BLDG amp MOVABLE RELATED ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC

EXPENSES (From Sch 10) FIXTURES EQUIP COSTS COST COST COST COST COST COST COST COST 000 100 200 300 301 302 303 304 305 306 307 308

GENERAL SERVICE COST CENTER 100 New Capital Related Costs-Buildings amp Fixt 4240377 200 New Capital Related Costs-Movable Equipm 1173026 0 300 Other Capital Related Costs 0 0 0 301 0 0 0 0 302 0 0 0 0 0 303 0 0 0 0 0 0 304 0 0 0 0 0 0 0 305 0 0 0 0 0 0 0 0 306 0 0 0 0 0 0 0 0 0 307 0 0 0 0 0 0 0 0 0 0 308 0 0 0 0 0 0 0 0 0 0 0 309 0 0 0 0 0 0 0 0 0 0 0 0 400 Employee Benefits 3174525 11695 3235 0 0 0 0 0 0 0 0 0 501 0 0 0 0 0 0 0 0 0 0 0 0 502 0 0 0 0 0 0 0 0 0 0 0 0 503 0 0 0 0 0 0 0 0 0 0 0 0 504 0 0 0 0 0 0 0 0 0 0 0 0 505 0 0 0 0 0 0 0 0 0 0 0 0 506 0 0 0 0 0 0 0 0 0 0 0 0 507 0 0 0 0 0 0 0 0 0 0 0 0 508 0 0 0 0 0 0 0 0 0 0 0 0 500 Administrative and General 7545972 489469 135403 0 0 0 0 0 0 0 0 0 600 Maintenance and Repairs 3012381 153146 42365 0 0 0 0 0 0 0 0 0 700 Operation of Plant 0 0 0 0 0 0 0 0 0 0 0 0 800 Laundry and Linen Service 308001 685 190 0 0 0 0 0 0 0 0 0 900 Housekeeping 1030564 35009 9685 0 0 0 0 0 0 0 0 0

1000 Dietary 1932595 130579 36122 0 0 0 0 0 0 0 0 0 1100 Cafeteria 0 78043 21589 0 0 0 0 0 0 0 0 0 1200 Maintenance of Personnel 0 0 0 0 0 0 0 0 0 0 0 0 1300 Nursing Administration 2729413 17512 4844 0 0 0 0 0 0 0 0 0 1400 Central Services and Supply 186144 81104 22436 0 0 0 0 0 0 0 0 0 1500 Pharmacy 1267265 18624 5152 0 0 0 0 0 0 0 0 0 1600 Medical Records amp Library 1019310 95098 26307 0 0 0 0 0 0 0 0 0 1700 Social Service 897148 16263 4499 0 0 0 0 0 0 0 0 0 1800 Other General Service (specify) 0 0 0 0 0 0 0 0 0 0 0 0 1900 Nonphysician Anesthetists 0 0 0 0 0 0 0 0 0 0 0 0 2000 Nursing School 0 0 0 0 0 0 0 0 0 0 0 0 2100 Intern amp Res Service-Salary amp Fringes (Approved) 0 0 0 0 0 0 0 0 0 0 0 0 2200 Intern amp Res Other Program Costs (Approved) 148412 0 0 0 0 0 0 0 0 0 0 0 2300 Paramedical Ed Program (specify) 0 0 0 0 0 0 0 0 0 0 0 0 2301 0 0 0 0 0 0 0 0 0 0 0 0 2302 0 0 0 0 0 0 0 0 0 0 0 0

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine) 13739800 949350 262621 0 0 0 0 0 0 0 0 0

3100 Intensive Care Unit 2095178 76398 21134 0 0 0 0 0 0 0 0 0 3200 Coronary Care Unit 0 0 0 0 0 0 0 0 0 0 0 0 3300 Burn Intensive Care Unit 0 0 0 0 0 0 0 0 0 0 0 0 3400 Surgical Intensive Care Unit 0 0 0 0 0 0 0 0 0 0 0 0 3500 Other Special Care (specify) 0 0 0 0 0 0 0 0 0 0 0 0 4000 Subprovider - IPF 0 0 0 0 0 0 0 0 0 0 0 0 4100 Subprovider - IRF 0 0 0 0 0 0 0 0 0 0 0 0 4200 Subprovider (specify) 4300 Nursery

4400 Skilled Nursing Facility 0 0 0 0 0 0 0 0 0 0 0 0 4500 Nursing Facility 0 0 0 0 0 0 0 0 0 0 0 0 4600 Other Long Term Care 0 0 0 0 0 0 0 0 0 0 0 0 4700 0 0 0 0 0 0 0 0 0 0 0 0

ANCILLARY COST CENTERS 5000 Operating Room 994885 127350 35229 0 0 0 0 0 0 0 0 0 5100 Recovery Room 0 0 0 0 0 0 0 0 0 0 0 0 5200 Labor Room and Delivery Room 0 0 0 0 0 0 0 0 0 0 0 0 5300 Anesthesiology 0 0 0 0 0 0 0 0 0 0 0 0 5400 Radiology-Diagnostic 868991 110371 30532 0 0 0 0 0 0 0 0 0 5500 Radiology-Therapeutic 0 0 0 0 0 0 0 0 0 0 0 0 5600 Radioisotope 0 0 0 0 0 0 0 0 0 0 0 0 5700 Computed Tomography (CT) Scan 0 0 0 0 0 0 0 0 0 0 0 0 5800 Magnetic Resonance Imaging (MRI) 0 0 0 0 0 0 0 0 0 0 0 0 5900 Cardiac Catheterization 0 0 0 0 0 0 0 0 0 0 0 0 6000 Laboratory 1939439 48440 13400 0 0 0 0 0 0 0 0 0 6100 PBP Clinical Laboratory Services-Program Only 0 0 0 0 0 0 0 0 0 0 0 0 6200 W hole Blood amp Packed Red Blood Cells 0 0 0 0 0 0 0 0 0 0 0 0 6300 Blood Storing Processing amp Trans 0 0 0 0 0 0 0 0 0 0 0 0 6400 Intravenous Therapy 0 0 0 0 0 0 0 0 0 0 0 0 6500 Respiratory Therapy 977285 19492 5392 0 0 0 0 0 0 0 0 0 6600 Physical Therapy 321718 3046 843 0 0 0 0 0 0 0 0 0 6700 Occupational Therapy 0 0 0 0 0 0 0 0 0 0 0 0 6800 PsychiatricPsychological 2253381 78789 21796 0 0 0 0 0 0 0 0 0 6900 Electrocardiology 83550 23192 6416 0 0 0 0 0 0 0 0 0 7000 Electroencephalography 0 0 0 0 0 0 0 0 0 0 0 0 7100 Medical Supplies Charged to Patients 1909028 0 0 0 0 0 0 0 0 0 0 0 7200 Implantable Devices Charged to Patients 864303 0 0 0 0 0 0 0 0 0 0 0 7300 Drugs Charged to Patients 1673442 0 0 0 0 0 0 0 0 0 0 0 7400 Renal Dialysis 0 0 0 0 0 0 0 0 0 0 0 0 7500 ASC (Non-Distinct Part) 0 0 0 0 0 0 0 0 0 0 0 0 7600 Other Ancillary (specify) 0 0 0 0 0 0 0 0 0 0 0 0 7700 0 0 0 0 0 0 0 0 0 0 0 0 7800 0 0 0 0 0 0 0 0 0 0 0 0 7900 0 0 0 0 0 0 0 0 0 0 0 0 8000 0 0 0 0 0 0 0 0 0 0 0 0 8100 0 0 0 0 0 0 0 0 0 0 0 0 8200 0 0 0 0 0 0 0 0 0 0 0 0 8300 0 0 0 0 0 0 0 0 0 0 0 0 8400 0 0 0 0 0 0 0 0 0 0 0 0 8500 0 0 0 0 0 0 0 0 0 0 0 0 8600 0 0 0 0 0 0 0 0 0 0 0 0 8700 0 0 0 0 0 0 0 0 0 0 0 0 8701 0 0 0 0 0 0 0 0 0 0 0 0 8800 Rural Health Clinic (RHC) 0 0 0 0 0 0 0 0 0 0 0 0 8900 Federally Qualified Health Center (FQHC) 0 0 0 0 0 0 0 0 0 0 0 0 9000 Clinic 1051572 590429 163332 0 0 0 0 0 0 0 0 0 9100 Emergency 0 0 0 0 0 0 0 0 0 0 0 0 9200 Observation Beds 0 0 0 0 0 0 0 0 0 0 0 0 9300 Other Outpatient Services (Specify) 0 0 0 0 0 0 0 0 0 0 0 0 9301 0 0 0 0 0 0 0 0 0 0 0 0 9302 0 0 0 0 0 0 0 0 0 0 0 0 9303 0 0 0 0 0 0 0 0 0 0 0 0 9304 0 0 0 0 0 0 0 0 0 0 0 0 9305 0 0 0 0 0 0 0 0 0 0 0 0

