List of Hospital Mergers for FY 2019 Final Rule Correction Notice Calculation of Factor 3 of the Uncompensated Care Payment																				
Merger information obtained as of June 2018																				
"Low Income Insured Days based on Medicaid days from hospitals' 2013 cost reports and FY 2016 SSI ratios. Uncompensated care costs based on Worksheet S-10 from hospitals' 2014 and 2015 cost reports. All cost report data from HCRIS, June 2018 update."																				
		Factor 3 Components of Acquired Hospital							Factor 3 Components of Surviving Hospital											
Surviving Provider Number	Provider Number Prior to Acquisition/Merger	2013 Medicaid Days (Annualized)	Length of 2013 Reporting Period	2016 SSI Days	2014 UCC (Annualized)	Length of 2014 Reporting Period	2015 UCC (Annualized)	Length of 2015 Reporting Period	2013 Medicaid Days (Annualized)	Length of 2013 Reporting Period	2016 SSI Days	2014 UCC (Annualized)	Length of 2014 Reporting Period	2015 UCC (Annualized)	Length of 2015 Reporting Period	DSH status of surviving provider number				
010005	010010	0	0	0	$0	0	$0	0	"6,981"	365	"2,118"	"$11,438,311"	365	"$10,732,305"	365	YES				
010029	010025	"2,791"	215	0	$0	0	$0	0	"13,187"	365	"3,516"	"$19,511,241"	365	"$18,717,713"	365	YES				
010085	010054	473	365	0	$0	0	$0	0	"9,130"	365	"1,983"	"$8,521,572"	365	"$10,089,391"	366	YES				
010092	010145	0	0	0	$0	0	$0	0	"34,511"	365	"8,965"	"$30,176,348"	365	"$28,617,273"	365	YES				
030012	030118	"4,346"	365	125	"$7,664,661"	365	"$8,810,741"	365	"1,403"	365	336	"$6,338,523"	365	"$12,502,781"	365	SCH				
030110	030001	"7,737"	365	"1,094"	"$3,699,170"	365	"$4,483,798"	365	"10,198"	365	"1,279"	"$11,221,727"	365	"$7,451,758"	366	YES				
040014	040080	"1,824"	365	0	"$445,326"	184	"$609,509"	45	"8,437"	365	"3,067"	"$12,535,583"	365	"$11,289,247"	365	YES				
050060	050732	"1,775"	365	0	"$439,878"	365	$0	0	"123,233"	365	"13,194"	"$16,009,772"	365	"$16,611,781"	366	YES				
050121	050196	"5,345"	365	0	"$5,451,935"	365	"$3,261,845"	334	"12,328"	365	"3,508"	"$3,940,365"	365	"$4,360,156"	365	YES				
050135	050752	0	0	0	$0	0	$0	0	"30,188"	365	"7,383"	"$5,518,040"	365	"$3,733,065"	365	YES				
070022	070001	0	0	0	$0	0	$0	0	"106,220"	384	"9,264"	"$28,155,797"	365	"$40,896,026"	365	YES				
070033	070015	729	365	0	"$1,453,474"	365	$0	0	"14,605"	365	"1,015"	"$10,495,237"	365	"$13,908,172"	365	YES				
100079	100009	"22,807"	365	"21,527"	"$24,970,890"	365	"$18,601,740"	366	"1,539"	365	127	$0	365	$0	366	NO				
100079	100240	14	365	0	"$3,552,009"	365	"$2,391,935"	366	"1,539"	365	127	$0	365	$0	366	NO				
100080	100234	"6,693"	365	598	"$4,663,464"	365	"$12,906,705"	275	"20,497"	365	"6,827"	"$41,985,319"	365	"$45,736,778"	366	YES				
100167	100061	0	0	0	$0	0	$0	0	"37,821"	365	"13,276"	"$23,993,646"	365	"$23,603,958"	366	YES				
110007	110163	0	0	0	$0	0	$0	0	"33,664"	365	"4,975"	"$45,410,079"	365	"$42,490,008"	366	YES				
110064	110186	"1,375"	365	0	"$411,486"	92	$0	0	"31,180"	365	"3,612"	"$23,222,256"	365	"$17,290,396"	366	YES				
