State of Texas

Uncompensated Care Final Reconciliation

Demonstration Year 4 - Engagement Year 2017

Addendum #2 Without Other Insurance and Medicare Payments

Medicaid

Number

Medicare

Number

(CCN) Hospital Name DSH / UC-Only

Final HSL

Including Other

Insurance and

Medicare

Payments

Other Insurance

Payments

Medicare

Payments

Final HSL

Excluding Other

Insurance or

Medicare

Payments

Final Schedule 1

UCC

Final Schedule 2

UCC

Total

Uncompensated

Care Costs

Excluding Other

Insurance and

Medicare

Payments

Disproportionate

Share Hospital

(DSH)

Payment

DSH Recoupment

Including Other

Insurance and

Medicare

Payments

DSH Recoupment

Excluding Other

Insurance and

Medicare

Payments

GME

Payments

Uncompensated

Care (UC)

Payment

UC Payment in

Excess of UC Cost

Including Other

Insurance and

Medicare

Payments

UC Payment in

Excess of UC Cost

Excluding Other

Insurance and

Medicare

Payments

130601104 450002 THE HOSPITALS OF PROVIDENCE - MEMORI DSH DY4 24,783,813$ 599,219$ 15,402,581$ 40,785,613$ 592,196$ -$ 41,377,809$ 9,965,112$ -$ -$ -$ 7,361,487$ -$ -$

135237906 450010 UNITED REGIONAL HEALTH CARE SYSTEM DSH DY4 36,499,379$ 1,335,032$ 17,761,056$ 55,595,467$ -$ -$ 55,595,467$ 5,815,704$ -$ -$ -$ 17,628,129$ -$ -$

127267603 450011 ST. JOSEPH REGIONAL HEALTH CENTER DSH DY4 24,602,919$ 473,269$ 14,441,440$ 39,517,628$ 3,813,435$ -$ 43,331,063$ 4,809,780$ -$ -$ -$ 17,288,882$ -$ -$

127295703 450015 DALLAS CO. HOSP. DIST. DSH DY4 551,793,520$ 1,049,476$ 43,861,473$ 596,704,469$ 127,318,893$ 41,050,422$ 765,073,784$ 188,828,752$ -$ -$ -$ 267,506,810$ -$ -$

139485012 450021 BAYLOR UNIVERSITY MEDICAL CTR DSH DY4 106,408,385$ 1,026,022$ 39,966,200$ 147,400,607$ -$ -$ 147,400,607$ 14,830,994$ -$ -$ -$ 54,550,437$ -$ -$

138951211 450024 UNIVERSITY MEDICAL CENTER OF EL PASO DSH DY4 95,858,792$ 1,172,514$ 14,707,426$ 111,738,732$ 731,386$ -$ 112,470,118$ 41,308,870$ -$ -$ -$ 40,987,028$ -$ -$

294543801 450028 VALLEY BAPTIST MED CNTR BROWNSVILLE DSH DY4 20,714,189$ 1,886,071$ 29,645,136$ 52,245,396$ 2,359,711$ -$ 54,605,107$ 6,369,301$ -$ -$ -$ 9,744,620$ -$ -$

162033801 450029 LAREDO MEDICAL CENTER DSH DY4 24,820,663$ 856,682$ 39,475,520$ 65,152,865$ 2,756,844$ -$ 67,909,709$ 8,810,559$ -$ -$ -$ 7,480,894$ -$ -$

112667403 450032 GOOD SHEPHERD MEDICAL CENTER - MARSHALL DSH DY4 8,075,689$ 198,832$ 5,449,328$ 13,723,849$ 563,754$ -$ 14,287,603$ 1,269,950$ -$ -$ -$ 3,207,440$ -$ -$

292096901 450033 VALLEY BAPTIST MEDICAL CENTER DSH DY4 45,618,141$ 384,932$ 34,730,148$ 80,733,221$ 1,235,908$ -$ 81,969,129$ 7,642,683$ -$ -$ -$ 16,566,510$ -$ -$

138296208 450034 CHRISTUS HOSPITAL DSH DY4 48,759,300$ 1,155,164$ 17,029,805$ 66,944,269$ 2,914,907$ -$ 69,859,176$ 7,987,147$ -$ -$ -$ 19,727,158$ -$ -$

181706601 450035 ST JOSEPH MEDICAL CENTER DSH DY4 35,012,942$ 95,966$ 15,808,281$ 50,917,189$ -$ -$ 50,917,189$ 11,772,209$ -$ -$ -$ 12,743,811$ -$ -$

094095902 450037 GOOD SHEPHERD MEDICAL CENTER DSH DY4 37,659,932$ 661,599$ 19,182,221$ 57,503,752$ 5,029,422$ -$ 62,533,174$ 8,350,379$ -$ -$ -$ 19,632,242$ -$ -$

126675104 450039 TCHD D/B/A JPS HEALTH NETWORK DSH DY4 282,891,240$ 2,197,818$ 25,649,722$ 310,738,780$ 35,567,518$ 6,707,027$ 353,013,325$ 100,695,036$ -$ -$ -$ 151,569,293$ -$ -$

139461107 450040 COVENANT HEALTH SYSTEM DSH DY4 48,474,739$ 2,679,817$ 22,406,146$ 73,560,702$ 9,135,219$ -$ 82,695,921$ 4,718,376$ -$ -$ -$ 22,871,723$ -$ -$

121775403 450046 CHRISTUS SPOHN HOSP CORPUS CHRISTI DSH DY4 97,906,801$ 3,403,339$ 34,884,119$ 136,194,259$ 9,008,230$ -$ 145,202,489$ 13,296,876$ -$ -$ -$ 45,888,942$ -$ -$

135032405 450051 METHODIST DALLAS MEDICAL CENTER DSH DY4 58,207,949$ 567,494$ 26,353,032$ 85,128,475$ 260,024$ -$ 85,388,499$ 12,363,704$ -$ -$ -$ 24,147,714$ -$ -$

137249208 450054 SCOTT AND WHITE MEMORIAL HOSPITAL DSH DY4 143,564,902$ 743,967$ 41,909,351$ 186,218,220$ 17,953,717$ -$ 204,171,937$ 14,037,184$ -$ -$ -$ 58,147,800$ -$ -$

133244705 450055 ROLLING PLAINS MEMORIAL HOSPITAL DSH DY4 4,631,604$ 25,331$ 1,932,642$ 6,589,577$ -$ -$ 6,589,577$ 1,684,116$ -$ -$ -$ 1,988,505$ -$ -$

159156201 450058 BAPTIST HEALTH SYSTEM DSH DY4 67,084,419$ 1,756,772$ 53,462,091$ 122,303,282$ 4,295,975$ -$ 126,599,257$ 22,764,109$ -$ -$ -$ 25,828,258$ -$ -$

137805107 450068 MEMORIAL HERMANN TEXAS MEDICAL CNTR DSH DY4 153,029,205$ 12,745,485$ 36,106,699$ 201,881,389$ 24,704,811$ -$ 226,586,200$ 27,900,715$ -$ -$ -$ 72,801,338$ -$ -$

112672402 450076 UT MD ANDERSON CANCER CENTER DSH DY4 9,617,733$ 15,299,398$ 41,838,661$ 66,755,792$ 4,921,253$ 324,528$ 72,001,573$ 27,936,768$ (19,906,147)$ -$ 1,587,112$ 5,982,175$ 736,394$ -$

