PICKERSGILL INC.
TOWSON, MD  21204

Medicare Provider Number: 215259
Cost report status: As Submitted
[Record Code 404528 - 1996]

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ADJUSTMENTS TO EXPENSES
PROVIDER NO:
215259
PERIOD:
FROM 01/01/2010
TO 12/31/2010
WORKSHEET A-8
DESCRIPTION (1) BASIS FOR ADJUSTMENT (2) AMOUNT EXPENSE CLASSIFICATION ON WORKSHEET A - TO / FROM WHICH THE AMOUNT IS TO BE ADJUSTED
COST CENTER LINE NO.  
1 2 3 4
1 Investment income on restricted funds (ch.2) funds (chapter 2)       1
2 Trade, quantity and time discounts on purchases (chapter 8)       2
3 Refunds and rebates of expenses (Chapter 8)       3
4 Rental of provider space by suppliers (Chapter 8)       4
5 Telephone services (pay stations excluded) (chapter 21)       5
6 Television and radio service (Chapter 21)       6
7 Parking lot (chapter 21)       7
8 Remuneration applicable to provider- based physician adjustment Worksheet A-8-2     8
9 Home office costs (chapter 21)       9
10 Sale of scrap, waste, etc. (chapter 23)       10
11 Nonallowable costs related to certain Capital expenditures (chapter 24)       11
12 Adjustment resulting from transactions Worksheet A-8-1     12
13 Laundry and Linen service       13
14 Revenue - Employee meals       14
15 Cost of meals - Guests       15
16 Sale of medical supplies to other than patients       16
17 Sale of drugs to other than patients       17
18 Sale of medical records and abstracts       18
19 Vending machines       19
20 Income from imposition of interest, finance or penalty charges (chapter 21)       20
21 Interest expense on Medicare overpayments and borrowings to repay Medicare overpayments       21
22 Other Adjustment (3)     22
23 Other Adjustment (3)     23
24 Adjustment for respiratory therapy costs in excess of limitation (chapter 14) (3) Oxygen (Inhalation) Therapy 24 24
25 Adjustment for physical therapy costs in excess of limitation (3) Physical Therapy 25 25
26 Adjustment for HHA physical therapy costs in excess of limitation See Instructions Physical Therapy - HHA 39 26
27 SUBTOTAL (Sum of lines 1-26)       27
28 Utilization review - physicians' compensation (chapter 21)   Utilization Review- SNF 54 28
29 Depreciation - buildings and fixtures   ### Capital Related Cost- Building 1 29
30 Depreciation - movable equipment   ### Capital Related Cost-Movable Equipment 2 30
31 Other Adjustment       31
32 TOTAL (line 27 plus the sum of lines 28 - 31) (Transfer to Worksheet A, col. 6, line 75)   ###     32
(1) Description - all chapter references in this column pertain to CMS Pub. 15-I
(2) Basis for adjustment
  A. Costs - if costs, including applicable overhead, can be determined.
  B. Amount Received - if cost cannot be determined.
(3) See Instructions to report therapy services provided on and after April 10, 1998.