AHCCCS Hospital Assessment	Preliminary Model for Discussion Purposes
Summary	Version 2 - Excluding High Medicare Utilization Hospitals

Assessment Basis:

Patient Discharges

Assessment Rate Inputs	
SFY 2015	
Urban Acute Provider	
468.00	
Non-CAH Rural Acute Provider	
468.00	
Freestanding Children's Provider	
0.00	
CAH	
468.00	
LTAC Provider	
117.00	
Small Psychiatric Providers and AZ State Hospital	
0.00	
Large Psychiatric Provider	
117.00	
Freestanding Rehabilitation Provider	
0.00	
Pediatric-Intensive  General Acute Hospitals	
374.50	
Medium Pediatric Intensive General Acute Hospitals	
421.25	
Psychiatric Sub-Provider	
117.00	
Rehabilitation Sub-Provider	
0.00	
Short Term Specialty Hospital	
0.00	
High Medicare Utilization Hospitals	
0.00	

Assessment Unit Threshold 	22,000
Assessment Unit Rate Above Threshold 	46.75

State Assessment Summary	SFY 2015	
Total Assessments	232,963,697	
State Share of Coverage Payments	232,962,600	
Assessments Net of State Share	1,097	

Hospital Net Gain/Loss Summary	SFY 2015	
Total Projected Coverage Payments (1)	640,474,275	
Estimated Net Gain/Loss	407,510,578	
Number of In-State Hospitals with Estimated Gain	90	
Number of In-State Hospitals with Estimated Loss	2	
Number of In-State Hospitals with $0 Gain or Loss	5	
Number of In-State Hospital Systems with Estimated Loss	0	

Note: (1) Model includes one new urban acute hospital whose benefit from the Medicaid expansion is not expected to increase aggregate statewide projected coverage payments; to avoid duplication this provider's projected benefit has been removed from aggregate statewide projected coverage payments.

AHCCCS Hospital Assessment	Preliminary Model for Discussion Purposes
CMS Assessment Tests	Version 2 - Excluding High Medicare Utilization Hospitals

	SFY 2015	
B1 Value	0.0000037465	
B2 Value	0.0000037083	
B1/B2 Value	1.0102908273	

Assessment Basis:

	SFY 2015	
Total Assessment Amount	232,963,697	
Inpatient Net Patient Revenues	6,135,861,156	
Ratio	3.80%	

B Test Calculation

Patient Discharges

Inpatient Hold Harmless Calculation

Tentative and Preliminary	Page - 2	DRAFT - 3/3/2014

AHCCCS Hospital Assessment 	Preliminary Model for Discussion Purposes
Summary by Provider Type 	Version 2 - Excluding High Medicare Utilization Hospitals

Assessment  Basis:

Patient Discharges

	Estimated Hospital Net Gain/Loss - SFY 2015	

Provider Type	

Assessment Amount	
Total Projected
Coverage Payments	
Estimated Net
Gain/Loss	
Number of Hospitals with Estimated Gain	
Number of Hospitals with Estimated Loss	

Urban Acute Provider	
137,066,119 	313,198,849 	176,132,731 	24 	1	

Non-CAH Rural Acute Provider	
33,941,700 	91,024,658 	57,082,958 	14 	0	

Freestanding Children's Provider	
- 	1,268,968 	1,268,968 	2 	0	

CAH	
3,423,420 	12,667,726 	9,244,306 	10 	0	

LTAC Provider	
380,016 	5,749,563 	5,369,547 	8 	0	

Small Psychiatric Providers and AZ State Hospital	
- 	2,425,031 	2,425,031 	6 	0	

Large Psychiatric Provider	
1,905,696 	13,989,377 	12,083,681 	4 	0	

Freestanding Rehabilitation  Provider	
- 	2,690,056 	2,690,056 	7 	0	

Pediatric-Intensive General Acute Hospitals	
17,680,079 	49,699,339 	32,019,260 	2 	0	

Medium Pediatric Intensive General Acute Hospitals	
38,566,667 	90,882,512 	52,315,845 	4 	1	

Short Term Specialty Hospital	
- 	3,043,394 	3,043,394 	4 	0	

High Medicare Utilization Hospitals	
- 	38,366,690 	38,366,690 	5 	0	

Border Providers	- 	14,574,841 	14,574,841 	243 	0	
Out of State Providers	
- 	1,318,351 	1,318,351 	530 	0	

New Hospital Adjustment		(425,078)	(425,078)		
Total	232,963,697	640,474,275	407,510,578	863	2	

