List of Hospital Mergers for 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' 2015 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	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			
010005	010010	0	0	0	$0.00	0	"6,981"	365	"2,192"	"$10,732,305.00"	365	YES			
010029	010025	"2,791"	215	0	$0.00	0	"13,187"	365	"3,129"	"$12,036,157.00"	365	YES			
010085	010054	473	365	0	$0.00	0	"9,130"	365	"1,921"	"$10,089,390.83"	366	YES			
010092	010145	0	0	0	$0.00	0	"34,511"	365	"7,907"	"$28,617,273.00"	365	YES			
030012	030118	"4,346"	365	0	"$8,810,741.00"	365	"1,403"	365	486	"$12,502,781.00"	365	SCH			
030110	030001	"7,737"	365	538	"$4,483,798.00"	365	"10,198"	365	"1,761"	"$7,451,758.22"	366	YES			
040014	040080	"1,824"	365	0	"$609,509.44"	45	"8,437"	365	"3,049"	"$11,289,247.00"	365	YES			
050060	050732	"1,775"	365	0	$0.00	0	"123,233"	365	"11,950"	"$16,611,781.27"	366	YES			
050121	050196	"5,345"	365	0	"$3,261,725.24"	334	"12,328"	365	"3,548"	"$4,360,156.00"	365	YES			
050135	050752	0	0	0	$0.00	0	"30,188"	365	"7,965"	"$3,733,065.00"	365	YES			
070022	070001	0	0	0	$0.00	0	"106,220"	384	"8,810"	"$40,896,026.00"	365	YES			
070033	070015	729	365	0	$0.00	0	"14,605"	365	823	"$11,889,202.00"	365	YES			
100079	100009	"22,807"	365	"19,828"	"$18,601,740.33"	366	"1,539"	365	148	$0.00	366	NO			
100079	100240	14	365	0	"$2,391,958.69"	366	"1,539"	365	148	$0.00	366	NO			
100080	100234	"6,693"	365	0	"$12,101,074.62"	275	"20,497"	365	"7,940"	"$42,321,273.31"	366	YES			
100167	100061	0	0	0	$0.00	0	"37,821"	365	"12,675"	"$23,603,957.62"	366	YES			
110007	110163	0	0	0	$0.00	0	"33,664"	365	"4,695"	"$42,490,008.02"	366	SCH			
110028	110039	"2,341"	365	173	"$1,509,084.00"	365	"24,671"	365	"5,392"	"$18,205,063.00"	365	YES			
110064	110186	"1,375"	365	0	$0.00	0	"31,180"	365	"3,013"	"$17,290,396.05"	366	YES			
110115	110219	0	0	0	$0.00	0	"36,956"	365	"5,956"	"$45,253,249.00"	365	YES			
110122	110212	0	0	0	$0.00	0	"15,919"	365	"3,297"	"$27,230,657.00"	365	YES			
140010	140051	"4,492"	365	0	$0.00	0	"19,906"	365	"2,255"	"$31,414,907.00"	365	YES			
140116	140176	"3,936"	365	306	"$4,491,261.17"	366	"4,534"	365	604	"$7,246,391.87"	366	YES			
150056	150038	479	365	0	"$2,161,619.22"	90	"119,392"	365	"8,428"	"$13,739,693.00"	365	YES			
150074	150129	354	365	0	"$2,373,490.14"	181	"18,328"	365	"3,474"	"$5,439,157.00"	365	YES			
150074	150154	620	365	0	$0.00	0	"18,328"	365	"3,474"	"$5,439,157.00"	365	YES			
150109	150003	"1,287"	365	0	$0.00	0	"10,100"	365	925	"$12,543,530.00"	365	YES			
170123	170202	0	0	0	$0.00	0	"38,691"	365	"2,238"	"$27,458,904.00"	365	YES			
190005	190122	0	0	0	$0.00	0	"23,874"	191	"2,879"	"$102,601,993.00"	365	YES			
190086	190257	63	365	0	"$1,270,651.61"	59	"6,960"	365	"1,172"	"$2,811,956.00"	365	YES			
190111	190236	"3,875"	365	"1,489"	"$6,399,761.00"	365	"23,009"	365	"7,582"	"$18,380,528.00"	365	YES			
190160	190261	4	365	0	$0.00	245	"11,058"	365	"3,582"	"$3,961,495.59"	366	YES			
190176	190177	"6,781"	365	735	"$6,178,139.00"	365	"28,180"	365	"4,731"	"$16,972,205.00"	365	YES			
190274	190175	610	365	0	$0.00	0	"8,039"	365	"1,203"	"$6,435,436.67"	366	YES			
200019	200040	981	122	0	$0.00	0	"3,825"	365	736	"$9,144,456.00"	365	YES			
220001	220058	190	365	34	"$432,595.00"	365	"6,125"	365	998	"$3,853,039.00"	365	YES			
220063	220082	"3,709"	365	0	$0.00	0	"16,004"	365	"5,239"	"$10,641,047.00"	365	YES			
220080	220174	"1,209"	365	0	$0.00	0	"13,311"	365	"3,487"	"$6,319,103.00"	365	YES			
230066	230004	"3,304"	365	0	$0.00	0	"10,303"	184	"2,626"	"$6,985,961.38"	366	YES			
240010	240061	"7,965"	365	0	$0.00	0	"23,303"	365	"4,273"	"$15,566,534.00"	365	SCH			
240043	240117	"1,948"	181	0	$0.00	0	"2,628"	365	309	"$8,336,197.00"	365	SCH			
240115	240132	"10,042"	365	318	"$3,153,698.00"	365	"15,829"	365	"2,606"	"$4,167,571.00"	365	YES			