138913209 450080 TITUS REGIONAL MEDICAL CENTER DSH DY4 4,996,867$ 136,523$ 3,642,237$ 8,775,627$ -$ -$ 8,775,627$ 3,387,796$ -$ -$ -$ 1,148,832$ -$ -$

020811801 450082 CHRISTUS SPOHN BEE HOSPITAL DSH DY4 7,240,965$ 114,641$ 3,338,199$ 10,693,805$ 25,360$ -$ 10,719,165$ 789,926$ -$ -$ -$ 4,131,068$ -$ -$

020812601 450083 ETMC- TYLER DSH DY4 25,134,358$ 1,643,329$ 31,795,009$ 58,572,696$ 12,156,413$ -$ 70,729,109$ 6,236,499$ -$ -$ -$ 15,425,856$ -$ -$

346945401 450085 GRAHAM REGIONAL MEDICAL CENTER DSH DY4 1,416,116$ 5,917$ 685,261$ 2,107,294$ -$ -$ 2,107,294$ 683,284$ (140,660)$ -$ -$ 888,013$ 14,521$ -$

121777003 450090 NORTH TEXAS MEDICAL CENTER DSH DY4 5,829,095$ 6,931$ 1,779,080$ 7,615,106$ 1,594,647$ -$ 9,209,753$ 2,228,204$ -$ -$ -$ 2,427,699$ -$ -$

110803703 450092 FORT DUNCAN MEDICAL CENTER DSH DY4 4,854,147$ 457,903$ 12,144,025$ 17,456,075$ 577,488$ -$ 18,033,563$ 2,435,672$ -$ -$ -$ 775,357$ -$ -$

020817501 450097 BAYSHORE MEDICAL CENTER DSH DY4 55,987,280$ 940,053$ 21,788,049$ 78,715,382$ -$ -$ 78,715,382$ 11,552,551$ -$ -$ -$ 17,539,992$ -$ -$

308032701 450099 PAMPA REGIONAL MEDICAL CENTER DSH DY4 3,074,964$ 61,253$ 2,172,753$ 5,308,970$ 277,122$ -$ 5,586,092$ 487,601$ (487,601)$ -$ -$ 4,124,930$ 772,845$ -$

138962907 450101 HILLCREST BAPTIST MEDICAL CENTER DSH DY4 41,586,577$ 123,541$ 8,776,070$ 50,486,188$ 5,422,220$ -$ 55,908,408$ 4,867,325$ -$ -$ -$ 12,494,825$ -$ -$

094108002 450102 CHRISTUS MOTHER FRANCIS HOSPITAL -TYLER DSH DY4 33,636,542$ 1,256,219$ 20,555,850$ 55,448,611$ 2,983,827$ -$ 58,432,438$ 6,842,130$ -$ -$ -$ 23,899,788$ -$ -$

094109802 450107 LAS PALMAS MEDICAL CENTER DSH DY4 23,713,416$ 1,217,957$ 45,835,062$ 70,766,435$ 7,764,062$ -$ 78,530,497$ 12,551,420$ -$ -$ -$ 10,053,637$ -$ -$

135151206 450108 CONNALLY MEMORIAL MEDICAL CENTER DSH DY4 2,931,032$ 1,384$ 1,261,104$ 4,193,520$ -$ -$ 4,193,520$ 1,147,590$ -$ -$ -$ 1,687,839$ -$ -$

094113001 450119 SOUTH TEXAS HEALTH SYSTEM DSH DY4 51,485,833$ 1,680,425$ 38,770,080$ 91,936,338$ 5,808,965$ -$ 97,745,303$ 12,763,668$ -$ -$ -$ 23,663,736$ -$ -$

137265806 450124 UNIVERISTY MED CENTER BRACKENRIDGE DSH DY4 128,070,941$ 345,809$ 13,391,886$ 141,808,636$ 10,968,719$ -$ 152,777,355$ 35,015,242$ -$ -$ -$ 49,530,974$ -$ -$

135035706 450128 KNAPP MEDICAL CENTER DSH DY4 20,123,162$ 221,886$ 17,801,589$ 38,146,637$ 436,229$ -$ 38,582,866$ 5,093,389$ -$ -$ -$ 6,322,024$ -$ -$

135235306 450132 MEDICAL CENTER HEALTH SYSTEM DSH DY4 44,693,423$ 1,702,049$ 16,779,885$ 63,175,357$ 17,050$ -$ 63,192,407$ 19,117,015$ -$ -$ -$ 9,659,546$ -$ -$

136143806 450133 MIDLAND MEMORIAL HOSPITAL DSH DY4 34,586,796$ 775,535$ 10,878,877$ 46,241,208$ -$ -$ 46,241,208$ 13,366,636$ -$ -$ -$ 9,310,617$ -$ -$

112677302 450135 TEXAS HEALTH FORT WORTH DSH DY4 79,291,799$ 2,510,377$ 30,720,507$ 112,522,683$ 1,539,390$ -$ 114,062,073$ 12,029,846$ -$ -$ -$ 23,213,998$ -$ -$

135036506 450137 BAYLOR ALL SAINTS MEDICAL CENTER DSH DY4 37,028,003$ 453,255$ 15,312,490$ 52,793,748$ -$ -$ 52,793,748$ 7,212,386$ -$ -$ -$ 9,028,972$ -$ -$

127298107 450144 PERMIAN REGIONAL MEDICAL CENTER DSH DY4 2,675,450$ 3,181$ 370,383$ 3,049,014$ 443,174$ -$ 3,492,188$ 1,219,375$ -$ -$ -$ 1,154,253$ -$ -$

094118902 450147 DETAR HEALTHCARE SYSTEMS DSH DY4 14,318,665$ 408,132$ 11,262,372$ 25,989,169$ 2,190,228$ -$ 28,179,397$ 2,619,934$ -$ -$ -$ 6,098,936$ -$ -$

094119702 450152 METROPLEX HOSPITAL DSH DY4 14,095,870$ 2,217,706$ 4,844,535$ 21,158,111$ 569,864$ -$ 21,727,975$ 2,780,412$ -$ -$ -$ 6,483,707$ -$ -$

119877204 450154 VAL VERDE REGIONAL MEDICAL CENTER DSH DY4 10,922,756$ 124,230$ 6,350,435$ 17,397,421$ 1,187,793$ -$ 18,585,214$ 3,614,727$ -$ -$ -$ 3,687,911$ -$ -$

133544006 450155 HEREFORD REGIONAL MEDICAL CTR DSH DY4 3,037,879$ 38,718$ 663,832$ 3,740,429$ 327,218$ -$ 4,067,647$ 1,228,024$ -$ -$ -$ 1,237,432$ -$ -$

136436606 450163 CHRISTUS SPOHN KLEBERG MEMORIAL HOSP DSH DY4 6,492,334$ 185,361$ 3,533,543$ 10,211,238$ 198,384$ -$ 10,409,622$ 1,394,619$ -$ -$ -$ 4,141,502$ -$ -$

121780403 450165 SOUTH TEXAS MEDICAL CENTER DSH DY4 4,972,645$ 30,523$ 2,718,113$ 7,721,281$ 2,706,568$ -$ 10,427,849$ 597,864$ -$ -$ -$ 3,668,229$ -$ -$