General Notes: 	(1) Model excludes IHS, 638, and closed providers.
(2) Small Psychiatric Providers and AZ State Hospital are providers with less than 2,500 patient discharges.
(3) Short Term Specialty Hospital defined based on ADHS Type= Hospital, Subtype= Specialty Hospital, License status begins with SH.
(4) Pediatric-Intensive General Acute Hospitals have at least 20% pediatric/NICU  licensed beds and Medium Pediatric Intensive
General Acute Hospitals have at 10-19% licensed pediatric/NICU  beds.
(5) High Medicare Utilization Hospitals are hospitals in which at least 50% of the Inpatient Discharges are for Medicare beneficiaries and have at least 5,000 Medicare discharges.
(6) Model includes one new urban acute hospital whose benefit from the Medicaid expansion is not expected to increase aggregate statewide projected coverage payments; to avoid duplication this provider's projected benefit has been removed from aggregate statewide projected coverage payments.

	Estimated Hospital Net Gain/Loss - SFY 2015	

Medicare
Provider ID	
Hospital Name	
Provider Type	
Hospital System	
Assessment
Amount	Total Projected Coverage Payments	
Estimated Net
Gain/Loss	
30001	MARYVALE HOSPITAL MED CTR	Urban Acute Provider	Abrazo Health Care	2,727,972	7,843,424	5,115,452	
30002	BANNER GOOD SAM MEDICAL C	Urban Acute Provider	Banner Health	11,055,318	41,238,615	30,183,296	
30010	CARONDELET ST MARYS HOSP	Urban Acute Provider	Carondelet Health Network	6,324,435	16,685,352	10,360,917	
30011	CARONDELET ST JOSEPHS-TUC	Urban Acute Provider	Carondelet Health Network	8,737,794	13,086,850	4,349,056	
30014	JOHN C. LINCOLN HOS N MTN	Urban Acute Provider	John C. Lincoln Health Network	7,627,464	18,621,862	10,994,398	
30024	ST JOSEPH'S HOSPITAL-PHX	Urban Acute Provider	Dignity	10,887,949	42,717,665	31,829,717	
30030	PHOENIX BAPTIST HOSPITAL	Urban Acute Provider	Abrazo Health Care	5,319,288	16,189,101	10,869,813	
30036	CHANDLER REGIONAL MED.CTR	Urban Acute Provider	Dignity	8,297,172	12,964,038	4,666,866	
30037	TEMPE ST. LUKE'S HOSPITAL	Urban Acute Provider	Iasis Healthcare Corporation	4,132,206	15,804,152	11,671,946	
30038	SCOTTSDALE HLTHCARE-OSBN	Urban Acute Provider	Scottsdale Healthcare	7,545,564	14,652,843	7,107,279	
30083	PARADISE VALLEY HOSPITAL	Urban Acute Provider	Abrazo Health Care	3,357,900	6,513,058	3,155,158	
30085	NORTHWEST MEDICAL CENTER	Urban Acute Provider	CHS	8,694,504	10,068,188	1,373,684	
30092	JOHN C LINCOLN-DEER VLLY	Urban Acute Provider	John C. Lincoln Health Network	5,725,980	12,420,280	6,694,300	
30094	ARROWHEAD HOSPITAL	Urban Acute Provider	Abrazo Health Care	5,908,032	7,548,330	1,640,298	
30110	WEST VALLEY HOSPITAL MED	Urban Acute Provider	Abrazo Health Care	4,982,328	10,059,355	5,077,027	
30111	UNIVERSITY PHYSICIAN HC	Urban Acute Provider	UA Healthcare	2,642,445	12,340,838	9,698,393	
