Worksheet B, Part II

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PARKER JEWISH INSTITUTE
NEW HYPE PARK, NY  11040

Medicare Provider Number: 335132
Cost report status: Reopened
[Record Code 419007 - 1996]
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ALLOCATION OF CAPITAL - RELATED COSTS
PROVIDER NO:
335132
PERIOD:
FROM 01/01/2009
TO 12/31/2009
WORKSHEET B Part II
  
COST CENTER
DIRECTLY
ASSIGNED
CAPITAL
RELATED COSTS
CAP. REL.
BUILDINGS
& FIXTURES
CAP. REL.
MOVABLE
EQUIPMENT
 SUBTOTAL
EMPLOYEE
BENEFITS
ADMINIS-
TRATIVE
& GENERAL
PLANT OPER.
MAINTENANCE
& REPAIRS
LAUNDRY
& LINEN
SERVICE
HOUSE
KEEPING
 DIETARY
NURSING
ADMINIS-
TRATION
CENTRAL
SERVICES
& SUPPLY
 PHARMACY MEDICAL RECORDS AND LIBRARY SOCIAL SERVICE INTERNS & RESIDENTS OTHER GENERAL SERVICE COST SUBTOTAL POST STEPDOWN ADJUSTMENTS TOTAL  
    0 1 2 2A 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
  GENERAL SERVICE COST CENTERS                                      
1 Capital-Related Costs - Building & Fixture                                   1
2 Capital-Related Costs - Movable Equipment                                   2
3 Employee Benefits ### ###                               3
4 Administrative and General ### ### ###                             4
5 Plant Operation, Maintenance and Repairs ### ### ### ###                           5
6 Laundry and Linen Service ### ### ### ### ###                         6
7 Housekeeping ### ### ### ### ###                       7
8 Dietary ### ### ### ### ### ###                     8
9 Nursing Administration ### ### ### ### ### ### ###                   9
10 Central Services and Supply ### ### ### ### ### ### ###                 10
11 Pharmacy ### ### ### ### ### ### ###               11
12 Medical Records and Library ### ### ### ### ### ### ###             12
13 Social Service ### ### ### ### ### ### ###           13
14 Intern & Residents (Approved Teaching Program)         14
15 Other General Service cost ### ### ### ### ### ### ###       15
  INPATIENT ROUTINE SERVICE COST CENTERS                                      
16 Skilled Nursing Facility ### ### ### ### ### ### ### ### ### ### ### ### ### 16
17                                           17
18 Nursing Facility ### ### ### 18
18.1 Intermediate Care Facility/Mentally Retarded 18.1
19 Other Long Term Care 19
20 Other Inpatient Routine Service Cost 20
  ANCILLARY SERVICE COST CENTER                                      
21 Radiology ### ### ### ### ### ### ### ### 21
22 Laboratory ### ### ### ### ### ### 22
23 Intravenous Therapy 23
24 Oxygen (Inhalation) Therapy 24
25 Physical Therapy ### ### ### ### ### ### ### ### ### 25
26 Occupational Therapy ### ### ### ### ### ### ### ### 26
27 Speech Pathology ### ### ### ### ### ### ### ### 27
28 Electrocardiology ### ### ### ### ### ### ### 28
29 Medical Supplies Charged to Patients ### ### ### ### 29
30 Drugs Charged to Patients ### ### ### ### 30
31 Dental Care - Title XIX only 31
32 Support Surfaces 32
33 Other Ancillary Service Cost ### ### ### ### ### 33
  OUTPATIENT SERVICE COST CENTERS                                      
34 Clinic 34
35 R H C 35
36 Other Outpatient Service Cost ### ### ### ### ### ### ### ### 36
  OTHER REIMBURSABLE COST CENTERS                                      
37 Administrative and General - HHA ### ### ### ### 37
38 Skilled Nursing Care - HHA ### ### ### ### 38
39 Physical Therapy - HHA ### ### ### ### 39
40 Occupational Therapy - HHA ### ### ### ### 40
41 Speech Pathology - HHA ### ### ### ### 41
42 Medical Social Services - HHA ### ### ### ### 42
43 Home Health Aide - HHA ### ### ### 43
44 Durable Medical Equipment - Rented - HHA 44
45 Durable Medical Equipment - Sold - HHA 45
46 Home Delivered Meals - HHA 46
47 Other Home Health Services - HHA ### ### ### ### 47
48 Ambulance 48
49 Interns and Residents (Not An Approved Teaching Program) 49
50 Outpatient Rehabilitation Provider 50
51 Other Reimbursable Cost 51
  SPECIAL PURPOSE COST CENTERS                                      
55 Hospice ### ### ### ### 55
56 Other Special Purpose Cost ### ### ### ### 56
57 Subtotals ### ### ### ### ### ### ### ### ### ### ### ### ### ### 57
  NON REIMBURSABLE COST CENTERS                                      
58 Gift, Flower, Coffee Shops and Canteen 58
59 Barber and Beauty Shop ### ### ### ### ### ### ### ### ### 59
60 Physicians' Private Offices ### ### ### ### 60
61 Nonpaid Workers ### ### ### ### ### ### ### ### 61
62 Patients Laundry 62
63 Other Non Reimbursable Cost 63
64 Cross Foot Adjustments               64
65 Negative Cost Center   65
75 Total ### ### ### ### ### ### ### ### ### ### ### ### ### ### 75