NONREIMBURSABLE COST CENTERS 9400 Home Program Dialysis 0 0 0 0 0 0 0 0 0 0 0 0 9500 Ambulance Services 0 0 0 0 0 0 0 0 0 0 0 0 9600 Durable Medical Equipment-Rented 0 0 0 0 0 0 0 0 0 0 0 0 9700 Durable Medical Equipment-Sold 0 0 0 0 0 0 0 0 0 0 0 0 9800 Other Reimbursable (specify) 0 0 0 0 0 0 0 0 0 0 0 0 9900 Outpatient Rehabilitation Provider (specify) 0 0 0 0 0 0 0 0 0 0 0 0

10000 Intern-Resident Service (not appvd tchng prgm) 0 0 0 0 0 0 0 0 0 0 0 0

10100 Home Health Agency 0 0 0 0 0 0 0 0 0 0 0 0

EXPENSES (From Sch 10) 000

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

10500 Kidney Acquisition 10600 Heart Acquisition 10700 Liver Acquisition 10800 Lung Acquisition 10900 Pancreas Acquisition 11000 Intestinal Acquisition 11100 Islet Acquisition 11200 Other Organ Acquisition (specify) 11300 Interest Expense 11400 Utilization Review-SNF

0 0 0 0 0 0 0 0 0 0

11500 Ambulatory Surgical Center (Distinct Part) 11600 Hospice 11700 Other Special Purpose (specify) 19000 Gift Flower Coffee Shop amp Canteen 19100 Research

0 0 0 0 0

19200 Physicians Private Offices 19300 Nonpaid W orkers 19400 Public Relations 19401 Patient Transportation 19402 Doctors Meal

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

ADMINIS-TRIAL BALANCE ALLOC EMPLOYEE ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ALLOC ACCUMULATE TRATIVE amp

EXPENSES COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL 309 400 501 502 503 504 505 506 507 508 500

GENERAL SERVICE COST CENTER 100 New Capital Related Costs-Buildings amp Fixt 200 New Capital Related Costs-Movable Equipm 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 0 501 0 0 502 0 0 0 503 0 0 0 0 504 0 0 0 0 0 505 0 0 0 0 0 0 506 0 0 0 0 0 0 0 507 0 0 0 0 0 0 0 0 508 0 0 0 0 0 0 0 0 0 500 Administrative and General 0 458051 0 0 0 0 0 0 0 0 8628895 600 Maintenance and Repairs 0 56751 0 0 0 0 0 0 0 0 3264643 564128 700 Operation of Plant 0 0 0 0 0 0 0 0 0 0 0 0 800 Laundry and Linen Service 0 0 0 0 0 0 0 0 0 0 308876 53374 900 Housekeeping 0 68199 0 0 0 0 0 0 0 0 1143456 197589

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

CENTRAL MEDICAL TRIAL BALANCE MAINT amp OPERATION LAUNDRY amp MAINT OF NURSING SERVICE RECORDS SOCIAL

EXPENSES REPAIR OF PLANT LINEN HOUSEKEEP DIETARY CAFETERIA PERSONNEL ADMIN amp SUPPLY PHARMACY amp LIBRARY SERVICE 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700

GENERAL SERVICE COST CENTER 100 New Capital Related Costs-Buildings amp Fixt 200 New Capital Related Costs-Movable Equipm 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 501 502 503 504 505 506 507 508 500 Administrative and General 600 Maintenance and Repairs 700 Operation of Plant 0 800 Laundry and Linen Service 732 0 900 Housekeeping 37378 0 12010

1000 Dietary 139416 0 2536 51139 1100 Cafeteria 83325 0 0 30564 150006 1200 Maintenance of Personnel 0 0 0 0 0 0 1300 Nursing Administration 18697 0 0 6858 0 9848 0 1400 Central Services and Supply 86593 0 0 31763 0 3996 0 0 1500 Pharmacy 19884 0 0 7294 0 12201 0 0 909 1600 Medical Records amp Library 101534 0 0 37243 0 10002 0 0 0 0 1700 Social Service 17364 0 0 6369 0 13227 0 0 0 0 0 1800 Other General Service (specify) 0 0 0 0 0 0 0 0 0 0 0 0 1900 Nonphysician Anesthetists 0 0 0 0 0 0 0 0 0 0 0 0 2000 Nursing School 0 0 0 0 0 0 0 0 0 0 0 0 2100 Intern amp Res Service-Salary amp Fringes (Approved) 0 0 0 0 0 0 0 0 0 0 0 0 2200 Intern amp Res Other Program Costs (Approved) 0 0 0 0 0 2601 0 0 0 0 0 0 2300 Paramedical Ed Program (specify) 0 0 0 0 0 0 0 0 0 0 0 0 2301 0 0 0 0 0 0 0 0 0 0 0 0 2302 0 0 0 0 0 0 0 0 0 0 0 0

Provider Nam e Fiscal Period Ended SILVER LAKE MEDICAL CENTER DECEMBER 31 2011

10500 Kidney Acquisition 0 0 0 0 0 0 0 0 0 0 0 0 10600 Heart Acquisition 0 0 0 0 0 0 0 0 0 0 0 0 10700 Liver Acquisition 0 0 0 0 0 0 0 0 0 0 0 0 10800 Lung Acquisition 0 0 0 0 0 0 0 0 0 0 0 0 10900 Pancreas Acquisition 0 0 0 0 0 0 0 0 0 0 0 0 11000 Intestinal Acquisition 0 0 0 0 0 0 0 0 0 0 0 0 11100 Islet Acquisition 0 0 0 0 0 0 0 0 0 0 0 0 11200 Other Organ Acquisition (specify) 0 0 0 0 0 0 0 0 0 0 0 0 11300 Interest Expense 0 0 0 0 0 0 0 0 0 0 0 0 11400 Utilization Review-SNF 0 0 0 0 0 0 0 0 0 0 0 0 11500 Ambulatory Surgical Center (Distinct Part) 0 0 0 0 0 0 0 0 0 0 0 0 11600 Hospice 0 0 0 0 0 0 0 0 0 0 0 0 11700 Other Special Purpose (specify) 0 0 0 0 0 0 0 0 0 0 0 0 19000 Gift Flower Coffee Shop amp Canteen 0 0 0 0 0 0 0 0 0 0 0 0 19100 Research 0 0 0 0 0 0 0 0 0 0 0 0 19200 Physicians Private Offices 0 0 0 0 0 0 0 0 0 0 0 0 19300 Nonpaid W orkers 0 0 0 0 0 0 0 0 0 0 0 0 19400 Public Relations 16356 0 0 5999 0 3294 0 0 0 0 0 0 19401 Patient Transportation 0 0 0 0 0 16402 0 0 152 0 0 0 19402 Doctors Meal 0 0 0 0 84397 0 0 0 0 0 0 0 19403 MOB 1143458 0 0 419426 0 0 0 0 0 0 0 0

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

POST OTHER GEN IampR OTHER PARAMEDICAL STEP-DOWN TOTAL

TRIAL BALANCE SVC NONPHYSICIAN NURSING I amp R SVC PROGRAM EDUCATION ALLOC ALLOC SUBTOTAL ADJUSTMENT COST EXPENSES (SPECIFIC) ANESTHETIST SCHOOL SAL amp BENEFITS COSTS PROGRAM COST COST (Adj 6)

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

GENERAL SERVICE COST CENTER 100 New Capital Related Costs-Buildings amp Fixt 200 New Capital Related Costs-Movable Equipm 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 501 502 503 504 505 506 507 508 500 Administrative and General 600 Maintenance and Repairs 700 Operation of Plant 800 Laundry and Linen Service 900 Housekeeping

1000 Dietary 1100 Cafeteria 1200 Maintenance of Personnel 1300 Nursing Administration 1400 Central Services and Supply 1500 Pharmacy 1600 Medical Records amp Library 1700 Social Service 1800 Other General Service (specify) 1900 Nonphysician Anesthetists 0 2000 Nursing School 0 0 2100 Intern amp Res Service-Salary amp Fringes (Approved) 0 0 0 2200 Intern amp Res Other Program Costs (Approved) 0 0 0 0 2300 Paramedical Ed Program (specify) 0 0 0 0 0 2301 0 0 0 0 0 0 2302 0 0 0 0 0 0 0

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine) 0 0 0 0 37822 0 0 0 26280443 0 26280443

3100 Intensive Care Unit 0 0 0 0 0 0 0 0 3590720 3590720 3200 Coronary Care Unit 0 0 0 0 0 0 0 0 0 0 3300 Burn Intensive Care Unit 0 0 0 0 0 0 0 0 0 0 3400 Surgical Intensive Care Unit 0 0 0 0 0 0 0 0 0 0 3500 Other Special Care (specify) 0 0 0 0 0 0 0 0 0 0 4000 Subprovider - IPF 0 0 0 0 0 0 0 0 0 0 4100 Subprovider - IRF 0 0 0 0 0 0 0 0 0 0 4200 Subprovider (specify) 4300 Nursery

