AHCCCS Hospital Assessment	Preliminary Model for Discussion Purposes
Summary	Version 3 - Medicare Discharges Excluded from Assessment

Assessment Basis:

Patient Discharges

Assessment Rate Inputs	
SFY 2015	
Urban Acute Provider	
636.50	
Non-CAH Rural Acute Provider	
636.50	
Freestanding Children's Provider	
0.00	
CAH	
636.50	
LTAC Provider	
159.25	
Small Psychiatric Providers and AZ State Hospital	
0.00	
Large Psychiatric Provider	
159.25	
Freestanding Rehabilitation Provider	
0.00	
Pediatric-Intensive  General Acute Hospitals	
509.25	
Medium Pediatric Intensive General Acute Hospitals	
572.75	
Psychiatric Sub-Provider	
159.25	
Rehabilitation Sub-Provider	
0.00	
Short Term Specialty Hospital	
0.00	
High Medicare/Out-of State Patient Utilization Hospital	
0.00	

Assessment Unit Threshold 	15,000
Assessment Unit Rate Above Threshold 	63.75

State Assessment Summary	SFY 2015	
Total Assessments	233,009,279	
State Share of Coverage Payments	232,962,600	
Assessments Net of State Share	46,679	

Hospital Net Gain/Loss Summary	SFY 2015	
Total Projected Coverage Payments (1)	640,474,275	
Estimated Net Gain/Loss	407,464,996	
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	1	

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.

Tentative and Preliminary	Page - 1	DRAFT - 3/3/2014

AHCCCS Hospital Assessment	Preliminary Model for Discussion Purposes
CMS Assessment Tests	Version 3 - Medicare Discharges Excluded from Assessment

	SFY 2015	
B1 Value	0.0000037465	
B2 Value	0.0000037218	
B1/B2 Value	1.0066194116	

Assessment Basis:

	SFY 2015	
Total Assessment Amount	233,009,279	
Inpatient Net Patient Revenues	6,848,287,094	
Ratio	3.40%	

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 3 - Medicare Discharges Excluded from Assessment

