CAMBRIDGE REHAB AND HLTH CTR
MOORESTOWN, NJ  08057

Medicare Provider Number: 315201
Cost report status: As Submitted
[Record Code 1351720 - 2010]

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COST ALLOCATION - GENERAL SERVICE COSTS Provider CCN: 315201
PERIOD:
FROM 01/01/2022
TO 12/31/2022
WORKSHEET B PART I
Cost Center Description Net Expenses for Cost Allocation (from Wkst. A, col. 7) Cap. Rel Buildings & Fixtures Cap. Rel Movable Equipment Employee Benefits Subtotal (Sum of cols. 0 - 3) Administrative & General Plant Oper. Maintenance & Repairs Laundry & Linen Service House Keeping Dietary Nursing Administration Central Services & Supply Pharmacy Medical Records & Library Social Service Nursing & Allied Health Education Other General Service Cost Subtotal Post Step-down Adjustments Total  
0 1 2 3 3 A 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
GENERAL SERVICE COST CENTERS                                          
1 Capital-Related Costs - Buildings & Fixtures 1,495,878 ###                                     1
2 Capital-Related Costs - Moveable Equipment 212,943 ###                                   2
3 Employee Benefits 1,448,101 ###                               3
4 Administrative and General 3,110,209 ### ### ###                             4
5 Plant Operation, Maintenance and Repairs 724,179 ### ### ### ###                           5
6 Laundry and Linen Service 105,386 ### ### ### ###                         6
7 Housekeeping 450,759 ### ### ### ###                       7
8 Dietary 1,125,346 ### ### ### ###                     8
9 Nursing Administration 1,071,157 ### ### ### ###                   9
10 Central Services and Supply 205,078 ### ### ### ###                 10
11 Pharmacy 60,366 ### ### ###               11
12 Medical Records and Library 30,631 ### ### ### ###             12
13 Social Service 129,141 ### ### ### ###           13
14 Nursing and Allied Health Education         14
15 Other General Service Cost 222,778 ### ### ### ###       15
INPATIENT ROUTINE SERVICE COST CENTERS                                          
30 Skilled Nursing Facility 5,578,750 ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### 30
31 Nursing Facility 31
32 ICF/IID 32
33 Other Long Term Care 33
ANCILLARY SERVICE COST CENTERS                                          
40 Radiology 39,880 ### ### ### ### 40
41 Laboratory 62,513 ### ### ### ### 41
42 Intravenous Therapy 28,261 ### ### ### ### 42
43 Oxygen (Inhalation) Therapy 54,363 ### ### ### ### ### 43
44 Physical Therapy 311,777 ### ### ### ### 44
45 Occupational Therapy 343,516 ### ### ### ### 45
46 Speech Pathology 313,322 ### ### ### ### 46
47 Electrocardiology 47
48 Medical Supplies Charged to Patients 48
49 Drugs Charged to Patients 293,596 ### ### ### ### 49
50 Dental Care - Title XIX only 50
51 Support Surfaces 4,476 ### ### ### ### 51
52 Other Ancillary Service Cost 52
OUTPATIENT SERVICE COST CENTERS                                          
60 Clinic 60
61 Rural Health Clinic (RHC) 61
62 FQHC 62
63 Other Outpatient Service Cost 63
OTHER REIMBURSABLE COST CENTERS                                          
70 Home Health Agency Cost 70
71 Ambulance 71
72 Outpatient Rehabilitation (specify) 72
73 CMHC 73
74 Other Reimbursable Cost 74
SPECIAL PURPOSE COST CENTERS                                          
83 Hospice 83
84 Other Special Purpose Cost 84
89 Subtotals 17,422,406 ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### 89
NON REIMBURSABLE COST CENTERS                                          
90 Gift, Flower, Coffee Shops and Canteen 90
91 Barber and Beauty Shop 91
92 Physicians' Private Offices 92
93 Nonpaid Workers 93
94 Patients' Laundry 94
95 Other Nonreimbursable Cost 95
98 Cross Foot Adjustments       98
99 Negative Cost Center 99
100 Total 17,422,406 ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### 100
FORM CMS-2540-10 (05/2011) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4120)
08-16   Rev. 7