4400 Skilled Nursing Facility 0 0 0 0 0 0 0 0 0 0 4500 Nursing Facility 0 0 0 0 0 0 0 0 0 0 4600 Other Long Term Care 0 0 0 0 0 0 0 0 0 0 4700 0 0 0 0 0 0 0 0 0 0

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

ANCILLARY COST CENTERS 5000 Operating Room 0 0 0 0 111665 0 0 0 2044615 0 2044615 5100 Recovery Room 0 0 0 0 0 0 0 0 0 0 5200 Labor Room and Delivery Room 0 0 0 0 0 0 0 0 0 0 5300 Anesthesiology 0 0 0 0 0 0 0 0 0 0 5400 Radiology-Diagnostic 0 0 0 0 43225 0 0 0 1537951 0 1537951 5500 Radiology-Therapeutic 0 0 0 0 0 0 0 0 0 0 5600 Radioisotope 0 0 0 0 0 0 0 0 0 0 5700 Computed Tomography (CT) Scan 0 0 0 0 0 0 0 0 0 0 5800 Magnetic Resonance Imaging (MRI) 0 0 0 0 0 0 0 0 0 0 5900 Cardiac Catheterization 0 0 0 0 0 0 0 0 0 0 6000 Laboratory 0 0 0 0 0 0 0 0 2897941 2897941 6100 PBP Clinical Laboratory Services-Program Only 0 0 0 0 0 0 0 0 0 0 6200 W hole Blood amp Packed Red Blood Cells 0 0 0 0 0 0 0 0 0 0 6300 Blood Storing Processing amp Trans 0 0 0 0 0 0 0 0 0 0 6400 Intravenous Therapy 0 0 0 0 0 0 0 0 0 0 6500 Respiratory Therapy 0 0 0 0 0 0 0 0 1457819 1457819 6600 Physical Therapy 0 0 0 0 0 0 0 0 424920 424920 6700 Occupational Therapy 0 0 0 0 0 0 0 0 0 0 6800 PsychiatricPsychological 0 0 0 0 0 0 0 0 4054146 4054146 6900 Electrocardiology 0 0 0 0 0 0 0 0 188812 188812 7000 Electroencephalography 0 0 0 0 0 0 0 0 0 0 7100 Medical Supplies Charged to Patients 0 0 0 0 0 0 0 0 2742483 2742483 7200 Implantable Devices Charged to Patients 0 0 0 0 0 0 0 0 1189992 1189992 7300 Drugs Charged to Patients 0 0 0 0 0 0 0 0 3921416 3921416 7400 Renal Dialysis 0 0 0 0 0 0 0 0 0 0 7500 ASC (Non-Distinct Part) 0 0 0 0 0 0 0 0 0 0 7600 Other Ancillary (specify) 0 0 0 0 0 0 0 0 0 0 7700 0 0 0 0 0 0 0 0 0 0 7800 0 0 0 0 0 0 0 0 0 0 7900 0 0 0 0 0 0 0 0 0 0 8000 0 0 0 0 0 0 0 0 0 0 8100 0 0 0 0 0 0 0 0 0 0 8200 0 0 0 0 0 0 0 0 0 0 8300 0 0 0 0 0 0 0 0 0 0 8400 0 0 0 0 0 0 0 0 0 0 8500 0 0 0 0 0 0 0 0 0 0 8600 0 0 0 0 0 0 0 0 0 0 8700 0 0 0 0 0 0 0 0 0 0 8701 0 0 0 0 0 0 0 0 0 0 8800 Rural Health Clinic (RHC) 0 0 0 0 0 0 0 0 0 0 8900 Federally Qualified Health Center (FQHC) 0 0 0 0 0 0 0 0 0 0 9000 Clinic 0 0 0 0 0 0 0 0 3508835 3508835 9100 Emergency 0 0 0 0 0 0 0 0 0 0 9200 Observation Beds 0 0 0 0 0 0 0 0 0 0 9300 Other Outpatient Services (Specify) 0 0 0 0 0 0 0 0 0 0 9301 0 0 0 0 0 0 0 0 0 0 9302 0 0 0 0 0 0 0 0 0 0 9303 0 0 0 0 0 0 0 0 0 0 9304 0 0 0 0 0 0 0 0 0 0 9305 0 0 0 0 0 0 0 0 0 0

NONREIMBURSABLE COST CENTERS 9400 Home Program Dialysis 0 0 0 0 0 0 0 0 0 0 9500 Ambulance Services 0 0 0 0 0 0 0 0 0 0 9600 Durable Medical Equipment-Rented 0 0 0 0 0 0 0 0 0 0 9700 Durable Medical Equipment-Sold 0 0 0 0 0 0 0 0 0 0 9800 Other Reimbursable (specify) 0 0 0 0 0 0 0 0 0 0 9900 Outpatient Rehabilitation Provider (specify) 0 0 0 0 0 0 0 0 0 0

10000 Intern-Resident Service (not appvd tchng prgm) 0 0 0 0 0 0 0 0 0 0

10100 Home Health Agency 0 0 0 0 0 0 0 0 0 0

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

10500 Kidney Acquisition 0 0 0 0 0 0 0 0 0 0 10600 Heart Acquisition 0 0 0 0 0 0 0 0 0 0 10700 Liver Acquisition 0 0 0 0 0 0 0 0 0 0 10800 Lung Acquisition 0 0 0 0 0 0 0 0 0 0 10900 Pancreas Acquisition 0 0 0 0 0 0 0 0 0 0 11000 Intestinal Acquisition 0 0 0 0 0 0 0 0 0 0 11100 Islet Acquisition 0 0 0 0 0 0 0 0 0 0 11200 Other Organ Acquisition (specify) 0 0 0 0 0 0 0 0 0 0 11300 Interest Expense 0 0 0 0 0 0 0 0 0 0 11400 Utilization Review-SNF 0 0 0 0 0 0 0 0 0 0 11500 Ambulatory Surgical Center (Distinct Part) 0 0 0 0 0 0 0 0 0 0 11600 Hospice 0 0 0 0 0 0 0 0 0 0 11700 Other Special Purpose (specify) 0 0 0 0 0 0 0 0 0 0 19000 Gift Flower Coffee Shop amp Canteen 0 0 0 0 0 0 0 0 0 0 19100 Research 0 0 0 0 0 0 0 0 0 0 19200 Physicians Private Offices 0 0 0 0 0 0 0 0 0 0 19300 Nonpaid W orkers 0 0 0 0 0 0 0 0 0 0 19400 Public Relations 0 0 0 0 0 0 0 0 311426 311426 19401 Patient Transportation 0 0 0 0 0 0 0 0 1162507 1162507 19402 Doctors Meal 0 0 0 0 0 0 0 0 84397 84397 19403 MOB 0 0 0 0 0 0 0 0 3166383 3166383

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA STATISTICS FOR COST ALLOCATION (WS B-1) SCHEDULE 9

NEW CAP REL NEW CAP REL OTHER STAT STAT STAT STAT STAT STAT STAT STAT STAT BLDG amp FIX MOV EQUIP CAP REL

(SQ FT) (SQ FT) (SQ FT) 100 200 300 301 302 303 304 305 306 307 308 309 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )

GENERAL SERVICE COST CENTERS 100 New Capital Related Costs-Buildings amp Fixtures 200 New Capital Related Costs-Movable Equipment 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 768 768 501 502 503 504 505 506 507 508 500 Administrative and General 32143 32143 600 Maintenance and Repairs 10057 10057 700 Operation of Plant 800 Laundry and Linen Service 45 45 900 Housekeeping 2299 2299

1000 Dietary 8575 8575 1100 Cafeteria 5125 5125 1200 Maintenance of Personnel 1300 Nursing Administration 1150 1150 1400 Central Services and Supply 5326 5326 1500 Pharmacy 1223 1223 1600 Medical Records amp Library 6245 6245 1700 Social Service 1068 1068 1800 Other General Service (specify) 1900 Nonphysician Anesthetists 2000 Nursing School 2100 Intern amp Res Service-Salary amp Fringes (Approved)

2200 Intern amp Res Other Program Costs (Approved) 2300 Paramedical Ed Program (specify) 2301 2302

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine) 62343 62343

3100 Intensive Care Unit 5017 5017 3200 Coronary Care Unit 3300 Burn Intensive Care Unit 3400 Surgical Intensive Care Unit 3500 Other Special Care (specify) 4000 Subprovider - IPF 4100 Subprovider - IRF 4200 4300

Subprovider (specify) Nursery

4400 Skilled Nursing Facility 4500 Nursing Facility 4600 Other Long Term Care 4700

Provider Name Fiscal Period Ended SILVER LAKE MEDICAL CENTER DECEM BER 31 2011

ANCILLARY COST CENTERS 5000 Operating Room 8363 8363 5100 Recovery Room 5200 Labor Room and Delivery Room 5300 Anesthesiology 5400 Radiology-Diagnostic 7248 7248 5500 Radiology-Therapeutic 5600 Radioisotope 5700 Computed Tomography (CT) Scan 5800 Magnetic Resonance Imaging (MRI) 5900 Cardiac Catheterization 6000 Laboratory 3181 3181 6100 PBP Clinical Laboratory Services-Program Only

