List of  Hospital Mergers for FY 2018 Final Rule Calculation of Factor 3 of the Uncompensated Care Payment																									
Merger information obtained as of September 2017																									
"Low Income Insured Days based on Medicaid days from hospitals 2012 and 2013 cost reports and FY 2014 and FY 2015 SSI ratios. Uncompensated care costs based on Worksheet S-10 from hospitals 2014 cost reports. All cost report data from HCRIS, March 2017 update."																									
Surviving Provider Number	Provider Number Prior to Acquisition/Merger	Factor 3 components of Acquired Provider					Factor 3 components of Surviving Provider					DSH status of surviving provider number													
		Medicaid Days		SSI Days		Uncompensated Care Costs	Medicaid Days		SSI Days		Uncompensated Care Costs														
		2012	2013	2014	2015	2014	2012	2013	2014	2015	2014														
010005	010010	0	0	0	0	0	6484	6844	1880	2035	10960871.91	YES													
010029	010025	3096	1644	170	0	0	12099	13187	3392	3645	20743990.78	YES													
010085	010054	2294	473	59	0	0	6398	9130	2790	2278	8011680.73	YES													
010092	010145	0	0	0	0	0	33116	34511	7659	8428	34478667.04	YES													
030012	030118	4231	4346	178	141	5003544.44	1345	1403	441	383	6091056.61	NO													
040014	040080	1847	1824	355	113	120918.27	8044	8437	2838	3490	10519008.38	YES													
050060	050732	0	0	590	518	259748.28	85197	123233	12373	13572	14684412.33	YES													
050135	050752	9497	0	0	0	0	20682	30188	9109	8506	2795822.35	YES													
070022	070001	17780	0	0	0	0	205982	0	9390	8394	43684184.73	YES													
070033	070015	0	0	22	0	1101846.17	13290	14605	876	1197	9964773.15	YES													
100080	100234	6749	6693	901	957	0	23557	20243	5557	5885	15841190.24	YES													
100167	100061	0	0	0	0	0	42688	37821	14636	14255	12092951.48	YES													
110007	110163	1118	0	0	0	0	37554	33664	5471	5337	30671288.71	YES													
110064	110186	4101	1375	301	0	75227.24	32543	31180	3387	3543	15434970.46	YES													
110115	110219	5710	0	0	0	0	29033	35979	6328	6442	14716415.36	YES													
110122	110212	0	0	0	0	0	16014	15919	3751	3372	17034452.14	YES													
140010	140051	4891	4492	3	0	0	20712	19906	2556	2227	33742806.75	YES													
150074	150129	145	278	120	56	2076683.57	18890	18328	2913	3083	17243732.14	YES													
170123	170202	334	0	0	0	0	39609	38779	2240	2046	7803897.67	YES													
190274	190175	1530	610	294	3	876725.55	8056	8039	1138	1256	5054811.23	YES													
190176	190177	6787	6781	"1,156"	"1,013"	2908788.07	28819	28180	4219	4949	8452074.14	YES													
190086	190257	36	63	43	6	139894.06	6496	6960	1434	1177	245490.75	YES													
190160	190261	24	0	14	13	0	10945	11058	2952	3854	2659039.75	YES													
200019	200040	1015	328	62	0	877517.56	3013	3825	824	771	11836503.07	YES													
220063	220082	3962	3709	725	0	1806693.51	15902	16004	3561	4800	7513432.15	YES													
220080	220174	1195	1557	590	0	831467.42	13012	16220	2950	3715	4947852.98	YES													
230066	230004	3084	3304	"1,731"	"1,550"	4226617.55	10681	5194	751	1464	7134015.06	YES													
240010	240061	9089	7965	115	0	0	22374	23303	4229	4375	22658468.31	SCH													
240043	240117	1933	966	0	0	0	1456	2628	225	231	2918888.97	SCH													
240115	240132	9929	11391	"1,034"	976	3284631.00	17203	15829	1789	2135	4356758.49	YES													
260138	264018	0	0	0	0	0	21458	20409	3063	3039	19051825.95	YES													
280060	280030	11083	10210	"1,206"	"1,579"	18498830.27	19189	18690	2358	2310	15460420.15	YES													
330101	330064	19608	10253	0	0	0	183260	192696	45268	44408	60615329.94	YES													
330234	330067	15287	12207	974	0	1549034.18	61489	63227	4179	5738	30167204.67	YES													
330350	330152	0	0	0	0	0	62133	48008	7029	7514	16147948.06	YES													
330241	330159	0	0	0	0	0	39576	44737	7042	7682	33709387.56	YES													
330214	330306	51425	49343	"9,715"	"10,330"	28429770.07	19491	18021	5570	6145	7287564.49	YES													
330195	330353	25431	23032	"8,313"	"7,747"	3556883.77	72428	78707	9387	8969	15063392.38	YES													
330195	330372	11241	8648	"2,041"	"2,313"	3594069.53	72428	78707	9387	8969	15063392.38	YES													
340075	340055	788	0	0	0	0	8422	8399	1360	1458	10475989.08	YES													
340053	340153	225	301	72	0	295294.08	46055	40629	3981	3982	33399512.60	YES													
360020	360019	6436	6987	"1,228"	806	4425340.12	23313	20679	3728	4054	19609350.85	YES													
360014	361305	0	0	0	0	0	2424	2388	479	370	4544130.19	SCH													
390194	390019	0	0	149	153	903079.56	2542	2096	631	616	1709012.16	YES													
390006	390189	0	0	0	0	0	35193	35975	3588	3144	13333517.75	YES													
430048	430094	0	0	0	0	0	914	868	67	95	1768519.29	SCH													
440068	440054	380	54	9	0	0	2527	2338	526	396	2633438.58	YES													
440156	440064	663	457	45	0	329276.29	31642	33464	3398	4101	4469419.58	YES													
440007	441308	0	0	0	0	0	486	517	310	275	644009.02	YES													
450617	450530	0	0	0	0	0	30109	27386	5578	5861	11539790.68	YES													
450018	450591	3353	2916	137	0	4687082.01	45949	49328	3028	3402	57828999.52	YES													
450209	450796	0	0	4	3	3954.03	28654	26576	1794	1632	27607661.40	YES													
450388	450878	0	0	0	0	0	103106	103817	18721	18820	57842777.24	YES													
450431	453038	0	0	0	0	0	41745	40782	3875	4075	24057360.64	YES													
510022	510085	1335	1112	219	0	1003124.10	46834	44869	8197	8856	19001724.20	YES													
520136	520170	0	0	0	0	0	30589	29745	3943	3863	5357701.51	YES													
530008	530010	1498	1438	130	0	522893.56	1276	1221	138	235	3546273.15	SCH													