110115	110219	0	0	0	$0	0	$0	0	"36,956"	365	"6,417"	"$40,767,343"	365	"$45,266,631"	365	YES				
110122	110212	0	0	0	$0	0	$0	0	"15,919"	365	"3,094"	"$20,442,634"	365	"$35,806,413"	365	YES				
140010	140051	"4,492"	365	0	$0	0	$0	0	"19,906"	365	"2,241"	"$44,658,542"	365	"$31,414,907"	365	YES				
150074	150129	278	365	0	"$2,116,158"	365	"$2,373,490"	181	"18,328"	365	"3,368"	"$18,644,950"	365	"$15,274,900"	365	YES				
150074	150154	620	365	0	"$8,388,926"	273	$0	0	"18,328"	365	"3,368"	"$18,644,950"	365	"$15,274,900"	365	YES				
150109	150003	"1,287"	365	0	"$8,007,321"	273	$0	0	"10,100"	365	726	"$13,907,046"	365	"$12,928,651"	365	YES				
170123	170202	0	0	0	$0	0	$0	0	"38,691"	365	"2,366"	"$24,558,682"	365	"$27,486,180"	365	YES				
190005	190122	0	0	0	$0	0	$0	0	"23,874"	191	"2,238"	"$115,262,843"	365	"$156,791,570"	365	YES				
190086	190257	63	365	0	"$139,894"	365	"$1,270,652"	59	"6,960"	365	"1,250"	"$3,294,613"	365	"$2,811,970"	365	YES				
190111	190236	"3,875"	365	"1,442"	"$6,834,674"	365	"$6,407,074"	365	"23,009"	365	"7,738"	"$24,115,342"	365	"$18,380,528"	365	YES				
190160	190261	4	365	0	$0	365	$0	245	"11,058"	365	"3,366"	"$3,202,941"	365	"$3,961,496"	366	YES				
190176	190177	"6,781"	365	"1,271"	"$5,156,404"	365	"$6,179,033"	365	"28,180"	365	"4,774"	"$9,484,547"	365	"$16,983,042"	365	YES				
190274	190175	610	365	0	"$2,673,907"	123	$0	0	"8,039"	365	"1,312"	"$5,772,659"	365	"$6,435,437"	366	YES				
200019	200040	981	122	0	"$3,607,243"	92	$0	0	"3,825"	365	879	"$11,489,897"	365	"$9,144,456"	365	YES				
220001	220058	190	365	17	"$347,189"	365	"$432,595"	365	"6,125"	365	"1,224"	"$3,756,657"	365	"$3,853,039"	365	YES				
220063	220082	"3,709"	365	0	"$3,285,451"	182	$0	0	"16,004"	365	"4,579"	"$8,798,219"	365	"$10,641,047"	365	YES				
220080	220174	"1,209"	365	0	"$1,583,320"	212	$0	0	"13,311"	365	"3,142"	"$5,298,912"	365	"$6,320,281"	365	YES				
230066	230004	"3,304"	365	0	"$5,219,414"	362	$0	0	"10,303"	184	"2,743"	"$4,682,609"	365	"$8,099,600"	366	YES				
240010	240061	"7,965"	365	0	$0	0	$0	0	"23,303"	365	"4,866"	"$17,467,972"	365	"$15,566,534"	365	SCH				
240043	240117	"1,948"	181	0	$0	0	$0	0	"2,628"	365	247	"$4,779,302"	365	"$8,336,197"	365	SCH				
240115	240132	"10,042"	365	"1,052"	"$3,852,776"	365	"$3,153,698"	365	"15,829"	365	"1,752"	"$5,564,986"	365	"$4,167,571"	365	YES				
280060	280030	"10,210"	365	687	"$19,930,588"	365	"$17,563,186"	221	"18,690"	365	"3,644"	"$17,508,081"	365	"$24,810,522"	366	YES				
330101	330064	"20,676"	181	0	$0	0	$0	0	"192,696"	365	"47,207"	"$69,824,177"	365	"$73,354,745"	365	YES				
330195	330353	"23,032"	365	"2,527"	"$11,516,309"	365	"$7,893,963"	378	"78,707"	365	"16,270"	"$21,329,093"	365	"$33,545,820"	365	YES				
330195	330372	"8,648"	365	769	"$9,966,041"	365	"$7,704,138"	378	"78,707"	365	"16,270"	"$21,329,093"	365	"$33,545,820"	365	YES				
330214	330306	"49,343"	365	"2,369"	"$28,517,019"	365	"$24,962,464"	243	"18,274"	365	"14,065"	"$15,205,919"	365	"$53,725,304"	366	YES				
