 List of  Hospital Mergers for FY 2017 Final Rule Calculation of Factor 3 of the Uncompensated Care Payment									
Merger information obtained as of January 2017									
"Low Income Insured Days based on Medicaid days from hospitals 2012 and 2013 cost reports and FY 2013 and FY 2014 SSI ratios. Uncompensated care costs based on Worksheet S-10 from hospitals 2014 cost reports. All cost report data from HCRIS, December 2016 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	
		2012	2013	2014	2012	2013	2014		
010005	010010	0	0	0	8587	8724	10960871.91	YES	
010029	010025	3801	2961	0	15255	16579	20743990.78	YES	
010085	010054	2764	532	0	10811	11920	8011680.73	YES	
010092	010145	0	0	0	40680	42170	34478667.04	SCH	
030012	030118	4329	4524	0	1643	1844	6085890.55	NO	
040080	040014	10844	11275	10519008.38	2236	2179	0	NO	
050060	050732	568	2365	0	97440	135606	14684412.33	YES	
050135	050752	11849	0	0	28333	39297	2795822.35	YES	
070033	070015	926	751	0	14405	15481	9491822.40	YES	
100167	100061	0	0	0	58942	52457	12092951.48	YES	
110007	110163	1782	0	0	42959	39135	30671288.71	YES	
110064	110186	4774	1676	0	35810	34567	15434970.46	YES	
110122	110212	0	0	0	20238	19670	17034452.14	YES	
140010	140051	6236	4495	0	21961	22462	33742806.75	YES	
150074	150129	578	398	0	22144	21241	17243732.14	YES	
190005	190122	7787	0	0	25612	25568	114773972.02	YES	
190274	190175	2013	904	0	9202	9177	5054546.17	YES	
190086	190257	99	106	0	8227	8394	245490.75	YES	
190160	190261	24	18	0	14265	14010	2659039.75	YES	
200019	200040	1322	1043	0	3604	4649	11836503.07	YES	
220063	220082	5395	4434	0	19151	19565	7513432.15	YES	
220080	220174	1913	1834	0	15814	15905	4947852.98	YES	
230066	230004	4870	5035	0	11386	11054	4769076.00	YES	
240010	240061	9659	8080	0	26444	27532	22658468.31	SCH	
240043	240117	2113	1948	0	1603	2853	2918888.97	SCH	
240115	240132	11185	12425	0	19092	17618	4356758.49	YES	
330101	330064	23851	20676	0	222662	237964	60615329.94	YES	
330234	330067	16966	13181	0	64927	67406	30167204.67	YES	
330350	330152	0	0	0	74220	55037	16147948.06	YES	
330241	330159	0	0	0	46837	51779	33709387.56	YES	
330214	330306	62861	59058	0	23794	23591	7287564.49	YES	
330195	330353	33208	31345	0	82209	88094	15063392.38	YES	
330195	330372	13546	10689	0	82209	88094	15063392.38	YES	
340075	340055	920	0	0	9584	10099	10475989.08	YES	
340053	340153	458	373	0	50881	44610	33399512.60	YES	
360020	360019	8030	8215	0	27213	24407	19609350.85	YES	
360014	361305	0	0	0	2970	2867	4544130.19	SCH	
390194	390019	304	168	0	3108	2727	1709012.16	YES	
390006	390189	0	0	0	38473	40314	13333517.75	YES	
430048	430094	0	0	0	969	935	1768519.29	SCH	
440068	440054	530	138	0	2966	2864	2633438.58	YES	
440156	440064	975	502	0	34760	36862	4469419.58	YES	
450617	450530	0	0	0	34767	32964	11539790.68	YES	
450018	450591	3538	3053	0	48922	52356	57628475.70	YES	
450209	450796	7	4	0	30591	28370	27607661.40	YES	
450388	450878	0	0	0	122339	122538	57842777.24	YES	
450431	453038	0	0	0	45966	44657	24057360.64	YES	
510022	510085	1797	1331	0	55046	53066	19011738.20	YES	
520136	520170	0	0	0	34829	33688	5357701.51	YES	
530008	530010	1654	1568	0	1373	1359	3546273.15	SCH	