112679902 450176 MISSION HOSPITAL DSH DY4 24,153,310$ 162,817$ 18,571,982$ 42,888,109$ 2,712,404$ -$ 45,600,513$ 5,623,006$ -$ -$ -$ 8,033,658$ -$ -$

121782006 450177 UVALDE MEMORIAL HOSPITAL DSH DY4 10,264,752$ 328,376$ 4,300,490$ 14,893,618$ 2,199,096$ -$ 17,092,714$ 4,352,105$ -$ -$ -$ 5,923,390$ -$ -$

130616905 450178 PECOS COUNTY MEMORIAL HOSPITAL DSH DY4 3,865,442$ 139,046$ 1,054,198$ 5,058,686$ -$ -$ 5,058,686$ 1,518,194$ -$ -$ -$ 1,343,052$ -$ -$

020834001 450184 MEMORIAL HERMANN HOSPITAL SYS DSH DY4 153,887,276$ 3,855,304$ 56,907,282$ 214,649,862$ 2,903,608$ -$ 217,553,470$ 23,018,810$ -$ -$ -$ 80,417,672$ -$ -$

133252005 450192 HILL REGIONAL HOSPITAL DSH DY4 4,171,291$ 41,420$ 1,312,635$ 5,525,346$ 1,160,876$ -$ 6,686,222$ 469,542$ -$ -$ -$ 3,012,291$ -$ -$

130612806 450194 ETMC JACKSONVILLE DSH DY4 3,109,865$ 112,358$ 2,139,723$ 5,361,946$ 507,802$ -$ 5,869,748$ 702,119$ (209,131)$ -$ -$ 2,900,700$ -$ -$

163111101 450196 PARIS REGIONAL MEDICAL CENTER DSH DY4 7,992,909$ 604,636$ 13,092,340$ 21,689,885$ -$ -$ 21,689,885$ 2,266,831$ -$ -$ -$ 1,602,403$ -$ -$

207311601 450200 WADLEY REGIONAL MEDICAL CENTER DSH DY4 11,907,400$ 1,803,142$ 9,243,556$ 22,954,098$ -$ -$ 22,954,098$ 2,836,545$ -$ -$ -$ 4,976,175$ -$ -$

137245009 450209 NORTHWEST TEXAS HOSPITAL DSH DY4 60,043,281$ 2,895,283$ 13,602,063$ 76,540,627$ 5,805,594$ -$ 82,346,221$ 12,881,722$ -$ -$ -$ 32,296,016$ -$ -$

094127002 450210 ETMC CARTHAGE DSH DY4 2,954,575$ 53,281$ 1,433,613$ 4,441,469$ 31,720$ -$ 4,473,189$ 1,427,672$ (738,331)$ -$ -$ 2,278,467$ -$ -$

139172412 450211 CHI ST LUKES HEALTH MEMORIAL LUFKIN DSH DY4 14,712,833$ 233,936$ 9,298,710$ 24,245,479$ 278,964$ -$ 24,524,443$ 2,746,539$ -$ -$ -$ 10,800,643$ -$ -$

136141205 450213 UNIVERSITY HEALTH SYSTEM DSH DY4 244,660,042$ 3,632,048$ 35,687,615$ 283,979,705$ 26,445,892$ 3,141,691$ 313,567,288$ 81,909,798$ -$ -$ -$ 100,689,177$ -$ -$

094129604 450221 MOORE COUNTY HOSP. DBA DUMAS MEM HOS DSH DY4 1,803,575$ 41,661$ 485,903$ 2,331,139$ 416,187$ -$ 2,747,326$ 1,487,948$ (306,104)$ -$ -$ 1,000,014$ -$ -$

138644310 450229 HENDRICK MEDICAL CENTER DSH DY4 46,336,595$ 459,982$ 20,897,547$ 67,694,124$ -$ -$ 67,694,124$ 5,151,354$ -$ -$ -$ 15,452,514$ -$ -$

322879301 450231 BAPTIST SAINT ANTHONYS HOSPITAL DSH DY4 28,804,508$ 923,284$ 11,877,527$ 41,605,319$ -$ -$ 41,605,319$ 4,117,590$ -$ -$ -$ 16,019,636$ -$ -$

121785303 450235 GONZALES HEALTHCARE SYSTEMS DSH DY4 2,485,853$ 9,262$ 985,944$ 3,481,059$ -$ -$ 3,481,059$ 1,233,349$ -$ -$ -$ 974,388$ -$ -$

366812101 450236 HOPKINS COUNTY MEMORIAL HOSPITAL DSH DY4 7,445,161$ 136,247$ 4,892,009$ 12,473,417$ 54,170$ -$ 12,527,587$ 3,927,914$ -$ -$ -$ 2,658,582$ -$ -$

119874904 450241 FAITH COMMUNITY HOSPITAL DSH DY4 2,131,803$ 57$ 204,629$ 2,336,489$ -$ -$ 2,336,489$ 325,458$ -$ -$ -$ 533,900$ -$ -$

094131202 450243 HAMLIN MEMORIAL HOSPITAL DSH DY4 464,312$ -$ 293,396$ 757,708$ 63,250$ -$ 820,958$ 262,282$ -$ -$ -$ 178,886$ -$ -$

121789503 450272 CENTRAL TEXAS MEDICAL CENTER DSH DY4 12,208,928$ 480,173$ 3,924,571$ 16,613,672$ 264,059$ -$ 16,877,731$ 1,825,080$ -$ -$ -$ 5,853,444$ -$ -$

Rate Analysis Department Page 1 of 5 5/28/2019

State of Texas

Uncompensated Care Final Reconciliation

Demonstration Year 4 - Engagement Year 2017

Addendum #2 Without Other Insurance and Medicare Payments

Medicaid

Number

Medicare

Number

(CCN) Hospital Name DSH / UC-Only

Final HSL

Including Other

Insurance and

Medicare

Payments

Other Insurance

Payments

Medicare

Payments

Final HSL

Excluding Other

Insurance or

Medicare

Payments

Final Schedule 1

UCC

Final Schedule 2

UCC

Total

Uncompensated

Care Costs

Excluding Other

Insurance and

Medicare

Payments

Disproportionate

Share Hospital

(DSH)

Payment

DSH Recoupment

Including Other

Insurance and

Medicare

Payments

DSH Recoupment

Excluding Other

Insurance and

Medicare

Payments

GME

Payments

Uncompensated

Care (UC)

Payment

UC Payment in

Excess of UC Cost

Including Other

Insurance and

Medicare

Payments

UC Payment in

Excess of UC Cost

Excluding Other

Insurance and

Medicare

Payments

133355104 450289 HARRIS HEALTH SYSTEM DSH DY4 579,085,892$ 176,481$ 21,965,108$ 601,227,481$ 22,353,088$ 36,697,406$ 660,277,975$ 187,147,524$ -$ -$ -$ 254,127,127$ -$ -$

112688002 450293 FRIO REGIONAL HOSPITAL DSH DY4 3,022,680$ 13,556$ 723,591$ 3,759,827$ -$ -$ 3,759,827$ 261,101$ -$ -$ -$ 1,765,689$ -$ -$

020860501 450299 COLLEGE STATION MEDICAL CENTER DSH DY4 13,881,483$ 66,468$ 4,822,153$ 18,770,104$ 409,640$ -$ 19,179,744$ 2,075,558$ -$ -$ -$ 5,221,401$ -$ -$