30114	ORO VALLEY HOSPITAL	Urban Acute Provider	CHS	2,179,476	2,130,981	(48,495)	
30115	BANNER ESTRELLA MEDICAL	Urban Acute Provider	Banner Health	8,796,528	14,834,326	6,037,798	
30119	MERCY GILBERT MED CENTER	Urban Acute Provider	Dignity	6,853,860	9,917,341	3,063,481	
30120	GILBERT HOSPITAL, L.L.C.	Urban Acute Provider	Gilbert Hospital	894,816	2,493,933	1,599,117	
30121	MOUNTAIN VISTA MED CTR	Urban Acute Provider	Iasis Healthcare Corporation	4,753,008	13,107,254	8,354,246	
30122	BANNER GATEWAY MEDICAL CT	Urban Acute Provider	Banner Health	6,390,072	7,322,337	932,265	
30123	SCOTTSDALE HLTHCARE-THOMP	Urban Acute Provider	Scottsdale Healthcare	1,780,740	2,120,302	339,562	
30130	BANNER IRONWOOD MEDICAL CENTER	Urban Acute Provider	Banner Health	1,135,368	2,093,347	957,979	
30132	FLORENCE HOSPITAL AT ANTHEM	Urban Acute Provider	FLORENCE HOSPITAL AT ANTHEM	315,900	425,078	109,178	
30007	VERDE VALLEY MEDICAL CTR.	Non-CAH Rural Acute Provider	N. AZ	2,064,114	5,860,030	3,795,916	
30012	YAVAPAI REG MED CENTER	Non-CAH Rural Acute Provider	Yavapai Regional Medical Center West Cam	3,275,064	5,251,591	1,976,527	
30016	CASA GRANDE REG MED CTR	Non-CAH Rural Acute Provider	Regional Care Services Corporation	4,201,938	8,806,152	4,604,214	
30023	FLAGSTAFF MEDICAL CENTER	Non-CAH Rural Acute Provider	N. AZ	6,144,372	16,858,741	10,714,369	
30033	PAYSON HOSPITAL CORP.	Non-CAH Rural Acute Provider	CHS	1,142,856	3,955,990	2,813,134	
30043	SIERRA VISTA REG HLTH CTR	Non-CAH Rural Acute Provider	Sierra Vista Regional Health Center	2,647,008	3,564,930	917,922	
30055	KINGMAN REGIONAL MED CTR	Non-CAH Rural Acute Provider	Kingman Regional Medical Center	3,682,224	10,616,148	6,933,924	
30062	SUMMIT HEALTHCARE REG.MED	Non-CAH Rural Acute Provider	Summit Healthcare	1,737,216	5,475,007	3,737,791	
30067	LA PAZ REGIONAL HOSPITAL	Non-CAH Rural Acute Provider	La Paz Regional Hospital	394,524	1,095,036	700,512	
30068	MT. GRAHAM REG. MED. CTR.	Non-CAH Rural Acute Provider	Mt. Graham Regional Medical Center	980,460	3,007,842	2,027,382	
30069	HAVASU REG MED CENTER LLC	Non-CAH Rural Acute Provider	LifePoint Hospitals, Inc.	2,750,436	6,752,363	4,001,927	
30101	WESTERN AZ REG MED CTR	Non-CAH Rural Acute Provider	CHS	2,997,072	11,723,851	8,726,779	
30117	VALLEY VIEW MEDICAL CENT	Non-CAH Rural Acute Provider	LifePoint Hospitals, Inc.	1,261,260	3,845,901	2,584,641	
30126	ARIZONA REGIONAL MED. CTR	Non-CAH Rural Acute Provider	Banner Health	663,156	4,211,074	3,547,918	
33301	LOS NINOS HOSPITAL	Freestanding Children's Provider	Hacienda Healthcare	-	7,813	7,813	
33302	PHOENIX CHILDREN'S HOSP	Freestanding Children's Provider	Phoenix Children's Hospital	-	1,261,156	1,261,156	
31300	WICKENBURG COMMUNITY HOSP	CAH	Wickenburg Community Hospital	200,772	391,788	191,016	

