MEDICAID SUPPLEMENTAL DATA

446.37 Cost allocation adjustments.

Account Adjustment Cost center affected number

(a) Depreciation--replacement cost to historical cost

(1) Buildings and fixtures Depreciation and Amortization-- Fixed Assets 8810

(2) Equipment Depreciation and Amortization-- Movable Equipment 8820

(b) Depreciation--accelerated Depreciation and Amortization-- to straight line-- Fixed Assets 8810 buildings and fixtures

(c) 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

(d) Unincorporated business Provision for Income Taxes 9410 tax

(e) Corporate income tax Provision for Income Taxes 9410

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

(g) Voluntary Agency Proficiency Testing Program

(1) Clinical laboratory Laboratory Services--Clinical 7210

(2) Other (specify) Specify Specify

(h) Grants, gifts and income for specific purpose Specify Specify

(i) Professional standards Medical Care Review 8740 review organization

Other (specify) Specify Specify

(j) Amounts may be expressed as:

(1) increases; or

(2) decreases.