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	142,933,768	335,862,418	192,928,650	27	1	
Non-CAH Rural Acute Provider	26,539,429	91,024,658	64,485,228	14	0	
Freestanding Children's Provider	-	1,268,968	1,268,968	2	0	
CAH	3,293,888	12,667,726	9,373,839	10	0	
LTAC Provider	231,390	5,749,563	5,518,173	8	0	
Small Psychiatric Providers and AZ State Hospital	-	2,425,031	2,425,031	6	0	
Large Psychiatric Provider	2,270,746	13,989,377	11,718,631	4	0	
Freestanding Rehabilitation Provider	-	2,690,056	2,690,056	7	0	
Pediatric-Intensive General Acute Hospitals	16,965,702	49,699,339	32,733,637	2	0	
Medium Pediatric Intensive General Acute Hospitals	40,774,357	103,984,438	63,210,081	5	1	
Short Term Specialty Hospital	-	3,043,394	3,043,394	4	0	
High Medicare/Out-of State Patient Utilization Hospital	-	2,601,196	2,601,196	1	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	233,009,279	640,474,275	407,464,996	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/Out-of State Patient Utilization Hospitals are Hospitals in which on average at least 15 percent of the
Inpatients are from outside of Arizona and at least 50 percent of the Inpatient Discharges are for Medicare beneficiaries. (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	3,344,171	7,843,424	4,499,253	
30002	BANNER GOOD SAM MEDICAL C	Urban Acute Provider	Banner Health	10,247,165	41,238,615	30,991,450	
30010	CARONDELET ST MARYS HOSP	Urban Acute Provider	Carondelet Health Network	4,159,182	16,685,352	12,526,170	
30011	CARONDELET ST JOSEPHS-TUC	Urban Acute Provider	Carondelet Health Network	6,493,503	13,086,850	6,593,348	
30014	JOHN C. LINCOLN HOS N MTN	Urban Acute Provider	John C. Lincoln Health Network	5,580,196	18,621,862	13,041,667	
30024	ST JOSEPH'S HOSPITAL-PHX	Urban Acute Provider	Dignity	10,485,263	42,717,665	32,232,403	
30030	PHOENIX BAPTIST HOSPITAL	Urban Acute Provider	Abrazo Health Care	5,992,648	16,189,101	10,196,453	
30036	CHANDLER REGIONAL MED.CTR	Urban Acute Provider	Dignity	8,734,053	12,964,038	4,229,985	
30037	TEMPE ST. LUKE'S HOSPITAL	Urban Acute Provider	Iasis Healthcare Corporation	4,650,615	15,804,152	11,153,537	
30038	SCOTTSDALE HLTHCARE-OSBN	Urban Acute Provider	Scottsdale Healthcare	5,826,521	14,652,843	8,826,322	
30061	BANNER BOSWELL MED CTR	Urban Acute Provider	Banner Health	3,200,959	6,701,067	3,500,109	
30083	PARADISE VALLEY HOSPITAL	Urban Acute Provider	Abrazo Health Care	3,783,993	6,513,058	2,729,066	
30085	NORTHWEST MEDICAL CENTER	Urban Acute Provider	CHS	8,635,396	10,068,188	1,432,792	
30088	BANNER BAYWOOD MEDICAL CN	Urban Acute Provider	Banner Health	4,486,052	8,751,730	4,265,678	
30092	JOHN C LINCOLN-DEER VLLY	Urban Acute Provider	John C. Lincoln Health Network	4,830,399	12,420,280	7,589,881	
30093	BANNER DEL E WEBB MED CTR	Urban Acute Provider	Banner Health	4,699,500	7,210,771	2,511,271	
30094	ARROWHEAD HOSPITAL	Urban Acute Provider	Abrazo Health Care	6,657,154	7,548,330	891,177	
30110	WEST VALLEY HOSPITAL MED	Urban Acute Provider	Abrazo Health Care	5,520,365	10,059,355	4,538,990	
30111	UNIVERSITY PHYSICIAN HC	Urban Acute Provider	UA Healthcare	2,522,641	12,340,838	9,818,197	
30114	ORO VALLEY HOSPITAL	Urban Acute Provider	CHS	1,722,369	2,130,981	408,612	
30115	BANNER ESTRELLA MEDICAL	Urban Acute Provider	Banner Health	8,215,306	14,834,326	6,619,020	
30119	MERCY GILBERT MED CENTER	Urban Acute Provider	Dignity	7,375,126	9,917,341	2,542,216	
30120	GILBERT HOSPITAL, L.L.C.	Urban Acute Provider	Gilbert Hospital	957,933	2,493,933	1,536,001	
30121	MOUNTAIN VISTA MED CTR	Urban Acute Provider	Iasis Healthcare Corporation	4,675,729	13,107,254	8,431,525	
30122	BANNER GATEWAY MEDICAL CT	Urban Acute Provider	Banner Health	7,279,014	7,322,337	43,323	
30123	SCOTTSDALE HLTHCARE-THOMP	Urban Acute Provider	Scottsdale Healthcare	1,276,183	2,120,302	844,120	
30130	BANNER IRONWOOD MEDICAL CENTER	Urban Acute Provider	Banner Health	1,152,702	2,093,347	940,645	
30132	FLORENCE HOSPITAL AT ANTHEM	Urban Acute Provider	FLORENCE HOSPITAL AT ANTHEM	429,638	425,078	(4,560)	
30007	VERDE VALLEY MEDICAL CTR.	Non-CAH Rural Acute Provider	N. AZ	1,332,199	5,860,030	4,527,831	
30012	YAVAPAI REG MED CENTER	Non-CAH Rural Acute Provider	Yavapai Regional Medical Center West Cam	2,074,354	5,251,591	3,177,238	
30016	CASA GRANDE REG MED CTR	Non-CAH Rural Acute Provider	Regional Care Services Corporation	3,449,371	8,806,152	5,356,781	
30023	FLAGSTAFF MEDICAL CENTER	Non-CAH Rural Acute Provider	N. AZ	5,773,435	16,858,741	11,085,306	
30033	PAYSON HOSPITAL CORP.	Non-CAH Rural Acute Provider	CHS	738,340	3,955,990	3,217,650	
30043	SIERRA VISTA REG HLTH CTR	Non-CAH Rural Acute Provider	Sierra Vista Regional Health Center	2,084,538	3,564,930	1,480,393	
30055	KINGMAN REGIONAL MED CTR	Non-CAH Rural Acute Provider	Kingman Regional Medical Center	3,084,479	10,616,148	7,531,669	
30062	SUMMIT HEALTHCARE REG.MED	Non-CAH Rural Acute Provider	Summit Healthcare	1,661,902	5,475,007	3,813,105	
30067	LA PAZ REGIONAL HOSPITAL	Non-CAH Rural Acute Provider	La Paz Regional Hospital	225,321	1,095,036	869,715	
30068	MT. GRAHAM REG. MED. CTR.	Non-CAH Rural Acute Provider	Mt. Graham Regional Medical Center	1,010,762	3,007,842	1,997,080	
30069	HAVASU REG MED CENTER LLC	Non-CAH Rural Acute Provider	LifePoint Hospitals, Inc.	1,754,831	6,752,363	4,997,533	
30101	WESTERN AZ REG MED CTR	Non-CAH Rural Acute Provider	CHS	2,187,651	11,723,851	9,536,201	
30117	VALLEY VIEW MEDICAL CENT	Non-CAH Rural Acute Provider	LifePoint Hospitals, Inc.	915,287	3,845,901	2,930,614	
30126	ARIZONA REGIONAL MED. CTR	Non-CAH Rural Acute Provider	Banner Health	246,962	4,211,074	3,964,112	