Sorted by Provider Type and then by Hospital Name in alphabetical order

	Estimated Hospital Net Gain/Loss - SFY 2015	

Medicare
Provider ID	
Hospital Name	
Provider Type	
Hospital System	
Assessment
Amount	Total Projected Coverage Payments	
Estimated Net
Gain/Loss	
31301	BENSON HOSPITAL	CAH	Benson Hospital	146,952	614,154	467,202	
31302	NORTHERN COCHISE HOSPITAL	CAH	Northern Cochise Community Hospital	232,128	738,469	506,341	
31303	SOUTHEAST MEDICAL CENTER	CAH	Southeast Arizona Medical Center	140,400	1,019,029	878,629	
31304	PAGE HOSPITAL	CAH	Banner Health	245,700	1,311,345	1,065,645	
31311	LITTLE COLORADO MED CTR	CAH	N. AZ	633,204	2,135,945	1,502,741	
31312	COPPER QUEEN HOSPITAL	CAH	Copper Queen Community Hospital	191,880	1,402,282	1,210,402	
31313	HOLY CROSS HOSPITAL-ARIZ	CAH	Carondelet Health Network	659,412	2,061,146	1,401,734	
31314	COBRE VALLEY COMM HOSP	CAH	Cobre Valley Regional Medical Center	801,684	2,399,296	1,597,612	
31315	WHITE MNTN REG MED CNTR	CAH	White Mountain Regional Medical Center	171,288	594,273	422,985	
32000	KINDRED HOSP AZ-NORTHWEST	LTAC Provider	Kindred Healthcare, Inc.	82,953	925,433	842,480	
32001	SELECT SPECIALTY HOSP-PHX	LTAC Provider	Select Specialty Hospital, Arizona, Inc.	53,820	2,008,178	1,954,358	
32002	KINDRED HOSPITAL-TUCSON	LTAC Provider	Kindred Healthcare, Inc.	46,917	355,826	308,909	
32004	CORNERSTONE HOSPITAL OF S	LTAC Provider	Cornerstone Healthcare Group	27,729	169,897	142,168	
32005	SELECT SPECIALTY-PHX D/T	LTAC Provider	Select Specialty Hospital, Arizona, Inc.	66,105	898,424	832,319	
32006	PROMISE HOSPITAL OF PHX	LTAC Provider	Promise Healthcare	24,804	834,365	809,561	
32007	RESTORA MESA	LTAC Provider	Restora	50,427	504,006	453,579	
32008	SUN CITY	LTAC Provider	Restora	27,261	53,433	26,172	
34020	HAVEN SENIOR HORIZONS	Small Psychiatric Providers and AZ State Hospital	HAVEN SENIOR HORIZONS	-	5,098	5,098	
34021	AZ STATE HOSPITAL	Small Psychiatric Providers and AZ State Hospital	State of Arizona	-	520,267	520,267	
34023	The Guidance Center, Inc.	Small Psychiatric Providers and AZ State Hospital	The Guidance Center, Inc.	-	454,168	454,168	
34025	WINDHAVEN PSYCHIATRIC HOS	Small Psychiatric Providers and AZ State Hospital	WINDHAVEN PSYCHIATRIC HOS	-	960,150	960,150	
34026	VALLEY HOSPITAL	Small Psychiatric Providers and AZ State Hospital	VALLEY HOSPITAL	-	69,190	69,190	
34027	Community Counseling Centers, Inc at PineView Hospital	Small Psychiatric Providers and AZ State Hospital	Community Counseling Centers, Inc at Pine	-	416,158	416,158	
34028	Aurora Behavioral Healthcare-Tempe	Small Psychiatric Providers and AZ State Hospital	Aurora Behavioral Health System	-	0	-	
N/A	Remuda Ranch Center for Anorexia and bulimia	Small Psychiatric Providers and AZ State Hospital	Remuda Ranch Center for Anorexia and bu	-	0	-	
34004	BANNER BEHAVORIAL HEALTH	Large Psychiatric Provider	Banner Health	477,711	2,699,220	2,221,509	
34013	ST LUKE'S BEHAVORIAL HOSP	Large Psychiatric Provider	Iasis Healthcare Corporation	664,794	6,035,463	5,370,669	
34022	SONORA BEHAVIORAL HEALTH	Large Psychiatric Provider	SONORA BEHAVIORAL HEALTH	309,933	1,790,197	1,480,264	
34024	AURORA BEHAVIORAL HEALTH	Large Psychiatric Provider	Aurora Behavioral Health System	453,258	3,464,496	3,011,238	
33025	HEALTHSOUTH MERIDIAN PT.	Freestanding Rehabilitation Provider	Healthsouth Rehab. Corp.	-	339,402	339,402	
33028	HEALTHSOUTH REHAB INST.	Freestanding Rehabilitation Provider	Healthsouth Rehab. Corp.	-	549,953	549,953	
33029	HLTHSOUTH REHAB.HOSP.OF.S	Freestanding Rehabilitation Provider	Healthsouth Rehab. Corp.	-	299,709	299,709	
33032	HEALTHSOUTH VALLEY OF SUN	Freestanding Rehabilitation Provider	Healthsouth Rehab. Corp.	-	605,737	605,737	
33034	YUMA REHABILITATION HOSPI	Freestanding Rehabilitation Provider	Healthsouth Rehab. Corp.	-	131,298	131,298	
33036	MOUNTAIN VALLEY REG REHAB	Freestanding Rehabilitation Provider	Ernest Health, Inc.	-	525,448	525,448	
33037	HEALTHSOUTH E.VALLEY REHA	Freestanding Rehabilitation Provider	Healthsouth Rehab. Corp.	-	238,508	238,508	
30064	UNIVERSITY MED CTR-AZ	Pediatric-Intensive General Acute Hospitals	UA Healthcare	8,502,106	31,431,078	22,928,972	
30065	BANNER DESERT MEDICAL CEN	Pediatric-Intensive General Acute Hospitals	Banner Health	9,177,974	18,268,261	9,090,287	
30006	TUCSON MEDICAL CENTER	Medium Pediatric Intensive General Acute Hospitals	TMC Healthcare	9,854,528	18,317,245	8,462,717	
30022	MARICOPA MEDICAL CENTER	Medium Pediatric Intensive General Acute Hospitals	MIHS	8,018,703	44,075,468	36,056,766	
30087	SCOTTSDALE HEALTHCARE - SHEA	Medium Pediatric Intensive General Acute Hospitals	Scottsdale Healthcare	9,008,431	6,709,513	(2,298,919)	
30089	BANNER THUNDERBIRD MEDICA	Medium Pediatric Intensive General Acute Hospitals	Banner Health	9,865,205	18,193,083	8,327,878	

