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STATE OF CALIFORNIA RECONCILIATION OF THE PROVIDER'S ADJUSTMENTS TO THE AUDIT REPORT_part1

STATE OF CALIFORNIA RECONCILIATION OF THE PROVIDER'S ADJUSTMENTS TO THE AUDIT REPORT Schedule 8A-1 Page 2 Provider Name: ZZT05538G 206190102 Provider No.: OSHPD Facility Number: Fiscal Period: JANUARY 1, 2007 THROUGH DECEMBER 31, 2007 BONNIE BRAE CONVALESCENT HOSPITAL AUDIT ADJ 10 AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ 155.02 Social Services - Fringe Benefits 155.03 Social Services - Agency Staff 155.04 Social Services - Other - Nonlabor 160.00 Activities 160.01 Activities - Salaries and Wages 160.02 Activities - Fringe Benefits 160.03 Activities - Agency Staff 160.04 Activities - Other - Nonlabor 165.00 Administration 23,396 165.01 Administration - Salaries and Wages 165.02 Administration - Fringe Benefits 165.03 Administration - Medical Records - Salaries and Wages 165.04 Administration - Medical. | STATE OF CALIFORNIA RECONCILIATION OF THE PROVIDER S ADJUSTMENTS TO THE AUDIT REPORT Schedule 8A-1 Page 2 Provider Name BONNIE BRAE CONVALESCENT HOSPITAL Provider No. ZZT05538G OSHPD Facility Number 206190102 Fiscal Period JANUARY 1 2007 THROUGH DECEMBER 31 2007 AUDIT ADJ 10 AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ AUDIT ADJ 155.02 Social Services - Fringe Benefits 155.03 Social Services - Agency staff 155.04 Social Services - other - Nonlabor 160.00 Activities 160.01 Activities - Salaries and Wages 160.02 Activities - Fringe Benefits 160.03 Activities - Agency staff 160.Í 165.Í linistration lies - Other - Nonlabor stration - Caregiver Training irvice Education - Nursing - Salaries and Wages rvice Education - Nursing - Fringe Benefits rvice Education - Nursing - Agency staff 165. CJizV drriid strati on - Salaries and Wages 165 ni strati on - Fringe Benefits 165.03 Administration - Medical Records - Salaries and Wages 165. C 4 A niQi strati on - Medical Records - Fringe Benefits 165. 5 ninistration - Medical Records - Agency staff 165.06 Administration - Medical Records - other - Nonlabor inistration - Liability Insurance inistration - Quality Assurance Fees Administration - other - Nonlabor 170.00 t dsrvice Education - Nursing 170.01 iervice Education - Nursing - other - Nonlabor 23 396 23 396 STATE OF CALIFORNIA ADJUSTMENTS TO R Provider Name BONNIE BRAE CONVALESCENT HOSPITAL 5.ŨŨ 5.01 5.02 5.03 5.04 10.00 10.01 30.00 4 _ 35.00 io.00 75.02 75.03 75.04 77.00 80.00 80.01 80.02 80.03 80.04 81.00 81.01 81.02 81.03 81.04 82.00 82.01 Plant Operations and Maintenance Plant Operations and Maintenance - Salaries and Wages Plant Operations and Maintenance - Fringe Benefits Plant Operations and Maintenance - Agency staff Plant Operations and Maintenance - other - Nonlabor Housekeeping Housekeeping - Salaries and Wages Housekeeping - Fringe Benefits Housekeeping - Agency staff Housekeeping - other - Nonlabor .