127303903 450330 OAKBEND MEDICAL CENTER DSH DY4 23,665,823$ 367,503$ 7,392,553$ 31,425,879$ 978,304$ -$ 32,404,183$ 4,464,500$ -$ -$ -$ 7,150,031$ -$ -$

112693002 450340 SAN ANGELO COMMUNITY MEDICAL CENTER DSH DY4 9,937,351$ 72,204$ 4,831,773$ 14,841,328$ 89,907$ -$ 14,931,235$ 1,236,198$ -$ -$ -$ 5,542,139$ -$ -$

094148602 450346 BAPTIST BEAUMONT HOSPITAL DSH DY4 33,463,932$ 1,208,031$ 17,792,065$ 52,464,028$ 2,607,482$ -$ 55,071,510$ 6,294,806$ -$ -$ -$ 12,139,116$ -$ -$

189791001 450347 HUNTSVILLE MEMORIAL DSH DY4 7,054,103$ 87,542$ 3,381,470$ 10,523,115$ 14,445$ -$ 10,537,560$ 1,297,817$ -$ -$ -$ 4,413,730$ -$ -$

133367602 450348 FALLS COMMUNITY HOSPITAL AND CLINIC DSH DY4 1,437,455$ 3,062$ 849,835$ 2,290,352$ 114,689$ -$ 2,405,041$ 121,088$ -$ -$ -$ 868,703$ -$ -$

131038504 450352 HUNT REGIONAL MEDICAL CENTER DSH DY4 15,622,721$ 187,672$ 8,298,270$ 24,108,663$ 1,701,480$ -$ 25,810,143$ 8,042,785$ -$ -$ -$ 3,929,247$ -$ -$

133250406 450369 CHILDRESS REGIONAL MEDICAL CENTER DSH DY4 2,445,998$ 43,062$ 1,003,914$ 3,492,974$ -$ -$ 3,492,974$ 936,514$ -$ -$ -$ 921,878$ -$ -$

135033210 450370 COLUMBUS COMMUNITY HOSPITAL DSH DY4 1,989,040$ 5,923$ 1,308,381$ 3,303,344$ 110,168$ -$ 3,413,512$ 463,090$ -$ -$ -$ 733,701$ -$ -$

094154402 450388 METHODIST HOSPITAL DSH DY4 133,701,853$ 4,421,927$ 68,120,094$ 206,243,874$ 5,685,527$ -$ 211,929,401$ 35,688,098$ -$ -$ -$ 49,544,137$ -$ -$

139173209 450389 ETMC ATHENS DSH DY4 13,202,866$ 322,263$ 5,227,748$ 18,752,877$ 364,740$ -$ 19,117,617$ 1,833,490$ -$ -$ -$ 5,994,592$ -$ -$

112697102 450395 CHI ST LUKES HEALTH MEMORIAL LIVINGSTON DSH DY4 5,769,357$ 228,148$ 2,775,815$ 8,773,320$ 199,738$ -$ 8,973,058$ 1,109,426$ -$ -$ -$ 3,373,063$ -$ -$

130618504 450399 BROWNFIELD REGIONAL MEDICAL CENTER DSH DY4 2,799,271$ 6,415$ 1,030,236$ 3,835,922$ 22,794$ -$ 3,858,716$ 1,053,873$ -$ -$ -$ 1,169,207$ -$ -$

094160103 450431 ST. DAVIDS MEDICAL CENTER DSH DY4 33,639,450$ 4,238,253$ 19,715,660$ 57,593,363$ 1,725,558$ -$ 59,318,921$ 12,580,584$ -$ -$ -$ 14,066,379$ -$ -$

112701102 450447 NAVARRO REGIONAL HOSPITAL DSH DY4 4,715,601$ 151,023$ 4,062,438$ 8,929,062$ 1,173,720$ -$ 10,102,782$ 1,011,159$ -$ -$ -$ 3,503,745$ -$ -$

020908201 450462 TEXAS HEALTH DALLAS DSH DY4 59,559,809$ 5,172,625$ 13,930,311$ 78,662,745$ -$ -$ 78,662,745$ 8,151,047$ -$ -$ -$ 21,365,934$ -$ -$

130959304 450465 MATAGORDA REGIONAL MEDICAL CENTER DSH DY4 6,268,104$ 246,231$ 3,073,295$ 9,587,630$ 99,897$ -$ 9,687,527$ 3,923,387$ (860,977)$ -$ -$ 3,253,568$ -$ -$

208843701 450475 ETMC HENDERSON DSH DY4 5,723,335$ 115,235$ 2,186,485$ 8,025,055$ 1,440,064$ -$ 9,465,119$ 823,412$ -$ -$ -$ 2,162,328$ -$ -$

189947801 450489 MEDICAL ARTS HOSPITAL DSH DY4 1,932,207$ 8,280$ 708,173$ 2,648,660$ -$ -$ 2,648,660$ 1,075,503$ (370,726)$ -$ -$ 1,227,430$ -$ -$

131030203 450508 NACOGDOCHES MEMORIAL HOSPITAL DSH DY4 12,074,340$ 53,312$ 5,542,600$ 17,670,252$ 1,414,635$ -$ 19,084,887$ 7,094,290$ -$ -$ -$ 4,916,481$ -$ -$

163925401 450518 THE MEDICAL CENTER OF SOUTHEAST TEXA DSH DY4 11,639,284$ 297,045$ 7,282,426$ 19,218,755$ -$ -$ 19,218,755$ 3,648,614$ -$ -$ -$ 4,326,275$ -$ -$

127263503 450539 COVENANT HOSPITAL PLAINVIEW DSH DY4 3,663,614$ 186,022$ 2,164,050$ 6,013,686$ -$ -$ 6,013,686$ 1,166,257$ (126,463)$ -$ -$ 2,623,820$ -$ -$

112705203 450558 ABILENE REG MED CTR DSH DY4 8,925,213$ 199,076$ 4,824,009$ 13,948,298$ 1,338,172$ -$ 15,286,470$ 1,826,937$ -$ -$ -$ 4,818,621$ -$ -$

138950412 450565 PALO PINTO GENERAL HOSPITAL DSH DY4 6,400,414$ 20,062$ 2,260,517$ 8,680,993$ -$ -$ 8,680,993$ 2,336,067$ -$ -$ -$ 1,450,062$ -$ -$

137226005 450571 SHANNON MEDICAL CENTER DSH DY4 22,019,674$ 1,573,981$ 14,434,092$ 38,027,747$ 2,608,078$ -$ 40,635,825$ 3,936,379$ -$ -$ -$ 13,541,980$ -$ -$

138353107 450586 BAYLOR COUNTY HOSPITAL DISTRICT DSH DY4 1,278,232$ 10,579$ 536,424$ 1,825,235$ -$ -$ 1,825,235$ 249,957$ -$ -$ -$ 143,134$ -$ -$

020930601 450587 BROWNWOOD REGIONAL MEDICAL CENTER DSH DY4 6,157,257$ 35,283$ 4,597,896$ 10,790,436$ 724,463$ -$ 11,514,899$ 1,557,647$ -$ -$ -$ 3,967,481$ -$ -$

