UPSTATE BLUE CROSS SUPPLEMENTAL DATA

446.30 Cost allocation adjustments.

Account

Description of adjustment Cost center affected number

(a) Interest on inter-fund borrowing

(1) Funded depreciation (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(2) Donor-restricted funds (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(3) Other (specify) (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(b) Unincorporated business tax Provision for Income Taxes 9410

(c) Corporate income taxes Provision for Income Taxes 9410

(d) Unrecovered cost of courtesy Employee Benefits-- allowances to employees and Non-Payroll-Related 8830 dependents

(e) Voluntary Agency Proficiency Testing Program

(1) Clinical laboratory Laboratory Services--Clinical 7210

(2) Other (specify) Specify Specify

(f) Grants, gifts and income for specific purposes Specify Specify

(g) Depreciation--straight Depreciation and Amortization-- line to accelerated Movable Equipment 8820

(h) 28B funding requirements

(1) Building and fixtures Depreciation/Amortization-- Fixed Assets 8810

(2) Movable equipment Depreciation/Amortization-- Movable Equipment 8820

(i) Hospital-based physicians on direct physician billing

(1) Diagnostic X-ray (i) Radiology--Diagnostic, and/or 7320

(ii) CT Scanner, and/or 7340

(iii) Radiology--Therapeutic, and/or 7360

(iv) Nuclear Medicine 7380

(2) Laboratory (i) Laboratory Services-- Clinical, and/or 7210

(ii) Laboratory Services-- Pathological, and/or 7230

(iii) Blood Storing and 7260 processing

(3) Electrocardiology Electrocardiology 7290

(4) Emergency room physicians Emergency Services 6710

(j) Other (specify) Specify Specify

(k) Amounts may be expressed as:

(1) increases; or

(2) decreases