6200 W hole Blood amp Packed Red Blood Cells 6300 Blood Storing Processing amp Trans 6400 Intravenous Therapy 6500 Respiratory Therapy 1280 1280 6600 Physical Therapy 200 200 6700 Occupational Therapy 6800 PsychiatricPsychological 5174 5174 6900 Electrocardiology 1523 1523 7000 Electroencephalography 7100 Medical Supplies Charged to Patients 7200 Implantable Devices Charged to Patients 7300 Drugs Charged to Patients 7400 Renal Dialysis 7500 ASC (Non-Distinct Part) 7600 Other Ancillary (specify) 7700 7800 7900 8000 8100 8200 8300 8400 8500 8600 8700 8701 8800 Rural Health Clinic (RHC) 8900 Federally Qualified Health Center (FQHC) 9000 Clinic 38773 38773 9100 Emergency 9200 Observation Beds 9300 Other Outpatient Services (Specify) 9301 9302 9303 9304 9305

NONREIMBURSABLE COST CENTERS 9400 Home Program Dialysis 9500 Ambulance Services 9600 Durable Medical Equipment-Rented 9700 Durable Medical Equipment-Sold 9800 Other Reimbursable (specify) 9900 Outpatient Rehabilitation Provider (specify) 10000 Intern-Resident Service (not appvd tchng prgm)

10100 Home Health Agency

10500 Kidney Acquisition 10600 Heart Acquisition 10700 Liver Acquisition 10800 Lung Acquisition 10900 Pancreas Acquisition 11000 Intestinal Acquisition 11100 Islet Acquisition 11200 Other Organ Acquisition (specify) 11300 Interest Expense 11400 Utilization Review-SNF 11500 Ambulatory Surgical Center (Distinct Part) 11600 Hospice 11700 Other Special Purpose (specify) 19000 Gift Flower Coffee Shop amp Canteen 19100 Research 19200 Physicians Private Offices 19300 Nonpaid W orkers 19400 Public Relations 1006 1006 19401 Patient Transportation 19402 Doctors Meal 19403 MOB 70330 70330

TOTAL 278462 278462 0 0 0 0 0 0 0 0 0 0 COST TO BE ALLOCATED 4240377 1173026 0 0 0 0 0 0 0 0 0 0 UNIT COST MULTIPLIER - SCH 8 15227848 4212517 0000000 0000000 0000000 0000000 0000000 0000000 0000000 0000000 0000000 0000000

STATE OF CALIFORNIA

GENERAL SERVICE COST CENTERS 100 New Capital Related Costs-Buildings amp Fixtures 200 New Capital Related Costs-Movable Equipment 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 501 502 503 504 505 506 507 508 500 Administrative and General 600 Maintenance and Repairs 700 Operation of Plant 800 Laundry and Linen Service 900 Housekeeping 1000 Dietary 1100 Cafeteria 1200 Maintenance of Personnel 1300 Nursing Administration 1400 Central Services and Supply 1500 Pharmacy 1600 Medical Records amp Library 1700 Social Service 1800 Other General Service (specify) 1900 Nonphysician Anesthetists 2000 Nursing School 2100 Intern amp Res Service-Salary amp Fringes (Approved)

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine)

3100 Intensive Care Unit 3200 Coronary Care Unit 3300 Burn Intensive Care Unit 3400 Surgical Intensive Care Unit 3500 Other Special Care (specify) 4000 Subprovider - IPF 4100 Subprovider - IRF 4200 Subprovider (specify) 4300 Nursery 4400 Skilled Nursing Facility 4500 Nursing Facility 4600 Other Long Term Care 4700

STATISTICS FOR COST ALLOCATION (WS B-1) SCHEDULE 91

Fiscal Period Ended DECEM BER 31 2011

EMP BENE (GROSS

SALARIES) 400 (Adj ) (Adj )

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

ADM amp GEN (ACCUM COST) 500

MANT amp REPAIRS (SQ FT)

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

EMP BENE STAT STAT STAT STAT STAT STAT STAT STAT RECON- ADM amp GEN MANT amp (GROSS CILIATION (ACCUM REPAIRS

SALARIES) COST) (SQ FT) 400 501 502 503 504 505 506 507 508 500 600 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )

ANCILLARY COST CENTERS 0 5000 Operating Room 782777 1235654 8363 5100 Recovery Room 0 5200 Labor Room and Delivery Room 0 5300 Anesthesiology 0 5400 Radiology-Diagnostic 620173 1071842 7248 5500 Radiology-Therapeutic 0 5600 Radioisotope 0 5700 Computed Tomography (CT) Scan 0 5800 Magnetic Resonance Imaging (MRI) 0 5900 Cardiac Catheterization 0 6000 Laboratory 1566937 2157796 3181 6100 PBP Clinical Laboratory Services-Program Only 0 6200 W hole Blood amp Packed Red Blood Cells 0 6300 Blood Storing Processing amp Trans 0 6400 Intravenous Therapy 0 6500 Respiratory Therapy 819794 1084056 1280 6600 Physical Therapy 239032 349482 200 6700 Occupational Therapy 0 6800 PsychiatricPsychological 1999834 2553724 5174 6900 Electrocardiology 113158 1523 7000 Electroencephalography 0 7100 Medical Supplies Charged to Patients 1909028 7200 Implantable Devices Charged to Patients 864303 7300 Drugs Charged to Patients 1673442 7400 Renal Dialysis 0 7500 ASC (Non-Distinct Part) 0 7600 Other Ancillary (specify) 0 7700 0 7800 0 7900 0 8000 0 8100 0 8200 0 8300 0 8400 0 8500 0 8600 0 8700 0 8701 0 8800 Rural Health Clinic (RHC) 0 8900 Federally Qualified Health Center (FQHC) 0 9000 Clinic 905639 1895795 38773 9100 Emergency 0 9200 Observation Beds 0 9300 Other Outpatient Services (Specify) 0 9301 0 9302 0 9303 0 9304 0 9305 0

NONREIMBURSABLE COST CENTERS 0 9400 Home Program Dialysis 0 9500 Ambulance Services 0 9600 Durable Medical Equipment-Rented 0 9700 Durable Medical Equipment-Sold 0 9800 Other Reimbursable (specify) 0 9900 Outpatient Rehabilitation Provider (specify) 0 10000 Intern-Resident Service (not appvd tchng prgm) 0

10100 Home Health Agency 0

10500 Kidney Acquisition 0 10600 Heart Acquisition 0 10700 Liver Acquisition 0 10800 Lung Acquisition 0 10900 Pancreas Acquisition 0 11000 Intestinal Acquisition 0 11100 Islet Acquisition 0 11200 Other Organ Acquisition (specify) 0 11300 Interest Expense 0 11400 Utilization Review-SNF 0 11500 Ambulatory Surgical Center (Distinct Part) 0 11600 Hospice 0 11700 Other Special Purpose (specify) 0 19000 Gift Flower Coffee Shop amp Canteen 0 19100 Research 0 19200 Physicians Private Offices 0 19300 Nonpaid W orkers 0 19400 Public Relations 178442 243670 1006 19401 Patient Transportation 563604 977109 19402 Doctors Meal 0 19403 MOB 1367241 70330

TOTAL 31930512 0 0 0 0 0 0 0 0 49935911 235494 COST TO BE ALLOCATED 3189455 0 0 0 0 0 0 0 0 8628895 3828772 UNIT COST MULTIPLIER - SCH 8 0099887 0000000 0000000 0000000 0000000 0000000 0000000 0000000 0000000 0172799 16258468

OPER LAUNDRY HOUSE- DIETARY CAFETERIA MANT OF NURSING CENT SERV PHARMACY MED REC SOC SERV OTHER SVC PLANT amp LINEN KEEPING (MEALS (PAID PERSONNEL ADMIN amp SUPPLY (COST (GROSS (GROSS (TIME (SQ FT) (LB LNDRY) (SQ FT) SERVED) FTES) (NURSE HR) CSTD REQUIS REQUIS) CHARGES) CHARGES) SPENT)

700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )

GENERAL SERVICE COST CENTERS 100 New Capital Related Costs-Buildings amp Fixture 200 New Capital Related Costs-Movable Equipme 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 501 502 503 504 505 506 507 508 500 Administrative and General 600 Maintenance and Repairs 700 Operation of Plant 800 Laundry and Linen Service 900 Housekeeping 14808

1000 Dietary 3127 8575 1100 Cafeteria 5125 26691 1200 Maintenance of Personnel 1300 Nursing Administration 1150 1151 1400 Central Services and Supply 5326 467 1500 Pharmacy 1223 1426 5428 1600 Medical Records amp Library 6245 1169 1700 Social Service 1068 1546 1800 Other General Service (specify) 1900 Nonphysician Anesthetists 2000 Nursing School 2100 Intern amp Res Service-Salary amp Fringes (Approved)