138911619 450597 CUERO COMMUNITY HOSPITAL DSH DY4 2,377,387$ 35,011$ 1,954,923$ 4,367,321$ 306,980$ -$ 4,674,301$ 2,048,355$ (667,697)$ -$ -$ 1,204,449$ -$ -$

121807504 450617 CLEAR LAKE REG MED CTR DSH DY4 40,918,737$ 4,083,300$ 17,645,552$ 62,647,589$ -$ -$ 62,647,589$ 11,615,565$ -$ -$ -$ 13,488,591$ -$ -$

217884001 450620 DIMMIT REGIONAL HOSPITAL DISTRICT DSH DY4 3,422,878$ 3,169$ 1,348,625$ 4,774,672$ 534,768$ -$ 5,309,440$ 2,040,981$ -$ -$ -$ 506,554$ -$ -$

193867201 450638 HOUSTON NORTHWEST MEDICAL CENTER DSH DY4 45,880,668$ 1,879,686$ 15,228,624$ 62,988,978$ 805,475$ -$ 63,794,453$ 7,027,554$ -$ -$ -$ 18,365,076$ -$ -$

094186602 450643 DOCTORS HOSPITAL OF LAREDO DSH DY4 13,303,933$ 459,008$ 14,304,269$ 28,067,210$ 238,335$ -$ 28,305,545$ 4,394,626$ -$ -$ -$ 4,749,946$ -$ -$

020943901 450647 MEDICAL CITY DALLAS HOSPITAL DSH DY4 33,813,805$ 10,456,486$ 17,853,681$ 62,123,972$ 1,949,353$ -$ 64,073,325$ 11,636,948$ -$ -$ -$ 9,247,884$ -$ -$

131043506 450653 SCENIC MT REGIONAL DSH DY4 5,089,440$ 665,817$ 1,642,881$ 7,398,138$ 625,676$ -$ 8,023,814$ 627,121$ -$ -$ -$ 2,272,099$ -$ -$

136332705 450654 STARR COUNTY MEMORIAL HOSPITAL DSH DY4 8,113,744$ 6,737$ 6,093,888$ 14,214,369$ -$ -$ 14,214,369$ 2,638,284$ -$ -$ -$ 3,286,727$ -$ -$

112711003 450661 ODESSA REGIONAL HOSPITAL DSH DY4 16,531,500$ 5,168,378$ 4,429,726$ 26,129,604$ -$ -$ 26,129,604$ 4,498,368$ -$ -$ -$ 6,072,441$ -$ -$

020947001 450662 VALLEY REGIONAL MEDICAL CENTER DSH DY4 21,916,379$ 1,139,525$ 22,270,280$ 45,326,184$ 3,022,960$ -$ 48,349,144$ 6,593,003$ -$ -$ -$ 6,513,189$ -$ -$

020950401 450675 MEDICAL CENTER OF ARLINGTON DSH DY4 29,813,910$ 1,045,622$ 10,429,723$ 41,289,255$ 555,847$ -$ 41,845,102$ 7,193,126$ -$ -$ -$ 9,224,361$ -$ -$

137999206 450686 UNIVERSITY MEDICAL CENTER DSH DY4 79,719,928$ 6,248,440$ 27,334,598$ 113,302,966$ 14,431,143$ 1,338,114$ 129,072,223$ 35,461,710$ -$ -$ -$ 24,072,454$ -$ -$

127278304 450690 UT HEALTH CENTER AT TYLER DSH DY4 16,182,660$ 264,630$ 4,690,939$ 21,138,229$ 546,750$ -$ 21,684,979$ 9,508,728$ -$ -$ 1,085,299$ 92,177$ -$ -$

136491104 450697 SOUTHWEST GENERAL HOSPITAL DSH DY4 19,264,344$ 1,266,157$ 14,014,043$ 34,544,544$ 1,404,812$ -$ 35,949,356$ 6,606,308$ -$ -$ -$ 5,154,625$ -$ -$

127313803 450698 LAMB HEALTHCARE CENTER DSH DY4 1,754,653$ 38,616$ 545,615$ 2,338,884$ -$ -$ 2,338,884$ 926,579$ (427,620)$ -$ -$ 1,273,047$ 17,353$ -$

112716902 450711 RIO GRANDE REGIONAL HOSPITAL DSH DY4 28,174,547$ 528,765$ 28,656,278$ 57,359,590$ 1,802,064$ -$ 59,161,654$ 9,958,400$ -$ -$ -$ 6,551,863$ -$ -$

112718503 450716 CYPRESS FAIRBANKS MEDICAL CENTER DSH DY4 20,552,303$ 3,466,566$ 6,231,915$ 30,250,784$ 1,944,491$ -$ 32,195,275$ 4,540,978$ -$ -$ -$ 7,032,181$ -$ -$

020966001 450742 LAKE POINTE MEDICAL CENTER DSH DY4 12,621,356$ 2,093,203$ 4,534,257$ 19,248,816$ 326,056$ -$ 19,574,872$ 2,417,268$ -$ -$ -$ 7,474,727$ -$ -$

121053602 450746 KNOX COUNTY HOSPITAL DSH DY4 496,948$ 1,947$ 124,346$ 623,241$ -$ -$ 623,241$ 243,519$ -$ -$ -$ 252,178$ -$ -$

133258705 450755 COVENANT HOSPITAL LEVELLAND DSH DY4 2,584,531$ 144,360$ 618,823$ 3,347,714$ -$ -$ 3,347,714$ 424,810$ -$ -$ -$ 1,754,601$ -$ -$

020973601 450788 CORPUS CHRISTI MEDICAL CENTER DSH DY4 33,737,772$ 3,612,693$ 15,652,186$ 53,002,651$ 260,665$ -$ 53,263,316$ 8,482,709$ -$ -$ -$ 9,446,157$ -$ -$

020976902 450801 CHRISTUS ST MICHAEL DSH DY4 29,458,222$ 3,033,645$ 17,507,042$ 49,998,909$ -$ -$ 49,998,909$ 5,918,483$ -$ -$ -$ 14,210,182$ -$ -$

094222903 450828 CHRISTUS SPOHN ALICE DSH DY4 8,986,488$ 184,160$ 6,020,550$ 15,191,198$ 94,706$ -$ 15,285,904$ 1,481,639$ (261,294)$ -$ -$ 7,766,143$ -$ -$

121822403 450833 ENNIS REGIONAL MEDICAL CENTER DSH DY4 4,316,602$ 278,043$ 1,871,198$ 6,465,843$ 177,661$ -$ 6,643,504$ 701,247$ -$ -$ -$ 788,286$ -$ -$

146021401 450848 MEMORIAL HERMANN SUGAR LAND HOSPITAL DSH DY4 12,210,773$ 429,594$ 3,870,457$ 16,510,824$ 106,463$ -$ 16,617,287$ 3,125,061$ -$ -$ -$ 5,361,552$ -$ -$

154504801 450855 HARLINGEN MEDICAL CENTER DSH DY4 13,017,551$ 183,788$ 11,090,756$ 24,292,095$ 3,482,686$ -$ 27,774,781$ 1,393,095$ -$ -$ -$ 7,447,967$ -$ -$

160709501 450869 DOCTORS HOSPITAL AT RENAISSANCE DSH DY4 55,300,110$ 829,640$ 62,759,521$ 118,889,271$ 337,325$ -$ 119,226,596$ 20,077,221$ -$ -$ -$ 7,808,661$ -$ -$