280060	280030	"10,210"	365	0	"$17,563,185.61"	221	"18,690"	365	"3,368"	"$15,297,146.01"	366	YES			
330101	330061	"7,422"	365	"1,719"	"$4,755,238.00"	365	"192,696"	365	"43,619"	"$73,354,745.00"	365	YES			
330101	330064	"20,676"	181	0	$0.00	0	"192,696"	365	"43,619"	"$73,354,745.00"	365	YES			
330103	390118	"5,431"	365	695	"$1,363,896.00"	365	"4,554"	365	875	"$2,057,299.00"	365	YES			
330195	330353	"23,032"	365	0	"$7,893,963.15"	378	"78,707"	365	"19,390"	"$27,381,279.00"	365	YES			
330195	330372	"8,648"	365	0	"$7,704,138.04"	378	"78,707"	365	"19,390"	"$27,381,279.00"	365	YES			
330214	330306	"49,343"	365	0	"$24,962,464.16"	243	"18,274"	365	"17,031"	"$23,682,974.14"	366	YES			
330229	330132	345	365	60	"$1,026,595.00"	365	"2,344"	365	270	"$2,559,518.00"	365	YES			
330234	330067	"12,207"	365	0	$0.00	0	"63,227"	365	"5,238"	"$15,259,056.00"	365	YES			
330241	330159	0	0	0	$0.00	0	"44,734"	365	"6,798"	"$20,772,496.00"	365	YES			
330350	330152	0	0	0	$0.00	0	"48,008"	365	"7,630"	"$7,486,180.00"	365	YES			
330393	330340	"2,985"	365	306	"$5,730,103.00"	365	"42,482"	365	"3,585"	"$26,641,148.00"	365	YES			
340053	340153	301	365	0	$0.00	0	"40,629"	365	"3,292"	"$25,785,632.00"	365	YES			
340075	340055	0	0	0	$0.00	0	"8,399"	365	"1,378"	"$11,892,949.00"	365	YES			
340115	340106	"1,937"	365	248	"$1,339,138.00"	365	"15,151"	365	"4,552"	"$24,170,807.00"	365	YES			
360019	360195	643	365	0	$0.00	0	"6,987"	365	0	"$4,090,095.73"	151	NO			
360020	360019	"6,987"	365	0	"$4,090,095.73"	151	"20,679"	365	"4,050"	"$14,499,333.00"	365	YES			
360075	360115	0	0	0	$0.00	0	"4,130"	365	"1,106"	"$4,669,785.00"	365	YES			
360179	360269	0	0	0	$0.00	0	"13,917"	365	"1,383"	"$12,270,970.90"	366	YES			
370028	370032	"8,883"	365	593	"$7,127,059.00"	365	"59,534"	365	"3,461"	"$17,561,401.57"	366	YES			
390006	390189	0	0	0	$0.00	0	"35,975"	365	"3,687"	"$24,663,378.10"	366	YES			
390030	390031	833	365	842	"$2,908,333.96"	366	"9,499"	365	713	"$6,778,017.09"	366	YES			
390133	390263	"2,820"	365	"1,587"	"$6,523,291.97"	366	"35,889"	365	"5,668"	"$28,589,111.67"	366	YES			
390194	390019	19	365	25	"$774,734.44"	366	"2,096"	365	703	"$2,035,753.59"	366	YES			
430048	430094	0	365	0	$0.00	0	868	365	73	"$2,793,501.57"	366	YES			
440002	440189	"3,431"	365	"1,096"	"$2,640,074.00"	365	"27,848"	365	"8,662"	"$31,098,566.45"	366	YES			
440068	440054	129	153	0	$0.00	0	"2,338"	365	316	"$5,465,532.00"	365	YES			
440156	440064	457	365	0	$0.00	0	"33,464"	365	"3,770"	"$12,336,249.06"	366	YES			
450018	450591	"2,916"	365	0	$0.00	0	"49,328"	365	"2,951"	"$73,190,051.31"	366	YES			
450032	450037	"23,622"	365	"2,216"	"$38,639,845.00"	365	"3,282"	365	850	"$14,412,061.00"	365	YES			
450209	450796	0	365	0	"$32,735.06"	181	"26,927"	365	"1,876"	"$34,759,507.00"	365	YES			
450388	450878	0	0	0	$0.00	0	"103,817"	365	"20,010"	"$110,616,789.30"	366	YES			
450617	450530	0	0	0	$0.00	0	"27,386"	365	"5,111"	"$40,882,966.00"	365	YES			
490075	490079	"3,561"	365	"1,006"	"$6,190,808.00"	365	"6,289"	365	"2,080"	"$8,298,928.21"	366	YES			
510022	510085	"1,112"	365	0	$0.00	0	"44,869"	365	"8,384"	"$10,292,439.00"	365	YES			
520009	520048	"3,155"	365	336	"$1,133,307.05"	366	"10,303"	365	722	"$2,893,632.24"	366	YES			
520136	520170	0	0	0	$0.00	0	"29,745"	365	"3,062"	"$12,395,546.60"	366	YES			
520136	520204	483	365	256	"$1,819,902.96"	366	"29,745"	365	"3,062"	"$12,395,546.60"	366	YES			
530008	530010	"1,438"	365	0	$0.00	0	"1,221"	365	167	"$4,213,001.00"	365	SCH			
530012	530033	123	365	19	"$850,175.00"	365	"4,097"	365	807	"$17,398,059.08"	366	SCH			
670034	670079	23	365	0	"$3,592,346.95"	366	99	365	745	"$8,195,816.71"	366	NO			
670062	670097	0	0	0	"$307,393.00"	365	0	365	4	"$986,424.00"	365	NO			
670095	670058	0	365	0	"$69,551.00"	365	0	0	0	"$92,913.00"	365	NO			
