List of Hospital Mergers for Alternative Policy under Consideration for the FY 2020 Notice of Proposed Rulemaking Calculation of Factor 3 of the Uncompensated Care Payment															
Merger information obtained as of February  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' 2017 cost reports. All cost report data from HCRIS, February 2019 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	2017 SSI Days	2017 UCC (Annualized)	Length of 2017 Reporting Period	2013 Medicaid Days (Annualized)	Length of 2013 Reporting Period	2017 SSI Days	2017 UCC (Annualized)	Length of 2017 Reporting Period	DSH status of surviving provider number			
010005	010010	0	0	0	$0.00	0	6981	365	2192	"$12,454,222.00"	365	YES			
010029	010025	2791	215	0	$0.00	0	13187	365	3129	"$16,359,119.00"	365	YES			
010085	010054	473	365	0	$0.00	0	9130	365	1921	"$12,427,896.00"	365	YES			
010092	010145	0	0	0	$0.00	0	34511	365	7907	"$35,273,792.00"	365	YES			
030012	030118	4346	365	0	$0.00	0	1403	365	486	"$10,146,969.00"	365	SCH			
030110	030001	7737	365	538	"$818,336.08"	120	10198	365	1761	"$9,301,189.00"	365	YES			
040014	040080	1824	365	0	$0.00	0	8437	365	3049	"$10,335,727.00"	365	YES			
050060	050732	1775	365	0	$0.00	0	123233	365	11950	"$28,837,558.00"	365	YES			
050121	050196	5345	365	0	$0.00	0	12328	365	3548	"$13,222,755.00"	365	YES			
050135	050752	0	0	0	$0.00	0	30188	365	7965	"$3,785,332.00"	365	YES			
070022	070001	0	0	0	$0.00	0	106220	384	8810	"$122,428,682.00"	365	YES			
070033	070015	729	365	0	$0.00	0	14605	365	823	"$13,857,194.00"	365	YES			
100079	100009	22807	365	19828	"$9,688,886.07"	150	1539	365	148	$0.00	365	NO			
100079	100240	14	365	0	"$6,211,484.83"	150	1539	365	148	$0.00	365	NO			
100080	100234	6693	365	0	$0.00	0	20497	365	7940	"$56,794,489.00"	365	YES			
100167	100061	0	0	0	$0.00	0	37821	365	12675	"$23,603,957.62"	366	YES			
110007	110163	0	0	0	$0.00	0	33664	365	4695	"$45,695,583.00"	365	SCH			
110028	110039	2341	365	173	"$1,946,828.44"	273	24671	365	5392	"$34,797,461.00"	365	YES			
110064	110186	1375	365	0	$0.00	0	31180	365	3013	"$34,776,696.00"	365	YES			
110115	110219	0	0	0	$0.00	0	36956	365	5956	"$64,583,369.00"	365	YES			
110122	110212	0	0	0	$0.00	0	15919	365	3297	"$24,070,609.00"	365	YES			
140010	140051	4492	365	0	$0.00	0	19906	365	2255	"$32,792,152.00"	365	YES			
140116	140176	3936	365	306	"$2,336,882.00"	365	4534	365	604	"$13,650,636.00"	365	YES			
150056	150038	479	365	0	$0.00	0	119392	365	8428	"$63,641,904.00"	365	YES			
150074	150129	354	365	0	$0.00	0	18328	365	3474	"$12,266,747.00"	365	YES			
150074	150154	620	365	0	$0.00	0	18328	365	3474	"$12,266,747.00"	365	YES			
150109	150003	1287	365	0	$0.00	0	10100	365	925	"$16,181,111.00"	365	YES			
170123	170202	0	0	0	$0.00	0	38691	365	2238	"$37,830,266.00"	365	YES			
190005	190122	0	0	0	$0.00	0	23874	191	2879	"$102,601,993.00"	365	YES			
190086	190257	63	365	0	$0.00	0	6960	365	1172	"$1,313,297.00"	365	YES			
190111	190236	3875	365	1489	"$3,863,431.00"	365	23009	365	7582	"$16,910,630.00"	365	YES			
190160	190261	4	365	0	$0.00	0	11058	365	3582	"$3,189,792.00"	365	YES			
190176	190177	6781	365	735	"$749,681.03"	126	28180	365	4731	"$9,324,292.00"	365	YES			
190274	190175	610	365	0	$0.00	0	8039	365	1203	"$3,488,795.00"	365	YES			
200019	200040	981	122	0	$0.00	0	3825	365	736	"$11,477,680.00"	365	YES			
220001	220058	190	365	34	"$516,882.00"	365	6125	365	998	"$3,765,486.00"	365	YES			
220063	220082	3709	365	0	$0.00	0	16004	365	5239	"$6,082,789.00"	365	YES			
220080	220174	1209	365	0	$0.00	0	13311	365	3487	"$5,207,770.00"	365	YES			
230066	230004	3304	365	0	$0.00	0	10303	184	2626	"$9,884,450.00"	365	YES			
