List of Hospital Mergers for FY 2019 Notice of Proposed Rulemaking Calculation of Factor 3 of the Uncompensated Care Payment																
Merger information obtained as of January 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, February 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"	"$8,535,731"	365	"$10,089,391"	366	YES
010092	010145	0	0	0	$0	0	$0	0	"34,511"	365	"8,965"	"$34,478,667"	365	"$28,617,273"	365	YES
030012	030118	"4,346"	365	125	"$7,664,661"	365	"$8,810,741"	365	"1,403"	365	336	"$19,989,335"	365	"$12,502,781"	365	SCH
040080	040014	"8,437"	365	"3,067"	"$12,535,583"	365	"$11,289,247"	365	"1,824"	365	0	"$445,326"	184	"$609,509"	45	NO
050121	050196	"5,345"	365	0	"$4,904,772"	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"	"$4,534,726"	365	"$3,733,065"	365	YES
070022	070001	0	0	0	$0	0	$0	0	"106,220"	384	"9,264"	"$28,155,797"	365	"$185,315,006"	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
100080	100234	"6,693"	365	598	"$4,663,464"	365	"$12,915,683"	275	"20,497"	365	"6,827"	"$41,991,034"	365	"$45,736,778"	366	YES
100167	100061	0	0	0	$0	0	$0	0	"37,821"	365	"13,276"	"$23,997,115"	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"	"$40,745,496"	365	"$45,266,631"	365	YES
110122	110212	0	0	0	$0	0	$0	0	"15,919"	365	"3,094"	"$20,443,551"	365	"$35,806,413"	365	YES
140010	140051	"4,492"	365	0	$0	0	$0	0	"19,906"	365	"2,241"	"$33,742,807"	365	"$30,725,873"	365	YES
150074	150129	278	365	0	"$2,116,158"	365	"$2,467,051"	181	"18,328"	365	"3,368"	"$18,644,950"	365	"$15,271,639"	365	YES
170123	170202	0	0	0	$0	0	$0	0	"38,691"	365	"2,366"	"$24,570,585"	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"	"$3,144,958"	365	"$2,812,685"	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"	"$16,325,718"	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	"$9,128,835"	365	YES
220063	220082	"3,709"	365	0	"$3,285,451"	182	$0	0	"16,004"	365	"4,579"	"$8,798,219"	365	"$10,637,449"	365	YES
220080	220174	"1,209"	365	0	"$1,583,320"	212	$0	0	"13,311"	365	"3,142"	"$5,298,912"	365	"$5,243,487"	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	"$2,918,889"	365	"$8,336,197"	365	SCH
240115	240132	"11,391"	365	"1,052"	"$3,852,776"	365	"$3,153,698"	365	"15,829"	365	"1,752"	"$5,565,283"	365	"$4,167,571"	365	YES
260138	264018	0	0	0	$0	0	$0	0	"20,409"	365	"3,218"	"$24,511,126"	365	"$19,730,555"	365	YES
280060	280030	"10,210"	365	687	"$19,930,588"	365	"$11,929,698"	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"	"$11,609,707"	365	"$18,242,131"	378	"78,707"	365	"16,270"	"$21,648,699"	365	"$33,545,820"	365	YES
330195	330372	"8,648"	365	769	"$4,635,458"	365	"$7,704,138"	378	"78,707"	365	"16,270"	"$21,648,699"	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"	"$42,970,568"	365	"$33,583,600"	365	YES
330241	330159	0	0	0	$0	0	$0	0	"44,737"	365	"6,668"	"$41,657,197"	365	"$35,507,703"	365	YES
330350	330152	0	0	0	$0	0	$0	0	"48,008"	365	"7,297"	"$16,089,150"	365	"$7,437,212"	365	YES
340053	340153	301	365	0	"$1,820,328"	80	$0	0	"40,629"	365	"3,577"	"$48,136,655"	365	"$47,151,069"	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
360014	361305	0	0	0	$0	0	$0	0	"2,388"	365	285	"$5,388,799"	365	"$4,070,543"	366	SCH
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
390006	390189	0	0	0	$0	0	$0	0	"35,975"	365	"3,741"	"$47,927,644"	365	"$36,664,864"	366	YES
430048	430094	0	365	0	$0	0	$0	0	868	365	71	"$1,768,519"	365	"$2,653,292"	366	SCH
440007	441308	0	0	0	$0	0	$0	0	517	365	333	"$729,479"	365	"$892,883"	365	YES
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"	"$19,260,824"	365	"$19,764,463"	366	YES
450018	450591	"2,916"	365	0	"$5,346,203"	320	$0	0	"49,328"	365	"3,317"	"$77,888,869"	365	"$98,654,005"	366	YES
450209	450796	0	365	0	"$3,954"	365	"$32,735"	181	"26,927"	365	"1,588"	"$74,184,741"	365	"$65,200,884"	365	YES
450388	450878	0	0	0	$0	0	$0	0	"103,817"	365	"19,808"	"$179,902,167"	365	"$39,364,345"	366	YES
450431	453038	0	0	0	$0	0	$0	0	"40,782"	365	"4,355"	"$30,009,075"	365	"$30,247,974"	365	YES
450617	450530	0	0	0	$0	0	$0	0	"27,386"	365	"5,679"	"$39,754,307"	365	"$42,653,134"	365	YES
510022	510085	"1,112"	365	0	"$2,821,061"	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	"$3,577,629"	365	"$4,213,001"	365	SCH
