List of Hospital Mergers for FY 2020 Final Rule Calculation of Factor 3 of the Uncompensated Care Payment												
Merger information obtained as of June 2019												
"Low Income Insured Days based on Medicaid days from hospitals' 2013 cost reports and FY 2017 SSI ratios. Uncompensated care costs based on Worksheet S-10 from hospitals' 2015 cost reports. All cost report data from HCRIS, June 2019 update."												
"NOTE: For mergers where the acquired hospital had no cost report data, the historical merger has not been shown."												
		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	2017 SSI Days	2015 UCC (Annualized)	Length of 2015 Reporting Period	2013 Medicaid Days (Annualized)	Length of 2013 Reporting Period	2017 SSI Days	2015 UCC (Annualized)	Length of 2015 Reporting Period	DSH status of surviving provider number
010029	010025	"2,791"	215				"15,978"	365	"3,129"	"$23,158,653.00"	365	YES
010085	010054	473	365				"9,603"	365	"1,921"	"$10,089,390.83"	366	YES
030012	030118	"4,346"	365		"$8,810,741.00"	365	"5,749"	365	486	"$12,502,478.00"	365	SCH
030110	030001	"7,737"	365	538	"$4,483,798.00"	365	"17,935"	365	"2,299"	"$7,451,758.22"	366	YES
040014	040080	"1,824"	365		"$609,509.44"	45	"10,261"	365	"3,049"	"$11,289,247.00"	365	YES
050060	050732	"1,775"	365				"125,008"	365	"11,950"	"$16,611,781.27"	366	YES
050121	050196	"5,345"	365		"$3,261,725.24"	334	"17,673"	365	"3,548"	"$4,360,156.00"	365	YES
070033	070015	729	365				"15,334"	365	823	"$12,025,156.00"	365	YES
100079	100240	14	365	0	"$2,391,958.69"	366	"24,360"	365	"19,976"	"$20,993,699.02"	366	NO
100079	100009	"22,807"	365	"19,828"	"$18,601,740.33"	366	"24,360"	365	"19,976"	"$20,993,699.02"	366	NO
100080	100234	"6,693"	365		"$12,101,074.62"	275	"27,190"	365	"7,940"	"$42,313,504.59"	366	YES
100206	100255	"2,047"	273	"1,426"	"$8,744,815.00"	365	"3,122"	304	"2,278"	"$6,799,409.00"	365	YES
110028	110039	"2,341"	365	173	"$1,509,084.00"	365	"27,012"	365	"5,565"	"$30,816,935.00"	365	YES
110064	110186	"1,375"	365				"32,555"	365	"3,013"	"$17,290,396.05"	366	YES
140010	140051	"4,492"	365				"24,398"	365	"2,255"	"$26,505,793.00"	365	YES
140116	140176	"3,936"	365	306	"$4,491,261.17"	366	"8,470"	365	910	"$6,241,922.84"	366	YES
150056	150038	479	365		"$2,161,619.22"	90	"119,871"	365	"8,428"	"$48,055,164.00"	365	YES
150074	150129	354	365		"$2,373,490.14"	181	"19,302"	365	"3,474"	"$5,438,657.00"	365	YES
150074	150154	620	365				"19,302"	365	"3,474"	"$5,438,657.00"	365	YES
150082	150175	211	365	57	"$1,042,083.00"	365	"15,253"	365	"3,364"	"$19,112,331.00"	365	YES
150109	150003	"1,287"	365				"11,387"	365	925	"$12,543,530.00"	365	YES
150162	150182	3	365	0	"$298,940.00"	365	"15,281"	365	"1,819"	"$26,648,087.00"	365	YES
190064	190242	"1,331"	365	554	"$4,823,512.90"	366	"31,998"	365	"8,634"	"$72,054,444.56"	366	YES
190086	190257	63	365		"$1,270,651.61"	59	"7,023"	365	"1,172"	"$2,811,956.00"	365	YES
190102	190205	"31,150"	365	6	"$2,067,048.85"	366	"36,263"	365	"2,653"	"$5,592,070.26"	366	YES
190111	190236	"3,875"	365	"1,489"	"$6,399,761.00"	365	"26,884"	365	"9,071"	"$18,380,528.00"	365	YES
190125	190246	13	365	51	"$149,904.00"	365	"19,859"	365	"3,905"	"$13,590,761.04"	366	YES
190160	190261	4	365		$0.00	245	"11,062"	365	"3,582"	"$3,961,495.59"	366	YES
190176	190177	"6,781"	365	735	"$6,178,139.00"	365	"34,961"	365	"5,466"	"$16,972,205.00"	365	YES
190274	190175	610	365				"8,649"	365	"1,203"	"$6,435,436.67"	366	YES
200019	200040	981	122				"4,806"	365	736	"$9,144,456.00"	365	YES
220001	220058	190	365	34	"$432,595.00"	365	"6,315"	365	"1,032"	"$3,853,039.00"	365	YES
220030	220050	324	365		"$975,355.00"	365	"1,241"	365	372	"$1,693,378.00"	365	YES
220063	220082	"3,709"	365				"19,713"	365	"5,239"	"$10,641,047.00"	365	YES