240010	240061	7965	365	0	$0.00	0	23303	365	4273	"$27,498,532.00"	365	SCH			
240043	240117	1948	181	0	$0.00	0	2628	365	309	"$11,908,499.00"	365	SCH			
240115	240132	10042	365	318	$0.00	0	15829	365	2606	"$9,406,729.00"	365	YES			
280060	280030	10210	365	0	$0.00	0	18690	365	3368	"$34,527,094.00"	365	YES			
330101	330061	7422	365	1719	"$4,633,509.00"	365	192696	365	43619	"$61,368,764.00"	365	YES			
330101	330064	20676	181	0	$0.00	0	192696	365	43619	"$61,368,764.00"	365	YES			
330103	390118	5431	365	695	"$1,720,338.19"	376	4554	365	875	"$2,573,703.00"	365	YES			
330195	330353	23032	365	0	$0.00	0	78707	365	19390	"$55,163,192.00"	365	YES			
330195	330372	8648	365	0	$0.00	0	78707	365	19390	"$55,163,192.00"	365	YES			
330214	330306	49343	365	0	$0.00	0	18274	365	17031	"$69,578,281.00"	365	YES			
330229	330132	345	365	60	"$1,347,521.00"	365	2344	365	270	"$859,494.00"	365	YES			
330234	330067	12207	365	0	$0.00	0	63227	365	5238	"$38,043,137.00"	365	YES			
330241	330159	0	0	0	$0.00	0	44734	365	6798	"$29,354,810.00"	365	YES			
330350	330152	0	0	0	$0.00	0	48008	365	7630	"$7,170,606.00"	365	YES			
330393	330340	2985	365	306	"$4,999,864.69"	212	42482	365	3585	"$89,250,880.00"	365	YES			
340053	340153	301	365	0	$0.00	0	40629	365	3292	"$39,072,204.00"	365	YES			
340075	340055	0	0	0	$0.00	0	8399	365	1378	"$12,845,110.00"	365	YES			
340115	340106	1937	365	248	"$1,713,463.23"	212	15151	365	4552	"$39,513,255.00"	365	YES			
360019	360195	643	365	0	$0.00	0	6987	365	0	"$4,090,095.73"	151	NO			
360020	360019	6987	365	0	$0.00	0	20679	365	4050	"$16,921,271.00"	365	YES			
360075	360115	0	0	0	$0.00	0	4130	365	1106	"$7,048,796.00"	365	YES			
360179	360269	0	0	0	$0.00	0	13917	365	1383	"$17,052,606.00"	365	YES			
370028	370032	8883	365	593	"$8,245,098.00"	365	59534	365	3461	"$47,235,389.00"	365	YES			
390006	390189	0	0	0	$0.00	0	35975	365	3687	"$14,088,394.00"	365	YES			
390030	390031	833	365	842	"$2,308,813.60"	329	9499	365	713	"$3,141,015.00"	365	YES			
390133	390263	2820	365	1587	"$5,678,318.21"	304	35889	365	5668	"$28,094,018.00"	365	YES			
390194	390019	19	365	25	$0.00	0	2096	365	703	"$2,366,885.00"	365	YES			
430048	430094	0	365	0	$0.00	0	868	365	73	"$2,715,818.00"	365	YES			
440002	440189	3431	365	1096	"$2,806,230.00"	365	27848	365	8662	"$21,487,446.00"	365	YES			
440068	440054	129	153	0	$0.00	0	2338	365	316	"$4,846,093.00"	365	YES			
440156	440064	457	365	0	$0.00	0	33464	365	3770	"$23,242,778.00"	365	YES			
450018	450591	2916	365	0	$0.00	0	49328	365	2951	"$55,989,179.00"	365	YES			
450032	450037	23622	365	2216	"$39,869,876.12"	335	3282	365	850	"$10,710,112.00"	365	YES			
450209	450796	0	365	0	$0.00	0	26927	365	1876	"$42,857,575.00"	365	YES			
450388	450878	0	0	0	$0.00	0	103817	365	20010	"$111,339,903.00"	365	YES			
450617	450530	0	0	0	$0.00	0	27386	365	5111	"$42,251,476.00"	365	YES			
490075	490079	3561	365	1006	"$6,381,217.45"	273	6289	365	2080	"$8,385,738.13"	184	YES			
510022	510085	1112	365	0	$0.00	0	44869	365	8384	"$42,187,940.00"	365	YES			
520009	520048	3155	365	336	"$1,853,529.93"	335	10303	365	722	"$4,404,709.00"	365	YES			
520136	520170	0	0	0	$0.00	0	29745	365	3062	"$9,436,581.00"	365	YES			
520136	520204	483	365	256	"$2,417,452.75"	335	29745	365	3062	"$9,436,581.00"	365	YES			
530008	530010	1438	365	0	$0.00	0	1221	365	167	"$3,461,567.00"	365	SCH			
530012	530033	123	365	19	"$52,932.00"	365	4097	365	807	"$18,232,881.00"	365	SCH			
670034	670079	23	365	0	$0.00	0	99	365	745	"$16,805,620.00"	365	NO			
670062	670097	0	0	0	"$307,393.00"	365	0	365	4	"$986,424.00"	365	NO			
670095	670058	0	365	0	"$16,524.18"	184	0	0	0	"$38,368.64"	184	NO			