Sorted by Provider Type and then by Hospital Name in alphabetical order

	Estimated Hospital Net Gain/Loss - SFY 2015	

Medicare
Provider ID	
Hospital Name	
Provider Type	
Hospital System	
Assessment
Amount	Total Projected Coverage Payments	
Estimated Net
Gain/Loss	
30118	YRMC EAST	Medium Pediatric Intensive General Acute Hospitals	Yavapai Regional Medical Center West Cam	1,819,800	3,587,203	1,767,403	
30105	BANNER HEART HOSPITAL	Short Term Specialty Hospital	Banner Health	-	1,968,576	1,968,576	
30107	ARIZONA SPINE AND JOINT	Short Term Specialty Hospital	Arizona Spine and Joint Hospital	-	16,264	16,264	
30108	SURGICAL SPECIALITY HOSP	Short Term Specialty Hospital	Surgical Specialty Hospital of Arizona	-	137,530	137,530	
30112	AZ ORTHOPEDIC SURGICAL HO	Short Term Specialty Hospital	Orthopedic & Surgical Specialty Company	-	921,024	921,024	
30131	ORTHOPEDIC AND SPINE INPATIENT SURGI	Short Term Specialty Hospital	O.A.S.I.S. hospital, Partners are CHW and	U	-	0	-	
N/A	Cancer Treatment Centers of America - Western Regional Medical  Short Term Specialty Hospital	Cancer Treatment Centers of America - Wes	-	0	-	
N/A	FREEDOM PAIN HOSPITAL	Short Term Specialty Hospital	FREEDOM PAIN HOSPITAL	-	0	-	
30061	BANNER BOSWELL MED CTR	High Medicare Utilization Hospitals	Banner Health	-	6,701,067	6,701,067	
30088	BANNER BAYWOOD MEDICAL CN	High Medicare Utilization Hospitals	Banner Health	-	8,751,730	8,751,730	
30093	BANNER DEL E WEBB MED CTR	High Medicare Utilization Hospitals	Banner Health	-	7,210,771	7,210,771	
30013	YUMA REGIONAL MED CENTER	High Medicare Utilization Hospitals	Yuma Regional Medical Center	-	13,101,926	13,101,926	
30103	MAYO CLINIC HOSPITAL	High Medicare Utilization Hospitals	Mayo	-	2,601,196	2,601,196	

Sorted by Provider Type and then by Hospital Name in alphabetical order

Total Border Providers	-	14,574,841	14,574,841	
Total Out of State Providers	-	1,318,351	1,318,351	
New Hospital Adjustment		(425,078.00)	(425,078.00)	
Total	232,963,697	640,474,275	407,510,578	

State Share of Coverage Payments			
232,962,600	
Assessment Net of State Share:			1,097	

Note: (1) New hospital whose benefit from the Medicaid expansion is not expected to increase aggregate statewide projected coverage payments; to avoid duplication this provider's projected benefit has been removed from aggregate statewide projected coverage payments.				