140714001 451303 LIMESTONE MEDICAL CENTER DSH DY4 1,574,386$ 6,870$ 1,146,870$ 2,728,126$ 170,541$ -$ 2,898,667$ 890,726$ -$ -$ -$ 1,290,307$ 436,105$ -$

137227806 451308 YOAKUM COUNTY HOSPITAL DSH DY4 2,117,410$ 162,883$ 848,606$ 3,128,899$ -$ -$ 3,128,899$ 894,418$ -$ -$ -$ 1,121,776$ -$ -$

112692202 451313 FISHER COUNTY HOSPITAL DISTRICT DSH DY4 534,712$ 976$ 308,451$ 844,139$ 2,217$ -$ 846,356$ 284,083$ -$ -$ -$ 507,487$ 254,641$ -$

020991801 451317 REFUGIO MEMORIAL HOSPITAL DSH DY4 728,475$ 13,451$ 1,848,425$ 2,590,351$ 9,330$ -$ 2,599,681$ 364,061$ -$ -$ -$ 632,073$ 258,328$ -$

141858401 451319 CHRISTUS MFH - JACKSONVILLE DSH DY4 3,057,963$ 61,367$ 1,300,840$ 4,420,170$ 979,101$ -$ 5,399,271$ 350,101$ -$ -$ -$ 3,949,008$ 262,044$ -$

020993401 451320 BAYSIDE COMMUNITY HOSPITAL DSH DY4 1,469,318$ 166$ 300,538$ 1,770,022$ -$ -$ 1,770,022$ -$ -$ -$ -$ 563,326$ -$ -$

121781205 451324 LILLIAN M. HUDSPETH MEMORIAL HOSP. DSH DY4 756,812$ 514$ 358,887$ 1,116,213$ 24,815$ -$ 1,141,028$ 421,162$ -$ -$ -$ 431,685$ 71,220$ -$

091770005 451325 CONCHO COUNTY HOSPITAL DSH DY4 581,650$ 366$ 548,695$ 1,130,711$ -$ -$ 1,130,711$ 67,083$ -$ -$ -$ 195,601$ -$ -$

154632701 451326 CHILLICOTHE HOSPITAL DISTRICT DSH DY4 87,594$ -$ 31,402$ 118,996$ -$ -$ 118,996$ 65,574$ (37,272)$ (5,870)$ -$ 69,252$ 9,960$ 9,960$

212140201 451330 MEDINA REGIONAL HOSPITAL DSH DY4 2,656,811$ 1,610$ 864,746$ 3,523,167$ 110,505$ -$ 3,633,672$ 1,345,109$ -$ -$ -$ 1,991,614$ 569,407$ -$

130826407 451331 COON MEMORIAL HOSPITAL DSH DY4 1,551,832$ 64,554$ 683,040$ 2,299,426$ -$ -$ 2,299,426$ 380,397$ -$ -$ -$ 386,827$ -$ -$

121787905 451334 PARKVIEW HOSPITAL DSH DY4 335,296$ 559$ 105,365$ 441,220$ 6,797$ -$ 448,017$ 211,302$ (124,167)$ (18,243)$ -$ 263,398$ 8,440$ 8,440$

Rate Analysis Department Page 2 of 5 5/28/2019

State of Texas

Uncompensated Care Final Reconciliation

Demonstration Year 4 - Engagement Year 2017

Addendum #2 Without Other Insurance and Medicare Payments

Medicaid

Number

Medicare

Number

(CCN) Hospital Name DSH / UC-Only

Final HSL

Including Other

Insurance and

Medicare

Payments

Other Insurance

Payments

Medicare

Payments

Final HSL

Excluding Other

Insurance or

Medicare

Payments

Final Schedule 1

UCC

Final Schedule 2

UCC

Total

Uncompensated

Care Costs

Excluding Other

Insurance and

Medicare

Payments

Disproportionate

Share Hospital

(DSH)

Payment

DSH Recoupment

Including Other

Insurance and

Medicare

Payments

DSH Recoupment

Excluding Other

Insurance and

Medicare

Payments

GME

Payments

Uncompensated

Care (UC)

Payment

UC Payment in

Excess of UC Cost

Including Other

Insurance and

Medicare

Payments

UC Payment in

Excess of UC Cost

Excluding Other

Insurance and

Medicare

Payments

126667806 451337 W.J. MANGOLD MEMORIAL HOSPITAL DSH DY4 1,169,931$ 9,338$ 430,109$ 1,609,378$ -$ -$ 1,609,378$ 590,800$ -$ -$ -$ 568,177$ -$ -$

112673204 451346 YOAKUM COMMUNITY HOSPITAL DSH DY4 2,126,570$ 14,526$ 1,218,646$ 3,359,742$ 5,404$ -$ 3,365,146$ 685,504$ -$ -$ -$ 973,662$ -$ -$

316360201 451347 COLEMAN COUNTY MEDICAL CENTER DSH DY4 783,034$ 3,988$ 743,120$ 1,530,142$ -$ -$ 1,530,142$ 368,405$ (252,969)$ -$ -$ 670,748$ 3,150$ -$

121692107 451352 HARDEMAN COUNTY HOSPITAL DSH DY4 706,034$ 1,369$ 892,244$ 1,599,647$ 5,436$ -$ 1,605,083$ 249,745$ -$ -$ -$ 310,078$ -$ -$

110856504 451354 OLNEY HAMILTON HOSPITAL DISTRICT DSH DY4 991,493$ -$ 860,868$ 1,852,361$ -$ -$ 1,852,361$ 552,071$ -$ -$ -$ 527,578$ 88,156$ -$

137909111 451356 MEMORIAL MEDICAL CENTER DSH DY4 2,630,462$ 12,363$ 1,241,475$ 3,884,300$ 263,738$ -$ 4,148,038$ 1,103,847$ -$ -$ -$ 1,109,439$ -$ -$

094121303 451358 MEMORIAL HOSPITAL-SEMINOLE DSH DY4 3,659,471$ 10,491$ 994,303$ 4,664,265$ 469,103$ -$ 5,133,368$ 1,508,582$ -$ -$ -$ 2,096,112$ -$ -$

112704504 451359 OCHILTREE GENERAL HOSPITAL DSH DY4 1,369,782$ 24,845$ 458,446$ 1,853,073$ -$ -$ 1,853,073$ 714,712$ -$ -$ -$ 63,360$ -$ -$

121808305 451363 JACKSON COUNTY HOSPITAL DSH DY4 1,675,465$ 9,922$ 1,187,411$ 2,872,798$ -$ -$ 2,872,798$ 581,895$ (398,961)$ -$ -$ 1,523,885$ 31,354$ -$

197063401 451369 GOLDEN PLAINS COMMUNITY HOSPITAL DSH DY4 4,437,717$ 4,039$ 929,439$ 5,371,195$ 427,704$ -$ 5,798,899$ 333,542$ -$ -$ -$ 3,675,937$ -$ -$

112684904 451377 REEVES COUNTY HOSPITAL DSH DY4 2,056,513$ 6,567$ 1,304,411$ 3,367,491$ 147,600$ -$ 3,515,091$ 1,335,840$ -$ -$ -$ 2,088,345$ 1,220,071$ -$