330234	330067	"12,207"	365	0	"$16,753,303"	128	$0	0	"63,227"	365	"5,240"	"$42,967,884"	365	"$33,583,600"	365	YES				
330241	330159	0	0	0	$0	0	$0	0	"44,734"	365	"6,668"	"$41,657,198"	365	"$23,712,170"	365	YES				
330350	330152	0	0	0	$0	0	$0	0	"48,008"	365	"7,297"	"$16,089,150"	365	"$7,486,180"	365	YES				
330393	330340	"2,985"	365	349	"$6,505,581"	365	"$5,730,103"	365	"42,482"	365	"3,155"	"$62,395,008"	365	"$74,179,913"	365	YES				
340053	340153	301	365	0	"$1,820,328"	80	$0	0	"40,629"	365	"3,577"	"$48,136,655"	365	"$25,785,952"	365	YES				
340075	340055	0	0	0	$0	0	$0	0	"8,399"	365	"1,369"	"$11,545,790"	365	"$11,892,949"	365	YES				
360019	360195	643	365	0	"$2,757,146"	194	$0	0	"6,987"	365	0	"$4,635,747"	365	"$4,091,667"	151	NO				
360020	360019	"6,987"	365	0	"$4,635,747"	365	"$4,091,667"	151	"20,679"	365	"4,276"	"$19,720,618"	365	"$16,660,234"	365	YES				
360075	360115	0	0	0	$0	0	$0	0	"4,130"	365	874	"$9,212,998"	365	"$7,018,989"	365	YES				
360179	360269	0	0	0	$0	0	$0	0	"13,917"	365	"1,366"	"$19,182,170"	365	"$21,077,752"	366	YES				
390006	390189	0	0	0	$0	0	$0	0	"35,975"	365	"3,741"	"$25,576,173"	365	"$36,664,864"	366	YES				
390030	390031	833	365	508	"$1,666,359"	365	"$2,908,332"	366	"9,499"	365	"1,047"	"$2,688,759"	365	"$6,778,017"	366	YES				
390133	390263	"2,820"	365	"1,366"	"$6,970,797"	365	"$6,523,292"	366	"35,889"	365	"4,893"	"$32,757,407"	365	"$28,596,137"	366	YES				
390194	390019	19	365	143	"$970,639"	365	"$774,734"	366	"2,096"	365	484	"$2,425,612"	365	"$2,037,955"	366	YES				
430048	430094	0	365	0	$0	0	$0	0	868	365	71	"$1,928,859"	365	"$2,788,911"	366	SCH				
440068	440054	129	153	0	$0	0	$0	0	"2,338"	365	302	"$3,051,764"	365	"$5,465,532"	365	YES				
440156	440064	457	365	0	"$2,618,578"	59	$0	0	"33,464"	365	"3,522"	"$19,259,105"	365	"$19,764,463"	366	YES				
450018	450591	"2,916"	365	0	"$5,346,203"	320	$0	0	"49,328"	365	"3,317"	"$68,332,576"	365	"$107,460,044"	366	YES				
450032	450037	"23,259"	365	"2,312"	"$50,855,773"	365	"$41,785,665"	365	"3,282"	365	912	"$14,251,091"	365	"$14,412,198"	365	YES				
450209	450796	0	365	0	"$3,954"	365	"$32,735"	181	"26,927"	365	"1,588"	"$39,722,430"	365	"$36,121,196"	365	YES				
450388	450878	0	0	0	$0	0	$0	0	"103,817"	365	"19,808"	"$103,731,198"	365	"$123,431,912"	366	YES				
450617	450530	0	0	0	$0	0	$0	0	"27,386"	365	"5,679"	"$39,750,547"	365	"$42,653,134"	365	YES				
490075	490079	"3,561"	365	977	"$6,045,281"	365	"$6,190,808"	365	"6,289"	365	"1,774"	"$10,053,480"	365	"$8,298,928"	366	YES				
510022	510085	"1,112"	365	0	"$2,821,041"	151	$0	0	"44,869"	365	"8,831"	"$23,643,280"	365	"$25,492,780"	365	YES				
520136	520170	0	0	0	$0	0	$0	0	"29,745"	365	"3,514"	"$13,171,463"	365	"$12,395,547"	366	YES				
530008	530010	"1,438"	365	0	"$1,590,469"	120	$0	0	"1,221"	365	222	"$3,577,453"	365	"$4,213,001"	365	SCH				
670034	670079	23	365	95	"$3,688,159"	365	"$3,556,397"	366	99	365	497	"$9,173,624"	365	"$8,195,817"	366	NO				
670062	670097	0	0	0	$0	0	"$307,393"	365	0	365	5	"$573,659"	365	"$986,424"	365	NO				
