UNCOMPENSATED COST REPORT
HOSPITAL: St Rose Dominican Hospitals Rose De Lima Campus 12 month Period Ending: 6/30/2020
Line PART I -   Calculate Ratio of Cost to Charges (RCC)
1 Total Operating Expenses (A)  $      29,478,195
2 Non - Operating Expense (A)  $                       -
3 Total Hospital Expenses  (sum of oper & non-oper exp)  $        29,478,195
Less Cost Directly Assigned to Uninsured Patients 
4           Graduate Medical Education Cost (B)  $- 
5           Emergency Room Physician Professional Fees (C)  $              12,586
          Other Directly Assigned Cost (list)  - (D) 
6               1) Enrollment Assistance  $- 
7               2) Personal Assistance Services  $- 
8               3) Indigent Patient Care Coordination Costs  $             (47,363)
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  $             (34,777)
15 Adjusted Cost Pool (Total expenses less excluded items)  $        29,443,418
16 Billed Charges (G)   $      183,794,050
17 Average Ratio of Cost to Charges ( adj cost / charges) 16.0%
(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.