List of  Hospital Mergers for FY 2018 Final Rule Calculation of Factor 3 of the Uncompensated Care Payment														
Merger information obtained as of July 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	"1,880"	"2,035"	10960871.91	YES		
010029	010025	3096	1644	170	0	0	12099	13187	"3,392"	"3,645"	20743990.78	YES		
010085	010054	2294	473	59	0	0	6398	9130	"2,790"	"2,278"	8011680.73	YES		
010092	010145	0	0	0	0	0	33116	34511	"7,659"	"8,428"	34478667.04	YES		
030012	030118	4231	4346	178	141	5003544.438	1345	1403	441	383	6091056.613	NO		
040014	040080	1847	1824	355	113	120918.2728	8044	8437	"2,838"	"3,490"	10519008.38	YES		
050060	050732	0	0	590	518	259748.2751	85197	123233	"12,373"	"13,572"	14684412.33	YES		
050135	050752	9497	0	0	0	0	20682	30188	"9,109"	"8,506"	2795822.348	YES		
070022	070001	17780	0	0	0	0	205982	0	"9,390"	"8,394"	43684184.73	YES		
070033	070015	0	0	22	0	1101846.171	13290	14605	876	"1,197"	9964773.146	YES		
100167	100061	0	0	0	0	0	42688	37821	"14,636"	"14,255"	12092951.48	YES		
110007	110163	1118	0	0	0	0	37554	33664	"5,471"	"5,337"	30671288.71	YES		
110064	110186	4101	1375	301	0	75227.24184	32543	31180	"3,387"	"3,543"	15434970.46	YES		
110122	110212	0	0	0	0	0	16014	15919	"3,751"	"3,372"	17034452.14	YES		
140010	140051	4891	4492	3	0	0	20712	19906	"2,556"	"2,227"	33742806.75	YES		
150074	150129	145	278	120	56	2076683.571	18890	18328	"2,913"	"3,083"	17243732.14	YES		
170123	170202	334	0	0	0	0	39609	38779	"2,240"	"2,046"	7803897.674	YES		
190274	190175	1530	610	294	3	876725.5547	8056	8039	"1,138"	"1,256"	5054811.231	YES		
190176	190177	6787	6781	"1,156"	"1,013"	2908788.067	28819	28180	"4,219"	"4,949"	8452074.141	YES		
190086	190257	36	63	43	6	139894.0563	6496	6960	"1,434"	"1,177"	245490.7453	YES		
190160	190261	24	0	14	13	0	10945	11058	"2,952"	"3,854"	2659039.746	YES		
200019	200040	1015	328	62	0	877517.5603	3013	3825	824	771	11836503.07	YES		
220063	220082	3962	3709	725	0	1806693.512	15902	16004	"3,561"	"4,800"	7513432.155	YES		
220080	220174	1195	1557	590	0	831467.4164	13012	16220	"2,950"	"3,715"	4947852.98	YES		
230066	230004	3084	3304	"1,731"	"1,550"	4226617.552	10681	5194	751	"1,464"	7134015.057	YES		
240010	240061	9089	7965	115	0	0	22374	23303	"4,229"	"4,375"	22658468.31	YES		
240043	240117	1933	966	0	0	0	1456	2628	225	231	2918888.969	SCH		
240115	240132	9929	11391	"1,034"	976	3284631.004	17203	15829	"1,789"	"2,135"	4356758.491	YES		
260138	264018	0	0	0	0	0	21458	20409	"3,063"	"3,039"	19051825.95	YES		
280060	280030	11083	10210	"1,206"	"1,579"	18498830.27	19189	18690	"2,358"	"2,310"	15460420.15	YES		
330101	330064	19608	10253	0	0	0	183260	192696	"45,268"	"44,408"	60615329.94	YES		
330234	330067	15287	12207	974	0	1549034.177	61489	63227	"4,179"	"5,738"	30167204.67	YES		
330350	330152	0	0	0	0	0	62133	48008	"7,029"	"7,514"	16147948.06	YES		
330241	330159	0	0	0	0	0	39576	44737	"7,042"	"7,682"	33709387.56	YES		
330214	330306	51425	49343	"9,715"	"10,330"	28429770.07	19491	18021	"5,570"	"6,145"	7287564.487	YES		
330195	330353	25431	23032	"8,313"	"7,747"	3556883.771	72428	78707	"9,387"	"8,969"	15063392.38	YES		
330195	330372	11241	8648	"2,041"	"2,313"	3594069.527	72428	78707	"9,387"	"8,969"	15063392.38	YES		
340075	340055	788	0	0	0	0	8422	8399	"1,360"	"1,458"	10475989.08	YES		
340053	340153	225	301	72	0	295294.0832	46055	40629	"3,981"	"3,982"	33399512.6	YES		
360020	360019	6436	6987	"1,228"	806	4425340.115	23313	20679	"3,728"	"4,054"	19609350.85	YES		
360014	361305	0	0	0	0	0	2424	2388	479	370	4544130.195	SCH		
390194	390019	0	0	149	153	903079.5604	2542	2096	631	616	1709012.162	YES		
390006	390189	0	0	0	0	0	35193	35975	"3,588"	"3,144"	13333517.75	YES		
430048	430094	0	0	0	0	0	914	868	67	95	1768519.294	SCH		
440068	440054	380	54	9	0	0	2527	2338	526	396	2633438.582	YES		
440156	440064	663	457	45	0	329276.2875	31642	33464	"3,398"	"4,101"	4469419.581	YES		
440007	441308	0	0	0	0	0	486	517	310	275	644009.0179	YES		
450617	450530	0	0	0	0	0	30109	27386	"5,578"	"5,861"	11539790.68	YES		
450018	450591	3353	2916	137	0	4687082.013	45949	49328	"3,028"	"3,402"	57828999.52	YES		
450209	450796	0	0	4	3	3954.03442	28654	26576	"1,794"	"1,632"	27607661.4	YES		
450388	450878	0	0	0	0	0	103106	103817	"18,721"	"18,820"	57842777.24	YES		
450431	453038	0	0	0	0	0	41745	40782	"3,875"	"4,075"	24057360.64	YES		
510022	510085	1335	1112	219	0	1003124.102	46834	44869	"8,197"	"8,856"	19001724.2	YES		
520136	520170	0	0	0	0	0	30589	29745	"3,943"	"3,863"	5357701.506	YES		
530008	530010	1498	1438	130	0	522893.5557	1276	1221	138	235	3546273.148	SCH		
														