220080	220174	"1,209"	365				"14,520"	365	"3,487"	"$6,319,103.00"	365	YES
230066	230004	"3,304"	365				"13,607"	184	"2,626"	"$6,985,961.38"	366	YES
240010	240061	"7,965"	365				"31,268"	365	"4,273"	"$3,357,038.00"	365	SCH
240043	240117	"1,948"	181				"4,576"	365	309	"$779,918.00"	365	SCH
240115	240132	"10,042"	365	318	"$3,163,320.00"	365	"25,871"	365	"2,924"	"$4,167,571.00"	365	YES
280060	280030	"10,210"	365		"$17,563,185.61"	221	"28,900"	365	"3,368"	"$26,454,944.70"	366	YES
330090	330108	"4,546"	365	316	"$200,896.00"	365	"16,367"	365	"2,392"	"$4,572,930.00"	365	YES
330101	330061	"7,422"	365	"1,719"	"$4,755,238.00"	365	"220,794"	365	"45,338"	"$73,354,745.00"	365	YES
330101	330064	"20,676"	181				"220,794"	365	"45,338"	"$73,354,745.00"	365	YES
330103	390118	"5,431"	365	695	"$1,363,896.00"	365	"9,985"	365	"1,570"	"$2,057,299.00"	365	YES
330195	330372	"8,648"	365		"$7,704,138.04"	378	"110,387"	365	"19,390"	"$33,021,632.00"	365	YES
330195	330353	"23,032"	365		"$7,893,963.15"	378	"110,387"	365	"19,390"	"$33,021,632.00"	365	YES
330214	330306	"49,343"	365		"$24,914,575.56"	243	"67,617"	365	"17,031"	"$54,693,914.66"	366	YES
330229	330132	345	365	60	"$1,026,595.00"	365	"2,689"	365	330	"$2,559,518.00"	365	YES
330234	330067	"12,207"	365				"75,434"	365	"5,238"	"$15,567,688.00"	365	YES
330393	330340	"2,985"	365	306	"$5,730,103.00"	365	"45,467"	365	"3,891"	"$28,238,065.00"	365	YES
340053	340153	301	365				"40,930"	365	"3,292"	"$25,785,632.00"	365	YES
340115	340106	"1,937"	365	248	"$1,339,138.00"	365	"17,088"	365	"4,800"	"$27,753,132.00"	365	YES
360020	360019	"6,987"	365		"$4,090,095.73"	151	"27,666"	365	"4,050"	"$14,499,333.00"	365	YES
360020	360195	643	365				"27,666"	365	"4,050"	"$14,499,333.00"	365	YES
360055	360141	"7,762"	365	577	"$700,739.00"	365	"15,406"	365	"1,858"	"$1,876,005.00"	365	YES
360068	360074	"5,091"	365	616	"$4,943,700.00"	365	"46,897"	365	"3,772"	"$12,488,283.00"	365	YES
370028	370032	"8,883"	365	593	"$7,127,059.00"	365	"68,417"	365	"4,054"	"$29,480,699.96"	366	YES
390030	390031	833	365	842	"$2,908,333.96"	366	"10,332"	365	"1,555"	"$6,778,017.09"	366	YES
390133	390263	"2,820"	365	"1,587"	"$6,523,505.38"	366	"38,709"	365	"7,255"	"$28,589,111.67"	366	YES
390194	390019	19	365	25	"$774,734.44"	366	"2,115"	365	728	"$2,035,753.59"	366	YES
420007	420083	"4,831"	365	837	"$8,116,234.74"	366	"38,135"	365	"6,001"	"$64,247,832.00"	365	YES
440002	440189	"3,431"	365	"1,096"	"$2,640,074.00"	365	"31,279"	365	"9,758"	"$31,137,218.55"	366	YES
440050	440025	"2,593"	365	630	"$2,130,805.18"	366	"4,513"	365	"1,166"	"$2,905,365.10"	366	YES
440068	440054	129	153				"2,467"	365	316	"$5,465,532.00"	365	YES
440156	440064	457	365				"33,921"	365	"3,770"	"$22,024,892.83"	366	YES
450018	450591	"2,916"	365				"52,244"	365	"2,951"	"$75,404,981.01"	366	YES
450032	450037	"23,622"	365	"2,216"	"$38,691,130.00"	365	"26,904"	365	"3,066"	"$14,412,061.00"	365	YES
450209	450796		365		"$32,735.06"	181	"26,927"	365	"1,876"	"$34,753,748.00"	365	YES
450670	450716	"14,961"	365	"1,113"	"$16,481,598.00"	365	"19,927"	365	"2,308"	"$12,051,661.75"	366	YES
490075	490079	"3,561"	365	"1,006"	"$6,139,383.00"	365	"9,850"	365	"3,086"	"$8,298,928.21"	366	YES
510022	510085	"1,112"	365				"45,981"	365	"8,384"	"$17,927,956.00"	365	YES
520009	520048	"3,155"	365	336	"$1,133,307.05"	366	"13,458"	365	"1,058"	"$2,893,632.24"	366	YES
520136	520204	483	365	256	"$1,819,902.96"	366	"30,228"	365	"3,318"	"$11,751,416.34"	366	YES
530008	530010	"1,438"	365				"2,659"	365	167	"$4,213,001.00"	365	SCH
530012	530033	123	365	19	"$850,175.00"	365	"4,220"	365	826	"$17,609,128.81"	366	SCH
670034	670079	23	365		"$3,592,346.95"	366	122	365	745	"$8,195,816.71"	366	NO
670062	670097			0	"$307,393.00"	365		365	N/A	"$986,424.00"	365	NO
670095	670058		365	0	"$69,551.00"	365			N/A	"$92,913.00"	365	NO
