REPORT ON THE COST REPORT REVIEW SETON MEDICAL CENTER DALY CITY, CALIFORNIA PROVIDER _part4 pot

STATE OF CALIFORNIAProvider No: LTC70037G COL.. To Adult Subacute Sch 1 COL 2 RELATED COL 1 ALLOCATED EXPENSES ADULT SUBACUTE SCH 5 COST CENTER EMP BENEFITS AUDITED SAL & AUDITED CAP AL

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STATE OF CALIFORNIA

Provider No:

LTC70037G

COL.

(To Adult Subacute Sch 1)

(COL 2)

RELATED (COL 1) ALLOCATED EXPENSES

ADULT SUBACUTE SCH 5

COST CENTER

EMP BENEFITS AUDITED SAL & AUDITED CAP

ALLOCATION OF INDIRECT EXPENSES

ADULT SUBACUTE

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0 0

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000000000000 000000000000 0

000000000000 000000000000

000000000000 000000000000 000000000000 000000000000 000000000000

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000000000000 000000000000

000000000000 000000000000 000000000000 0

000000000000 000000000000

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0 0

000 0000 0

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32.00 33.00

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59.03 60.00

85.00 86.00

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