Nevada Hospital Reporting
(Pursuant to NRS 449.490, Sections 2 through 4)
Hospital Name:	[Insert ]
Subsidized Health Services
Benefit $
Total Uncompensated Cost from Uncompensated Cost Report filed with DHCFP	$35,334,539.00
Less: Medicaid Disproportionate Share Payments received for the Period	$0.00
Less: Other Payments Received for these Accounts (County Supplemental Funds, etc.)	$2,139,607.00
Net Uncompensated Care	$33,194,932.00
Uncompensated SCHIP (Nevada Checkup) Cost	$0.00
Uncompensated Medicare Cost (see instructions)	$9,679,155.00
Uncompensated Clinic or Other Cost	$0.00
Other Subsidized Health Services	$0.00
Less: Cost Reported in Another Category	$307,366.25
Total Subsidized Health Services	$42,566,720.75