2200 Intern amp Res Other Program Costs (Approved) 304 2300 Paramedical Ed Program (specify) 2301 2302

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine) 346185 62343 385886 22572 139176 2356 81465754 81465754

3100 Intensive Care Unit 35245 5017 1443 1849 34357 779 8519000 8519000 3200 Coronary Care Unit 3300 Burn Intensive Care Unit 3400 Surgical Intensive Care Unit 3500 Other Special Care (specify) 4000 Subprovider - IPF 4100 Subprovider - IRF 4200 4300

OPER LAUNDRY HOUSE- DIETARY CAFETERIA MANT OF NURSING CENT SERV PHARMACY MED REC SOC SERV OTHER SVC PLANT amp LINEN KEEPING (MEALS (PAID PERSONNEL ADMIN amp SUPPLY (COST (GROSS (GROSS (TIME (SQ FT) (LB LNDRY) (SQ FT) SERVED) FTES) (NURSE HR) (CSTD REQUIS) REQUIS) CHARGES) CHARGES) SPENT)

ANCILLARY COST CENTERS 5000 Operating Room 16714 8363 386 982 9610 41770 9149585 9149585 5100 Recovery Room 5200 Labor Room and Delivery Room 5300 Anesthesiology 5400 Radiology-Diagnostic 4045 7248 963 17966 5097795 5097795 5500 Radiology-Therapeutic 5600 Radioisotope 5700 Computed Tomography (CT) Scan 5800 Magnetic Resonance Imaging (MRI) 5900 Cardiac Catheterization 6000 Laboratory 3181 2841 18099 22111822 22111822 6100 PBP Clinical Laboratory Services-Program Only

6200 W hole Blood amp Packed Red Blood Cells 6300 Blood Storing Processing amp Trans 6400 Intravenous Therapy 6500 Respiratory Therapy 1280 1128 1 12182434 12182434 6600 Physical Therapy 2352 200 353 466078 466078 6700 Occupational Therapy 6800 PsychiatricPsychological 5174 53884 4053 5410 12137 42469195 42469195 6900 Electrocardiology 1523 1827744 1827744 7000 Electroencephalography 7100 Medical Supplies Charged to Patients 1909028 15096631 15096631 7200 Implantable Devices Charged to Patients 864303 2592908 2592908 7300 Drugs Charged to Patients 1673442 22381305 22381305 7400 Renal Dialysis 7500 ASC (Non-Distinct Part) 7600 Other Ancillary (specify) 7700 7800 7900 8000 8100 8200 8300 8400 8500 8600 8700 8701 8800 Rural Health Clinic (RHC) 8900 Federally Qualified Health Center (FQHC) 9000 Clinic 25062 38773 5345 1395 20212 2849185 2849185 9100 Emergency 9200 Observation Beds 9300 Other Outpatient Services (Specify) 9301 9302 9303 9304 9305

10500 Kidney Acquisition 10600 Heart Acquisition 10700 Liver Acquisition 10800 Lung Acquisition 10900 Pancreas Acquisition 11000 Intestinal Acquisition 11100 Islet Acquisition 11200 Other Organ Acquisition (specify) 11300 Interest Expense 11400 Utilization Review-SNF 11500 Ambulatory Surgical Center (Distinct Part) 11600 Hospice 11700 Other Special Purpose (specify) 19000 Gift Flower Coffee Shop amp Canteen 19100 Research 19200 Physicians Private Offices 19300 Nonpaid W orkers 19400 Public Relations 1006 385 19401 Patient Transportation 1917 909 19402 Doctors Meal 15017 19403 MOB 70330

NONPHY- NURSING IampR IampR PARAMEDICAL STAT STAT SICIAN ANE SCHOOL SVCampSAL OTHER PROG ED PROG

(ASG TIME) (ASG TIME) 1900 2000 2100 2200 2300 2301 2302 (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj ) (Adj )

GENERAL SERVICE COST CENTERS 100 New Capital Related Costs-Buildings amp Fixture 200 New Capital Related Costs-Movable Equipme 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 501 502 503 504 505 506 507 508 500 Administrative and General 600 Maintenance and Repairs 700 Operation of Plant 800 Laundry and Linen Service 900 Housekeeping

1000 Dietary 1100 Cafeteria 1200 Maintenance of Personnel 1300 Nursing Administration 1400 Central Services and Supply 1500 Pharmacy 1600 Medical Records amp Library 1700 Social Service 1800 Other General Service (specify) 1900 Nonphysician Anesthetists 2000 Nursing School 2100 Intern amp Res Service-Salary amp Fringes (Approved)

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine) 420

3100 Intensive Care Unit 3200 Coronary Care Unit 3300 Burn Intensive Care Unit 3400 Surgical Intensive Care Unit 3500 Other Special Care (specify) 4000 Subprovider - IPF 4100 Subprovider - IRF 4200 4300

ANCILLARY COST CENTERS 5000 Operating Room 1240 5100 Recovery Room 5200 Labor Room and Delivery Room 5300 Anesthesiology 5400 Radiology-Diagnostic 480 5500 Radiology-Therapeutic 5600 Radioisotope 5700 Computed Tomography (CT) Scan 5800 Magnetic Resonance Imaging (MRI) 5900 Cardiac Catheterization 6000 Laboratory 6100 PBP Clinical Laboratory Services-Program Only

6200 W hole Blood amp Packed Red Blood Cells 6300 Blood Storing Processing amp Trans 6400 Intravenous Therapy 6500 Respiratory Therapy 6600 Physical Therapy 6700 Occupational Therapy 6800 PsychiatricPsychological 6900 Electrocardiology 7000 Electroencephalography 7100 Medical Supplies Charged to Patients 7200 Implantable Devices Charged to Patients 7300 Drugs Charged to Patients 7400 Renal Dialysis 7500 ASC (Non-Distinct Part) 7600 Other Ancillary (specify) 7700 7800 7900 8000 8100 8200 8300 8400 8500 8600 8700 8701 8800 Rural Health Clinic (RHC) 8900 Federally Qualified Health Center (FQHC) 9000 Clinic 9100 Emergency 9200 Observation Beds 9300 Other Outpatient Services (Specify) 9301 9302 9303 9304 9305

10500 Kidney Acquisition 10600 Heart Acquisition 10700 Liver Acquisition 10800 Lung Acquisition 10900 Pancreas Acquisition 11000 Intestinal Acquisition 11100 Islet Acquisition 11200 Other Organ Acquisition (specify) 11300 Interest Expense 11400 Utilization Review-SNF 11500 Ambulatory Surgical Center (Distinct Part) 11600 Hospice 11700 Other Special Purpose (specify) 19000 Gift Flower Coffee Shop amp Canteen 19100 Research 19200 Physicians Private Offices 19300 Nonpaid W orkers 19400 Public Relations 19401 Patient Transportation 19402 Doctors Meal 19403 MOB

TOTAL 0 0 0 2140 0 0 0 COST TO BE ALLOCATED 0 0 0 192712 0 0 0 UNIT COST MULTIPLIER - SCH 8 0000000 0000000 0000000 90052203 0000000 0000000 0000000

STATE OF CALIFORNIA SCHEDULE 10

TRIAL BALANCE OF EXPENSES

REPORTED (From Sch 10A) ADJUSTMENTS AUDITED

GENERAL SERVICE COST CENTERS 100 New Capital Related Costs-Buildings amp Fixtures $ 8317690 $ (4077313) $ 4240377 200 New Capital Related Costs-Movable Equipment 1173026 0 1173026 300 Other Capital Related Costs 0 0 0 301 0 0 0 302 0 0 0 303 0 0 0 304 0 0 0 305 0 0 0 306 0 0 0 307 0 0 0 308 0 0 0 309 0 0 0 400 Employee Benefits 3174525 0 3174525 501 0 0 0 502 0 0 0 503 0 0 0 504 0 0 0 505 0 0 0 506 0 0 0 507 0 0 0 508 0 0 0 500 Administrative and General 12367084 (4821112) 7545972 600 Maintenance and Repairs 3012381 0 3012381 700 Operation of Plant 0 0 0 800 Laundry and Linen Service 308001 0 308001 900 Housekeeping 1030564 0 1030564

1000 Dietary 2049590 (116995) 1932595 1100 Cafeteria (116995) 116995 0 1200 Maintenance of Personnel 0 0 0 1300 Nursing Administration 2729413 0 2729413 1400 Central Services and Supply 186144 0 186144 1500 Pharmacy 1267265 0 1267265 1600 Medical Records amp Library 1019310 0 1019310 1700 Social Service 897148 0 897148 1800 Other General Service (specify) 0 0 0 1900 Nonphysician Anesthetists 0 0 0 2000 Nursing School 0 0 0 2100 Intern amp Res Service-Salary amp Fringes (Approved) 0 0 0 2200 Intern amp Res Other Program Costs (Approved) 148412 0 148412 2300 Paramedical Ed Program (specify) 0 0 0 2301 0 0 0 2302 0 0 0