	
Estimated Hospital Net Gain/Loss - SFY 2015	

Hospital System	
Assessment Amount	
Total Projected
Coverage Payments	
Estimated Net Gain/Loss	
Abrazo Health Care	22,295,520	48,153,268	25,857,748	
Arizona Spine and Joint Hospital	-	16,264	16,264	
Aurora Behavioral Health System	453,258 	3,464,496 	3,011,238	
Banner Health	47,807,032 	134,803,751 	86,996,718	
Benson Hospital	146,952	614,154	467,202	
Cancer Treatment Centers of America - Western Regional Medical	-	-	-	
Carondelet Health Network	15,721,641	31,833,349	16,111,708	
CHS	15,013,908 	27,879,010 	12,865,102	
Cobre Valley Regional Medical Center	801,684	2,399,296	1,597,612	
Community Counseling Centers, Inc at PineView Hospital	-	416,158	416,158	
Copper Queen Community  Hospital	191,880 	1,402,282 	1,210,402	
Cornerstone  Healthcare  Group	27,729 	169,897 	142,168	
Dignity	26,038,981	65,599,044	39,560,064	
Ernest Health, Inc.	- 	525,448 	525,448	
FLORENCE HOSPITAL AT ANTHEM	315,900	425,078	109,178	
FREEDOM PAIN HOSPITAL	-	-	-	
Gilbert Hospital	894,816 	2,493,933 	1,599,117	
Hacienda Healthcare	- 	7,813 	7,813	
HAVEN SENIOR HORIZONS	- 	5,098 	5,098	
Healthsouth  Rehab. Corp.	- 	2,164,607 	2,164,607	
Iasis Healthcare Corporation	9,550,008	34,946,869	25,396,861	
John C. Lincoln Health Network	13,353,444 	31,042,142 	17,688,698	
Kindred Healthcare,  Inc.	129,870 	1,281,259 	1,151,389	
Kingman Regional Medical Center	3,682,224	10,616,148	6,933,924	
La Paz Regional Hospital	394,524	1,095,036	700,512	
LifePoint Hospitals, Inc.	4,011,696 	10,598,265 	6,586,569	
Mayo	-	2,601,196	2,601,196	
MIHS	8,018,703	44,075,468	36,056,766	
Mt. Graham Regional Medical Center	980,460	3,007,842	2,027,382	
N. AZ	8,841,690 	24,854,715 	16,013,025	
Northern Cochise Community Hospital	232,128	738,469	506,341	
O.A.S.I.S. hospital, Partners are CHW and United Surgical Partner	-	-	-	
Orthopedic  & Surgical Specialty Company	- 	921,024 	921,024	
Phoenix Children's Hospital	-	1,261,156	1,261,156	
Promise Healthcare	24,804 	834,365 	809,561	
Regional Care Services Corporation	4,201,938 	8,806,152 	4,604,214	
Remuda Ranch Center for Anorexia and bulimia	-	-	-	
Restora	77,688 	557,440 	479,752	
Scottsdale Healthcare	18,334,735 	23,482,657 	5,147,922	
Select Specialty Hospital, Arizona, Inc.	119,925 	2,906,603 	2,786,678	
Sierra Vista Regional Health Center	2,647,008	3,564,930	917,922	
SONORA BEHAVIORAL  HEALTH	309,933 	1,790,197 	1,480,264	
Southeast Arizona Medical Center	140,400	1,019,029	878,629	
State of Arizona	-	520,267	520,267	

	
Estimated Hospital Net Gain/Loss - SFY 2015	

Hospital System	
Assessment Amount	
Total Projected
Coverage Payments	
Estimated Net Gain/Loss	
Summit Healthcare	1,737,216	5,475,007	3,737,791	
Surgical Specialty Hospital of Arizona	- 	137,530 	137,530	
The Guidance Center, Inc.	- 	454,168 	454,168	
TMC Healthcare	9,854,528 	18,317,245 	8,462,717	
UA Healthcare	11,144,551	43,771,916	32,627,366	
VALLEY HOSPITAL	-	69,190	69,190	
White Mountain Regional Medical Center	171,288	594,273	422,985	
Wickenburg  Community  Hospital	200,772 	391,788 	191,016	
WINDHAVEN PSYCHIATRIC HOS	-	960,150	960,150	
Yavapai Regional Medical Center West Campus	5,094,864	8,838,794	3,743,930	
Yuma Regional Medical Center	- 	13,101,926 	13,101,926	

Total Border Providers	-	14,574,841	14,574,841	
Total Out of State Providers	-	1,318,351	1,318,351	

New Hospital Adjustment		
(425,078.00)	
(425,078.00)	
Total	232,963,697	640,474,275	407,510,578	

State Share of Coverage Payments			
232,962,600	
Assessment Net of State Share:			1,097