094224503 451378 BIG BEND REGIONAL MED CTR DSH DY4 2,638,100$ 74,325$ 1,155,309$ 3,867,734$ 551,031$ -$ 4,418,765$ 247,229$ -$ -$ -$ 2,500,128$ -$ -$

136330112 451384 D.M. COGDELL MEMORIAL HOSPITAL DSH DY4 2,843,917$ 78,255$ 872,251$ 3,794,423$ -$ -$ 3,794,423$ 2,038,221$ (1,585,890)$ (635,384)$ -$ 2,452,747$ 61,161$ 61,161$

137075116 451385 GOODALL-WITCHER HOSPITAL AUTHORITY DSH DY4 986,024$ -$ 596,016$ 1,582,040$ -$ -$ 1,582,040$ 3,413$ -$ -$ -$ 171,868$ -$ -$

021184901 453300 COOK CHILDRENS MEDICAL CENTER DSH DY4 10,211,212$ 83,028,938$ 610,914$ 93,851,064$ 38,998,128$ 895,219$ 133,744,411$ 16,395,128$ (6,183,916)$ -$ -$ 1,307,096$ -$ -$

138910807 453302 CHILDRENS MEDICAL CENTER OF DALLAS DSH DY4 41,996,346$ 32,266,594$ 1,524,048$ 75,786,988$ 30,328,434$ -$ 106,115,422$ 22,293,766$ -$ -$ -$ 33,656,538$ -$ -$

127319504 453306 COVENANT CHILDRENS HOSPITAL DSH DY4 5,124,322$ 3,398,716$ 4,051$ 8,527,089$ 5,579,116$ -$ 14,106,205$ 3,594,821$ -$ -$ -$ 1,950,221$ -$ -$

186599001 453310 DELL CHILDRENS MEDICAL CENTER DSH DY4 13,684,913$ 8,863,866$ 507,465$ 23,056,244$ 6,916,819$ -$ 29,973,063$ 5,489,457$ -$ -$ -$ 2,371,491$ -$ -$

291854201 453313 EL PASO CHLIDRENS HOSPITAL DSH DY4 17,875,217$ 292,234$ 56,178$ 18,223,629$ -$ -$ 18,223,629$ 5,623,232$ -$ -$ -$ 7,300,154$ -$ -$

020844903 453315 CHILDRENS HOSPITAL OF SAN ANTONIO DSH DY4 29,646,421$ 6,419,020$ 396,971$ 36,462,412$ 13,283,029$ -$ 49,745,441$ 11,120,846$ -$ -$ -$ 12,963,223$ -$ -$

112742503 453323 CLARITY CHILD GUIDANCE CENTER DSH DY4 1,438,948$ 407,000$ -$ 1,845,948$ 215,410$ -$ 2,061,358$ 2,352,481$ (929,505)$ (522,505)$ -$ 234,990$ 3,608$ 3,608$

176692501 670004 ST. MARKS MEDICAL CENTER DSH DY4 1,217,501$ 45,267$ 1,474,547$ 2,737,315$ -$ -$ 2,737,315$ 309,217$ -$ -$ -$ 148,880$ -$ -$

196829901 670047 HOSPITALS OF PROVIDENCE EAST CAMPUS DSH DY4 17,835,468$ 356,767$ 11,946,056$ 30,138,291$ -$ -$ 30,138,291$ 3,747,217$ -$ -$ -$ 6,081,117$ -$ -$

136488705 450005 BAPTIST ORANGE HOSPITAL Non-DSH DY4 4,237,150$ 10,164$ 971,787$ 5,219,101$ -$ -$ 5,219,101$ -$ -$ -$ -$ 130,394$ -$ -$

127294003 450007 PETERSON REGIONAL MEDICAL CENTER Non-DSH DY4 7,090,387$ 55,009$ 3,672,153$ 10,817,549$ 1,510,990$ -$ 12,328,539$ -$ -$ -$ -$ 7,544,394$ -$ -$

137907508 450023 CITIZENS MEDICAL CENTER Non-DSH DY4 18,080,255$ 66,619$ 6,642,544$ 24,789,418$ 4,111,944$ -$ 28,901,362$ -$ -$ -$ -$ 8,130,256$ -$ -$

111829102 450042 PROVIDENCE HEALTH CENTER Non-DSH DY4 24,836,818$ 88,353$ 14,755,145$ 39,680,316$ 2,885,968$ -$ 42,566,284$ -$ -$ -$ -$ 15,942,534$ -$ -$

175287501 450044 UT SOUTHWESTERN UNIVERSITY HOSP Non-DSH DY4 49,067,690$ 8,846,391$ 26,279,033$ 84,193,114$ -$ -$ 84,193,114$ -$ -$ -$ 1,418,878$ 21,615,349$ -$ -$

135225404 450056 DCHSA-D.B.A.-SETON MEDICAL CTR Non-DSH DY4 45,944,347$ 936,879$ 11,845,950$ 58,727,176$ 591,481$ -$ 59,318,657$ -$ -$ -$ -$ 15,654,501$ -$ -$

130614405 450064 ARLINGTON MEMORIAL HOSPITAL Non-DSH DY4 30,642,512$ 645,852$ 10,425,441$ 41,713,805$ -$ -$ 41,713,805$ -$ -$ -$ -$ 7,805,871$ -$ -$

112671602 450072 BRAZOSPORT REGIONAL HEALTH SYSTEM Non-DSH DY4 10,456,843$ 81,461$ 3,289,257$ 13,827,561$ 611,552$ -$ 14,439,113$ -$ -$ -$ -$ 4,111,222$ -$ -$

364187001 450078 ANSON GENERAL HOSPITAL Non-DSH DY4 649,487$ -$ 935,237$ 1,584,724$ -$ -$ 1,584,724$ -$ -$ -$ -$ 408,615$ -$ -$

121776205 450079 BAYLOR MEDICAL CENTER AT IRVING Non-DSH DY4 37,399,662$ 279,356$ 9,682,802$ 47,361,820$ -$ -$ 47,361,820$ -$ -$ -$ -$ 18,597,023$ -$ -$

094105602 450087 NORTH HILLS HOSPITAL Non-DSH DY4 13,313,670$ 181,021$ 4,248,207$ 17,742,898$ -$ -$ 17,742,898$ -$ -$ -$ -$ 8,318,047$ -$ -$

138411709 450104 GUADALUPE REGIONAL MEDICAL CENTER Non-DSH DY4 13,944,197$ 227,390$ 6,413,240$ 20,584,827$ 43,589$ -$ 20,628,416$ -$ -$ -$ -$ 6,165,038$ -$ -$

297342201 450130 NIX HEALTH CARE SYSTEM Non-DSH DY4 19,744,109$ 842,423$ 15,647,641$ 36,234,173$ -$ -$ 36,234,173$ -$ -$ -$ -$ 6,882,518$ -$ -$

286326801 450143 SETON SMITHVILLE REGIONAL HOSPITAL Non-DSH DY4 3,000,081$ 9,354$ 483,800$ 3,493,235$ -$ -$ 3,493,235$ -$ -$ -$ -$ 1,817,162$ -$ -$

131036903 450148 TEXAS HEALTH CLEBURNE Non-DSH DY4 11,911,877$ 124,648$ 3,240,685$ 15,277,210$ -$ -$ 15,277,210$ -$ -$ -$ -$ 1,147,558$ -$ -$