INPATIENT ROUTINE COST CENTERS 0 3000 Adults amp Pediatrics (Gen Routine) 13739800 0 13739800 3100 Intensive Care Unit 2095178 0 2095178 3200 Coronary Care Unit 0 0 0 3300 Burn Intensive Care Unit 0 0 0 3400 Surgical Intensive Care Unit 0 0 0 3500 Other Special Care (specify) 0 0 0 4000 Subprovider - IPF 0 0 0 4100 Subprovider - IRF 0 0 0 4200 Subprovider (specify) 0 0 0 4300 Nursery 0 0 0 4400 Skilled Nursing Facility 0 0 0 4500 Nursing Facility 0 0 0 4600 Other Long Term Care 0 0 0 4700 0 0 0

ANCILLARY COST CENTERS 5000 Operating Room $ 994885 $ 0 $ 994885 5100 Recovery Room 0 0 0 5200 Labor Room and Delivery Room 0 0 0 5300 Anesthesiology 0 0 0 5400 Radiology-Diagnostic 868991 0 868991 5500 Radiology-Therapeutic 0 0 0 5600 Radioisotope 0 0 0 5700 Computed Tomography (CT) Scan 0 0 0 5800 Magnetic Resonance Imaging (MRI) 0 0 0 5900 Cardiac Catheterization 0 0 0 6000 Laboratory 1939439 0 1939439 6100 PBP Clinical Laboratory Services-Program Only 0 0 0 6200 W hole Blood amp Packed Red Blood Cells 0 0 0 6300 Blood Storing Processing amp Trans 0 0 0 6400 Intravenous Therapy 0 0 0 6500 Respiratory Therapy 977285 0 977285 6600 Physical Therapy 321718 0 321718 6700 Occupational Therapy 0 0 0 6800 PsychiatricPsychological 2253381 0 2253381 6900 Electrocardiology 83550 0 83550 7000 Electroencephalography 0 0 0 7100 Medical Supplies Charged to Patients 1909028 0 1909028 7200 Implantable Devices Charged to Patients 864303 0 864303 7300 Drugs Charged to Patients 1673442 0 1673442 7400 Renal Dialysis 0 0 0 7500 ASC (Non-Distinct Part) 0 0 0 7600 Other Ancillary (specify) 0 0 0 7700 0 0 0 7800 0 0 0 7900 0 0 0 8000 0 0 0 8100 0 0 0 8200 0 0 0 8300 0 0 0 8400 0 0 0 8500 0 0 0 8600 0 0 0 8700 0 0 0 8701 0 0 0 8800 Rural Health Clinic (RHC) 0 0 0 8900 Federally Qualified Health Center (FQHC) 0 0 0 9000 Clinic 1051572 0 1051572 9100 Emergency 0 0 0 9200 Observation Beds 0 0 0 9300 Other Outpatient Services (Specify) 0 0 0 9301 0 0 0 9302 0 0 0 9303 0 0 0 9304 0 0 0 9305 0 0 0

SUBTOTAL $ 66336130 $ (8898425) $ 57437705 NONREIMBURSABLE COST CENTERS

9400 Home Program Dialysis 0 0 0 9500 Ambulance Services 0 0 0 9600 Durable Medical Equipment-Rented 0 0 0 9700 Durable Medical Equipment-Sold 0 0 0

9800 Other Reimbursable (specify) 0 0 0 9900 Outpatient Rehabilitation Provider (specify) 0 0 0

10000 Intern-Resident Service (not appvd tchng prgm) 0 0 0 10100 Home Health Agency 0 0 0 10500 Kidney Acquisition 0 0 0 10600 Heart Acquisition 0 0 0 10700 Liver Acquisition 0 0 0 10800 Lung Acquisition 0 0 0 10900 Pancreas Acquisition 0 0 0 11000 Intestinal Acquisition 0 0 0 11100 Islet Acquisition 0 0 0 11200 Other Organ Acquisition (specify) 0 0 0 11300 Interest Expense 0 0 0 11400 Utilization Review-SNF 0 0 0 11500 Ambulatory Surgical Center (Distinct Part) 0 0 0 11600 Hospice 0 0 0 11700 Other Special Purpose (specify) 0 0 0 19000 Gift Flower Coffee Shop amp Canteen 0 0 0 19100 Research 0 0 0 19200 Physicians Private Offices 0 0 0 19300 Nonpaid W orkers 0 0 0 19400 Public Relations 206289 0 206289 19401 Patient Transportation 920812 0 920812 19402 Doctors Meal 0 0 0 19403 MOB 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS SCHEDULE 10A Page 1

TOTAL ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ (Page 1 amp 2) 1 2 3 4 5

GENERAL SERVICE COST CENTER 100 New Capital Related Costs-Buildings amp Fixtur ($4077313) (210967) (3866346) 200 New Capital Related Costs-Movable Equipme 0 300 Other Capital Related Costs 0 301 0 302 0 303 0 304 0 305 0 306 0 307 0 308 0 309 0 400 Employee Benefits 0 501 0 502 0 503 0 504 0 505 0 506 0 507 0 508 0 500 Administrative and General (4821112) (2192) (4818920) 600 Maintenance and Repairs 0 700 Operation of Plant 0 800 Laundry and Linen Service 0 900 Housekeeping 0

1000 Dietary (116995) (116995) 1100 Cafeteria 116995 116995 1200 Maintenance of Personnel 0 1300 Nursing Administration 0 1400 Central Services and Supply 0 1500 Pharmacy 0 1600 Medical Records amp Library 0 1700 Social Service 0 1800 Other General Service (specify) 0 1900 Nonphysician Anesthetists 0 2000 Nursing School 0 2100 Intern amp Res Service-Salary amp Fringes (Appr 0 2200 Intern amp Res Other Program Costs (Approve 0 2300 Paramedical Ed Program (specify) 0 2301 0 2302 0

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine) 0 3100 Intensive Care Unit 0 3200 Coronary Care Unit 0 3300 Burn Intensive Care Unit 0

3400 Surgical Intensive Care Unit 0 3500 Other Special Care (specify) 0 4000 Subprovider - IPF 0 4100 Subprovider - IRF 0 4200 Subprovider (specify) 0 4300 Nursery 0 4400 Skilled Nursing Facility 0 4500 Nursing Facility 0 4600 Other Long Term Care 0 4700 0

ANCILLARY COST CENTERS 5000 Operating Room 0 5100 Recovery Room 0 5200 Labor Room and Delivery Room 0 5300 Anesthesiology 0 5400 Radiology-Diagnostic 0 5500 Radiology-Therapeutic 0 5600 Radioisotope 0 5700 Computed Tomography (CT) Scan 0 5800 Magnetic Resonance Imaging (MRI) 0 5900 Cardiac Catheterization 0 6000 Laboratory 0 6100 PBP Clinical Laboratory Services-Program Only 0 6200 W hole Blood amp Packed Red Blood Cells 0 6300 Blood Storing Processing amp Trans 0 6400 Intravenous Therapy 0 6500 Respiratory Therapy 0 6600 Physical Therapy 0 6700 Occupational Therapy 0 6800 PsychiatricPsychological 0 6900 Electrocardiology 0 7000 Electroencephalography 0 7100 Medical Supplies Charged to Patients 0 7200 Implantable Devices Charged to Patients 0 7300 Drugs Charged to Patients 0 7400 Renal Dialysis 0 7500 ASC (Non-Distinct Part) 0 7600 Other Ancillary (specify) 0 7700 0 7800 0 7900 0 8000 0 8100 0 8200 0 8300 0 8400 0 8500 0 8600 0 8700 0 8701 0 8800 Rural Health Clinic (RHC) 0 8900 Federally Qualified Health Center (FQHC) 0 9000 Clinic 0 9100 Emergency 0 9200 Observation Beds 0 9300 Other Outpatient Services (Specify) 0 9301 0 9302 0 9303 0 9304 0 9305 0

NONREIMBURSABLE COST CENTERS 9400 Home Program Dialysis 0 9500 Ambulance Services 0 9600 Durable Medical Equipment-Rented 0 9700 Durable Medical Equipment-Sold 0 9800 Other Reimbursable (specify) 0 9900 Outpatient Rehabilitation Provider (specify) 0

10000 Intern-Resident Service (not appvd tchng prgm) 0 10100 Home Health Agency 0

STATE OF CALIFORNIA

10500 Kidney Acquisition 10600 Heart Acquisition

10700 Liver Acquisition 10800 Lung Acquisition 10900 Pancreas Acquisition 11000 Intestinal Acquisition 11100 Islet Acquisition 11200 Other Organ Acquisition (specify) 11300 Interest Expense 11400 Utilization Review-SNF 11500 Ambulatory Surgical Center (Distinct Part) 11600 Hospice 11700 Other Special Purpose (specify) 19000 Gift Flower Coffee Shop amp Canteen 19100 Research 19200 Physicians Private Offices 19300 Nonpaid W orkers 19400 Public Relations 19401 Patient Transportation 19402 Doctors Meal 19403 MOB

