UNCOMPENSATED COST REPORT
HOSPITAL:		Centennial Hills Hospital		12 month Period Ending:	2018
Line		PART I -   Calculate Ratio of Cost to Charges (RCC)
1		Total Operating Expenses (A)			$      211,937,626		Y:\State Reporting\AB342 - NHA Community Benefits\FYE2018\NHQR Acute Hospital Reports 2018.xlsx Tab A07 Column W
2		Non - Operating Expense (A)			$          9,831,040		Y:\State Reporting\AB342 - NHA Community Benefits\FYE2018\NHQR Acute Hospital Reports 2018.xlsx Tab A08 Column W
3		Total Hospital Expenses  (sum of oper & non-oper exp)			$      221,768,666
		Less Cost Directly Assigned to Uninsured Patients
4		Graduate Medical Education Cost (B)			$447,767		Nevada Hospital Report Part I, Health Professionals Education (Line 91) Look for GME
5		Emergency Room Physician Professional Fees (C)			$          3,723,846		Add 70100-630010; 70100-630030;74500-630030; 86100-630050
		Other Directly Assigned Cost (list)  - (D)
6		1)  Eligibility Fees			$            287,209		85300-641507
7		2)			$                       -
8		3)			$                       -
9		4)			$                       -
10		5)			$                       -
		Less Cost Prohibited by CMS for DSH Purposes
11		Offsite Clinic Cost (E)			$                       -
		Other Excluded Cost (list)  - (F)
12		1)			$                       -
13		2)			$                       -
14		Total Expenses Excluded from Cost Pool			$          4,458,822
15		Adjusted Cost Pool (Total expenses less excluded items)			$      217,309,844
16		Billed Charges (G)			$   2,341,932,154		Y:\State Reporting\AB342 - NHA Community Benefits\FYE2018\NHQR Acute Hospital Reports 2018.xlsx Tab A02 plus A03 Column K
17		Average Ratio of Cost to Charges ( adj cost / charges)			9.3%
	(A)	From the Nevada Hospital Quarterly Reports found at:
		http://www.nhqrnv.com
	(B)	Resident /Faculty Salaries and other costs in support of GME from hospital records.
		Exclude Allied Health education programs.
	(C)	ER / Trauma /Anesthesiology on-call coverage and compensation to physicians for indigent patient care.
		From hospital records.   Exclude directorship fees and other services not directly related to patient care.
	(D)	Any identifiable cost solely related to uninsured patients from hospital records.
		Examples include payments to nursing homes for placement of patients without pay source,
		and eligibility workers in excess of standard social services staff.
	(E)	All costs associated with operating clinics not on hospital campus from hospital records.
	(F)	Any other cost category specifically prohibited for DSH by regulation or policy
	(G)	From NHQR for your hospital for the reporting period.
	Note: Cost reported as AB342 community benefits are included either in pool or directly assigned.