281514401 450162 GRACE MEDICAL CENTER Non-DSH DY4 2,383,094$ 27,452$ 838,492$ 3,249,038$ 24,666$ -$ 3,273,704$ -$ -$ -$ -$ 1,079,561$ -$ -$

127300503 450193 CHI ST LUKES HEALTH BAYLOR MED CTR Non-DSH DY4 66,403,992$ 6,818,675$ 30,182,251$ 103,404,918$ -$ -$ 103,404,918$ -$ -$ -$ -$ 28,397,076$ -$ -$

184409401 450203 WEATHERFORD REGIONAL Non-DSH DY4 11,812,662$ 68,180$ 3,847,219$ 15,728,061$ 461,372$ -$ 16,189,433$ -$ -$ -$ -$ 6,560,923$ -$ -$

020841501 450222 CONROE REGIONAL MEDICAL CENTER Non-DSH DY4 34,705,031$ 936,504$ 11,876,849$ 47,518,384$ -$ -$ 47,518,384$ -$ -$ -$ -$ 13,723,475$ -$ -$

020844901 450237 SANTA ROSA HEALTHCARE Non-DSH DY4 50,766,780$ 852,117$ 20,079,210$ 71,698,107$ -$ -$ 71,698,107$ -$ -$ -$ -$ 27,165,478$ -$ -$

083290905 450253 BELLVILLE GENERAL HOSPITAL Non-DSH DY4 1,376,208$ 1,485$ 272,645$ 1,650,338$ 81,930$ -$ 1,732,268$ -$ -$ -$ -$ 1,099,626$ -$ -$

130606006 450271 DECATUR COMMUNITY HOSPITAL Non-DSH DY4 15,844,711$ 68,882$ 4,648,100$ 20,561,693$ -$ -$ 20,561,693$ -$ -$ -$ -$ 13,200,013$ -$ -$

362293801 450280 BAYLOR MEDICAL CENTER AT GARLAND Non-DSH DY4 26,364,939$ 42,591$ 10,883,281$ 37,290,811$ -$ -$ 37,290,811$ -$ -$ -$ -$ 14,838,140$ -$ -$

094140302 450292 PRESBYTERIAN HOSPITAL OF KAUFMAN Non-DSH DY4 6,274,474$ 118,743$ 2,489,366$ 8,882,583$ -$ -$ 8,882,583$ -$ -$ -$ -$ 2,333,151$ -$ -$

126842708 450306 STAMFORD MEMORIAL HOSPITAL Non-DSH DY4 1,313,781$ 69$ 310,393$ 1,624,243$ 49,125$ -$ 1,673,368$ -$ -$ -$ -$ 979,305$ -$ -$

137949705 450358 THE METHODIST HOSPITAL Non-DSH DY4 61,204,262$ 791,602$ 42,742,001$ 104,737,865$ -$ -$ 104,737,865$ -$ -$ -$ -$ 28,733,133$ -$ -$

112698903 450403 MEDICAL CENTER OF MCKINNEY Non-DSH DY4 16,183,766$ 343,761$ 10,654,145$ 27,181,672$ -$ -$ 27,181,672$ -$ -$ -$ -$ 6,851,030$ -$ -$

137074409 450411 EASTLAND MEMORIAL HOSPITAL Non-DSH DY4 1,624,236$ 4,832$ 1,158,481$ 2,787,549$ 43,250$ -$ 2,830,799$ -$ -$ -$ -$ 1,569,645$ -$ -$

127304703 450419 TEXAS HEALTH HARRIS METHODIST AZLE Non-DSH DY4 5,652,871$ 31,906$ 1,337,673$ 7,022,450$ -$ -$ 7,022,450$ -$ -$ -$ -$ 2,085,936$ -$ -$

137962006 450424 SAN JACINTO METHODIST HOSPITAL Non-DSH DY4 32,120,310$ 232,919$ 9,530,719$ 41,883,948$ -$ -$ 41,883,948$ -$ -$ -$ -$ 27,624,820$ -$ -$

216719901 450451 GLEN ROSE MEDICAL CENTER Non-DSH DY4 1,816,785$ 8,557$ 629,129$ 2,454,471$ 1,015,464$ -$ 3,469,935$ -$ -$ -$ -$ 1,528,573$ -$ -$

136381405 450460 TYLER COUNTY HOSPITAL Non-DSH DY4 1,442,054$ 4,827$ 696,182$ 2,143,063$ 252,590$ -$ 2,395,653$ -$ -$ -$ -$ 1,376,582$ -$ -$

094164302 450484 WOODLAND HEIGHTS MED CENTER Non-DSH DY4 6,918,670$ 167,872$ 6,087,488$ 13,174,030$ 949,216$ -$ 14,123,246$ -$ -$ -$ -$ 3,766,024$ -$ -$

127305405 450497 BOWIE MEMORIAL HOSPITAL Non-DSH DY4 406,207$ 10,177$ 786,442$ 1,202,826$ -$ -$ 1,202,826$ -$ -$ -$ -$ 938,586$ 532,379$ -$

337991901 450498 STEPHENS MEMORIAL HOSPITAL Non-DSH DY4 1,735,490$ 1,731$ 508,293$ 2,245,514$ 235,617$ -$ 2,481,131$ -$ -$ -$ -$ 1,285,160$ -$ -$

209345201 450537 METHODIST RICHARDSON MEDICAL CENTER Non-DSH DY4 17,679,040$ 779,002$ 4,628,608$ 23,086,650$ -$ -$ 23,086,650$ -$ -$ -$ -$ 5,751,073$ -$ -$

127262703 450563 BAYLOR MEDICAL CENTER-GRAPEVINE Non-DSH DY4 11,400,453$ 234,880$ 2,883,376$ 14,518,709$ -$ -$ 14,518,709$ -$ -$ -$ -$ 5,125,255$ -$ -$

109588703 450578 HEMPHILL COUNTY HOSPITAL Non-DSH DY4 436,610$ 194$ 125,007$ 561,811$ 166,043$ -$ 727,854$ -$ -$ -$ -$ 980,329$ 377,676$ 252,475$

112707808 450584 WILBARGER GENERAL HOSPITAL Non-DSH DY4 1,489,155$ 5,044$ 1,159,755$ 2,653,954$ 269,086$ -$ 2,923,040$ -$ -$ -$ -$ 1,216,669$ -$ -$

094178302 450596 LAKE GRANBURY MEDICAL CENTER Non-DSH DY4 5,714,423$ 86,056$ 2,890,441$ 8,690,920$ 649,570$ -$ 9,340,490$ -$ -$ -$ -$ 4,188,838$ -$ -$

136430906 450604 HILL COUNTRY MEMORIAL HOSPITAL Non-DSH DY4 3,310,218$ 61,149$ 1,837,167$ 5,208,534$ 1,089,596$ -$ 6,298,130$ -$ -$ -$ -$ 3,416,643$ -$ -$

020934801 450610 MEMORIAL HERMANN MEMORIAL CITY MEDIC Non-DSH DY4 45,181,120$ 2,044,546$ 9,881,115$ 57,106,781$ 150,340$ -$ 57,257,121$ -$ -$ -$ -$ 21,622,710$ -$ -$

111905902 450634 DENTON REGIONAL MED CENTER Non-DSH DY4 19,856,636$ 412,149$ 8,216,051$ 28,484,836$ -$