20000 TOTAL

ADJUSTMENTS TO REPORTED COSTS SCHEDULE 10A Page 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ

GENERAL SERVICE COST CENTER 100 New Capital Related Costs-Buildings amp Fixture 200 New Capital Related Costs-Movable Equipme 300 Other Capital Related Costs 301 302 303 304 305 306 307 308 309 400 Employee Benefits 501 502 503 504 505 506 507 508 500 Administrative and General 600 Maintenance and Repairs 700 Operation of Plant 800 Laundry and Linen Service 900 Housekeeping

1000 Dietary 1100 Cafeteria 1200 Maintenance of Personnel 1300 Nursing Administration 1400 Central Services and Supply 1500 Pharmacy 1600 Medical Records amp Library 1700 Social Service 1800 Other General Service (specify) 1900 Nonphysician Anesthetists 2000 Nursing School 2100 Intern amp Res Service-Salary amp Fringes (Appro 2200 Intern amp Res Other Program Costs (Approved 2300 Paramedical Ed Program (specify) 2301 2302

INPATIENT ROUTINE COST CENTERS 3000 Adults amp Pediatrics (Gen Routine) 3100 Intensive Care Unit 3200 Coronary Care Unit 3300 Burn Intensive Care Unit

3400 Surgical Intensive Care Unit 3500 Other Special Care (specify) 4000 Subprovider - IPF 4100 Subprovider - IRF 4200 Subprovider (specify) 4300 Nursery 4400 Skilled Nursing Facility 4500 Nursing Facility 4600 Other Long Term Care 4700

ANCILLARY COST CENTERS 5000 Operating Room 5100 Recovery Room 5200 Labor Room and Delivery Room 5300 Anesthesiology 5400 Radiology-Diagnostic 5500 Radiology-Therapeutic 5600 Radioisotope 5700 Computed Tomography (CT) Scan 5800 Magnetic Resonance Imaging (MRI) 5900 Cardiac Catheterization 6000 Laboratory 6100 PBP Clinical Laboratory Services-Program Only

NONREIMBURSABLE COST CENTERS 9400 Home Program Dialysis 9500 Ambulance Services 9600 Durable Medical Equipment-Rented 9700 Durable Medical Equipment-Sold 9800 Other Reimbursable (specify) 9900 Outpatient Rehabilitation Provider (specify)

10000 Intern-Resident Service (not appvd tchng prgm)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

State of California Department of Health Care Services

Provider Name Fiscal Period Provider NPI Adjustments SILVER LAKE MEDICAL CENTER JANUARY 1 2011 THROUGH DECEMBER 31 2011 1427293216 17

Report References

Explanation of Audit Adjustments As

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

Cost Report W ork Sheet Part Title Line Col

1 10A A 10A A

1000 1100

RECLASSIFICATION OF REPORTED COSTS

Dietary Cafeteria

To reclassify the providers cafeteria revenue abatement against the dietary cost center 42 CFR 4139 CMS Pub 15-1 Section 2328D CMS Pub 15-2 Section 3613

$2049590 ($116995) (116995) 116995

$1932595 0

Fiscal Period JANUARY 1 2011 THROUGH DECEMBER 31 2011

Provider NPI 1427293216 17

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

ADJUSTMENTS TO REPORTED COSTS

7 New Capital Related Costs - Buildings and Fixtures

To adjust the reported costs of ownership to agree with the providers schedule 42 CFR 41320 and 41324 CMS Pub 15-1 Sections 2300 and 2304

To eliminate costs of ownership due to insufficient documentation 42 CFR 41320 and 41324 CMS Pub 15-1 Sections 2300 and 2304

7 Administrative and General

To eliminate patient television expense not related to patient care and to agree with the providers documentation 42 CFR 4139(c)(3) 41320 and 41324 CMS Pub 15-1 Sections 21023 2300 2304 and 21061

To eliminate nonallowable quality assurance fees W ampI Code Sections 1416832(i) and 1416932(i)

2500 Adults and Pediatrics 2500 Operating Room 2500 Radiology-Diagnostic

To reverse the providers post step-down elimination of costs for Interns and Residents for proper cost determination 42 CFR 41320 and 41324 CMS Pub 15-1 Section 2120

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

7 4A Not Reported 4A Not Reported

9 4B Not Reported 4B Not Reported

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

ADJUSTMENTS TO REPORTED MEDI-CAL SETTLEMENT DATA - NONCONTRACT

Medi-Cal Administrative Days (January 2011 amp March 2011 through May 2011) 0 Medi-Cal Administrative Day Rate (January 2011 amp March 2011 through May 2011 $000

Medi-Cal Administrative Days (June 2011) 0 Medi-Cal Administrative Day Rate (June 2011) $000

Medi-Cal Administrative Days (August 2011) 0 Medi-Cal Administrative Day Rate (August 2011) $000

Medi-Cal Routine Service Charges $0

Medi-Cal Coinsurance $0

Medi-Cal Interim Payments $0

To adjust Medi-Cal Settlement Data to agree with the following Fiscal Intermediary Payment Data Service Period January 1 2011 through December 31 2011 Payment Period January 1 2011 through May 31 2013 Report Date June 21 2013 42 CFR 41320 41324 41350 41353 41360 41364 and 433139 CMS Pub 15-1 Sections 2300 2304 2404 and 2408 CCR Title 22 Sections 51173 51511 51541 and 51542

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

13 Contract 4 D-1 I XIX Contract 4A D-1 I XIX

14 Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX Contract 6 D-3 XIX

15 Contract 2 E-3 VII XIX Contract 2 E-3 VII XIX

ADJUSTMENTS TO REPORTED MEDI-CAL SETTLEMENT DATA - CONTRACT

900 1 Medi-Cal Days - Adults and Pediatrics 24566 (21980) 4300 1 Medi-Cal Days - Intensive Care Unit 1131 (192)

5000 2 Medi-Cal Ancillary Charges - Operating Room $854684 $296748 5400 2 Medi-Cal Ancillary Charges - Radiology-Diagnostic 1407277 (642093) 6000 2 Medi-Cal Ancillary Charges - Laboratory 7620289 (4174049) 6500 2 Medi-Cal Ancillary Charges - Respiratory Therapy 5354917 (1413273) 6600 2 Medi-Cal Ancillary Charges - Physical Therapy 58000 (27409) 6800 2 Medi-Cal Ancillary Charges - PsychiatricPsychological Services 17663250 (17663250) 6900 2 Medi-Cal Ancillary Charges - Electrocardiology 431562 (106261) 7100 2 Medi-Cal Ancillary Charges - Medical Supplies Charged to Patients 4631885 (377208) 7200 2 Medi-Cal Ancillary Charges - Implantable Devices Charged to Patients 68419 (68419) 7300 2 Medi-Cal Ancillary Charges - Drugs Charged to Patients 9844191 (6191753) 9000 2 Medi-Cal Ancillary Charges - Clinic 811243 (811243)

10100 2 Medi-Cal Ancillary Charges - Total 48745717 (31178210)

800 1 Medi-Cal Routine Service Charges $47653530 ($38884280) 900 1 Medi-Cal Ancillary Service Charges 48745717 (31178210)

3200 1 Medi-Cal Deductibles $0 $1485 3300 1 Medi-Cal Coinsurance 0 148251

To adjust Medi-Cal Settlement Data to agree with the following Fiscal Intermediary Payment Data Service Period January 1 2011 Through December 31 2011 Payment Period January 1 2011 Through May 31 2013 Report Date June 21 2013 42 CFR 41320 41324 41353 and 433139 CMS Pub 15-1 Sections 2304 2404 and 2408 CCR Title 22 Section 51541

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

ADJUSTMENT TO OTHER MATTERS

Medi-Cal Credit Balances To recover outstanding Medi-Cal credit balances 42 CFR 41320 and 41324 CMS Pub 15-1 Sections 2300 and 2304 CCR Title 22 Sections 50761 and 514581

$0 $19107 $19107

1211106190661D SILVER LAKE MEDICAL CENTER

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

TOOBY DOUGLAS EDMUNDD G BROWN JR DIRECTOR GOVERNOR

Novembber 5 2013

George Koutsakos Chief Finnancial Off icer Silver Laake Medicaal Center 1711 Weest Templee Street Los Anggeles Califoornia 900266

SILVERR LAKE MEDDICAL CENNTER NATIONNAL PROVIDER IDENNTIFIER (NPPI) 14272933216 FISCAL PERIOD EENDED DECEMBER 331 2011

We havee examinedd the Providders Medi-CCal Cost Reeport for th e above-reeferenced fiscals period Our examinnation was made undeer the authoority of Secction 141700 of the Wellfare and Insttitutions Code and wass limited to a review off the cost reeport and aaccompanying financiall statementts Medi-Caal payment ddata reportts prior fisccal periods Medi-Cal programm audit repoort and Meddicare audit report for the currentt fiscal periood if appliccable and available

In our oppinion the audited commbined setttlement for the fiscal pperiod due tthe State inn the amount of $19107 and the audited costts presentedd in the Summary of FFindings represennt a proper determinattion in accoordance with the reimbbursement principlesp oof applicabble programms

This auddit report includes the

1 SSummary off Findings

2 CComputationn of Medi-CCal Reimbursement Seettlement (NNONCONTTRACT SSchedules)

3 CComputationn of Medi-CCal Cost (COONTRACT Scheduless)

4 AAudit Adjusttments Schedule

The auddited settlemment will bee incorporatted into a SStatement(ss) of Accounnt Status which mmay reflect tentative rettroactive addjustment ddeterminatioons paymeents from thhe providerr and otherr financial trransactionss initiated byy the Depaartment Thhe Statement(s)

Financiaal AuditsBurbaankA amp I MS 22101 1405 Norrth San Fernanndo Boulevard Room 203 Buurbank CA 915504 Telepphone (818) 2995-2620 FAX (818) 563-33244

Internet Addrress wwwdhccscagov

(916) 440-7700

Original Signed By

Certified

SUMMARY OF FINDINGS

SETTLEMENT COST

Net Change

Audited Cost

25483627

(19962376)

5521251

$ (19107)

Net Change

SUMMARY OF FINDINGS

SETTLEMENT COST

Net Change

REPORTED AUDITED

4 $ 0 $ 0

9 $ 0 $ 0

10 $ 0 $ 0

REPORTED AUDITED

(To Schedule 1)

REPORTED AUDITED

4 $ 0 $ 0

5 $ 0 $ 0

(To Schedule 1)

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

(916) 440-7700

Original Signed By

Certified

SUMMARY OF FINDINGS

SETTLEMENT COST

Net Change

Audited Cost

25483627

(19962376)

5521251

$ (19107)

Net Change

SUMMARY OF FINDINGS

SETTLEMENT COST

Net Change

REPORTED AUDITED

4 $ 0 $ 0

9 $ 0 $ 0

10 $ 0 $ 0

REPORTED AUDITED

(To Schedule 1)

REPORTED AUDITED

4 $ 0 $ 0

5 $ 0 $ 0

(To Schedule 1)

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUMMARY OF FINDINGS

SETTLEMENT COST

Net Change

Audited Cost

25483627

(19962376)

5521251

$ (19107)

Net Change

SUMMARY OF FINDINGS

SETTLEMENT COST

Net Change

REPORTED AUDITED

4 $ 0 $ 0

9 $ 0 $ 0

10 $ 0 $ 0

REPORTED AUDITED

(To Schedule 1)

REPORTED AUDITED

4 $ 0 $ 0

5 $ 0 $ 0

(To Schedule 1)

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUMMARY OF FINDINGS

SETTLEMENT COST

Net Change

REPORTED AUDITED

4 $ 0 $ 0

9 $ 0 $ 0

10 $ 0 $ 0

REPORTED AUDITED

(To Schedule 1)

REPORTED AUDITED

4 $ 0 $ 0

5 $ 0 $ 0

(To Schedule 1)

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

REPORTED AUDITED

4 $ 0 $ 0

9 $ 0 $ 0

10 $ 0 $ 0

REPORTED AUDITED

(To Schedule 1)

REPORTED AUDITED

4 $ 0 $ 0

5 $ 0 $ 0

(To Schedule 1)

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

REPORTED AUDITED

(To Schedule 1)

REPORTED AUDITED

4 $ 0 $ 0

5 $ 0 $ 0

(To Schedule 1)

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

REPORTED AUDITED

4 $ 0 $ 0

5 $ 0 $ 0

(To Schedule 1)

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

48547 48547

0 48547

0 0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

611990

54134 0

28137 938

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0000 0

$ 39646812434

$ 1628870

35907202434

14752300

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

40948 55

0000 0

40116 14

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

PORTED

0000 0

AUDITED

312713

0000 0

$ 0000

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

TOTAL ANCILLARY

(Adj )

MEDI-CAL

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

(Adj )

(Adj ) TO CHARGES

MEDI-CAL

(Adj )

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

REPORTED AUDITED

4 $ 0 $ 0

6 $ 0 $ 0

7 $ 0 $ 0

11 $ 0 $ 0

12 $ 0 $ 0

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

REPORTED AUDITED

(To Contract Sch 1)

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

REPORTED AUDITED

5 $ 0 $ 0

(To Contract Sch 1)

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

48547 48547

0 48547

0 0 0 0

4854748547

048547

$ $ $ $ $ $ $ $ $ $ $

000000000000

2971007100000

29710071

$ $ $ $ $ $ $ $ $ $ $

000 000 000 000

26280443 0 0 0 0 0

26280443

$ $ $ $ $ $ $ $ $ $

814657540

814657540364694

000167808

000000

029710071

$ $ $ $ $ $ $ $ $ $

81465754 0

81465754 0322595

000 167808

000 000

0 26280443

6119915034146

54134 1399905

18422520

1385241 0

2785146

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0000 0

39646812434

1628871131

1842252

35907202434

147523939

1385241

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

0000 0

000 0 0

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

TOTAL ANCILLARY

(Adj )

CHARGES MEDI-CAL

(Contract Sch 6)

MEDI-CAL COST

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

(Adj 14) AUDITED

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

COST CENTERS (Adj )

REMUNERATION HBP

(Adj )

TO CHARGES

(Adj )

MEDI-CAL CHARGES

MEDI-CAL COST

0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0 0 0 0000000 0

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

FIXTURES100

EQUIP 200

COSTS 300

COST 301

COST 302

COST 303

COST 304

COST 305

COST 306

COST 307

COST 308

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

206289 920812

15319 0 0

4238 0 0

0 0 0 0 0

19403 MOB 0 1070975 296266 0 0 0 0 0 0 0 0 0

TOTAL 58564806 4240377 1173026 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

17824 56297

0 0 0 0 0

243670 977109

42106 168844

0 19403 MOB 0 0 0 0 0 0 0 0 0 0 1367241 236258

TOTAL 0 3189455 0 0 0 0 0 0 0 0 58564806 8628895

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

0 TOTAL 3828772 0 362981 1390433 2746272 380743 0 3375774 481168 1686271 1544333 1210178

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

1800 1900 2000 2100 2200 2300 2301 2302 2400 2500 2600

TOTAL 0 0 0 0 192712 0 0 0 58564806 0 58564806

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

STATE OF CALIFORNIA

EMP BENE (GROSS

501 (Adj ) (Adj )

502 (Adj ) (Adj )

503 (Adj ) (Adj )

504 (Adj ) (Adj )

505 (Adj ) (Adj )

506 (Adj ) (Adj )

507 (Adj ) (Adj )

508 (Adj ) (Adj )

RECON-CILIATION

600 (Adj ) (Adj )

4585679 568145 3264643

0 308876 45

682755 1143456 2299 777886 2176997 8575

99632 5125 0

965425 2848203 1150 162844 305949 5326

1125520 1403466 1223 492748 1189934 6245 825391 1000356 1068

0 0 0 0

137034 162100 0 0 0 0

12260469 16176437 62343

1670384 2359561 5017 0 0 0 0 0 0 0 0 0 0 0 0

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

SUBTOTAL $ 1127101 $ 0 $ 1127101 200 TOTAL $ 67463231 $ (8898425) $ 58564806

(To Schedule 8)

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

STATE OF CALIFORNIA

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

($8898425) 0 (210967) (3866346) (2192) (4818920) 0 0 0 0 0 0 0 (To Sch 10)

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

20000 TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

1 10A A 10A A

1000 1100

Dietary Cafeteria

$2049590 ($116995) (116995) 116995

$1932595 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

6 83 B 83 B 83 B

3000 5000 5400

$8317690

$12367084

($40606) (119883) (46407)

($210967)

(3866346) ($4077313)

($2192)

(4818920) ($4821112)

$40606 119883 46407

$4240377

$7545972

$0 0 0

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

10 2 Not Reported

11 3 Not Reported

12 1 Not Reported

55 $40948

14 $40116

3 $31271

$153750

$27626

55 $40948

14 $40116

3 $31271

$153750

$27626

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

Adjustments

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

2586 939

$1151432 765184

3446240 3941644

30591 0

325301 4254677

0 3652438

0 17567507

$8769250 17567507

$1485 148251

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

Report References

Reported Increase

(Decrease) As

Adjusted Adj No

Audit Report

17 Contract 1 NA

$0 $19107 $19107

Documents

REPORT COST REPORT REVIEW SILVER LAKE ... ON THE COST REPORT REVIEW SILVER LAKE MEDICAL CENTER LOS ANGELES, CALIFORNIA NATIONAL PROVIDER IDENTIFIER: 1427293216 FISCAL PERIOD ENDED