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	
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	124,754	391,788	267,034	
31301	BENSON HOSPITAL	CAH	Benson Hospital	103,113	614,154	511,041	
31302	NORTHERN COCHISE HOSPITAL	CAH	Northern Cochise Community Hospital	184,585	738,469	553,884	
31303	SOUTHEAST MEDICAL CENTER	CAH	Southeast Arizona Medical Center	133,029	1,019,029	886,000	
31304	PAGE HOSPITAL	CAH	Banner Health	275,605	1,311,345	1,035,740	
31311	LITTLE COLORADO MED CTR	CAH	N. AZ	681,055	2,135,945	1,454,890	
31312	COPPER QUEEN HOSPITAL	CAH	Copper Queen Community Hospital	154,670	1,402,282	1,247,612	
31313	HOLY CROSS HOSPITAL-ARIZ	CAH	Carondelet Health Network	854,820	2,061,146	1,206,327	
31314	COBRE VALLEY COMM HOSP	CAH	Cobre Valley Regional Medical Center	640,956	2,399,296	1,758,340	
31315	WHITE MNTN REG MED CNTR	CAH	White Mountain Regional Medical Center	141,303	594,273	452,970	
32000	KINDRED HOSP AZ-NORTHWEST	LTAC Provider	Kindred Healthcare, Inc.	24,525	925,433	900,908	
32001	SELECT SPECIALTY HOSP-PHX	LTAC Provider	Select Specialty Hospital, Arizona, Inc.	39,016	2,008,178	1,969,162	
32002	KINDRED HOSPITAL-TUCSON	LTAC Provider	Kindred Healthcare, Inc.	34,398	355,826	321,428	
32004	CORNERSTONE HOSPITAL OF S	LTAC Provider	Cornerstone Healthcare Group	12,422	169,897	157,476	
32005	SELECT SPECIALTY-PHX D/T	LTAC Provider	Select Specialty Hospital, Arizona, Inc.	59,082	898,424	839,343	
32006	PROMISE HOSPITAL OF PHX	LTAC Provider	Promise Healthcare	19,906	834,365	814,459	
32007	RESTORA MESA	LTAC Provider	Restora	30,258	504,006	473,749	
32008	SUN CITY	LTAC Provider	Restora	11,785	53,433	41,649	
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	618,686	2,699,220	2,080,533	
34013	ST LUKE'S BEHAVORIAL HOSP	Large Psychiatric Provider	Iasis Healthcare Corporation	769,974	6,035,463	5,265,490	
34022	SONORA BEHAVIORAL HEALTH	Large Psychiatric Provider	SONORA BEHAVIORAL HEALTH	336,973	1,790,197	1,453,224	
34024	AURORA BEHAVIORAL HEALTH	Large Psychiatric Provider	Aurora Behavioral Health System	545,113	3,464,496	2,919,383	
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	7,951,163	31,431,078	23,479,915	
30065	BANNER DESERT MEDICAL CEN	Pediatric-Intensive General Acute Hospitals	Banner Health	9,014,539	18,268,261	9,253,722	
30006	TUCSON MEDICAL CENTER	Medium Pediatric Intensive General Acute Hospitals	TMC Healthcare	9,087,615	18,317,245	9,229,631	

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	
30013	YUMA REGIONAL MED CENTER	Medium Pediatric Intensive General Acute Hospitals	Yuma Regional Medical Center	3,446,237	13,101,926	9,655,689	
30022	MARICOPA MEDICAL CENTER	Medium Pediatric Intensive General Acute Hospitals	MIHS	9,210,238	44,075,468	34,865,231	
30087	SCOTTSDALE HEALTHCARE - SHEA	Medium Pediatric Intensive General Acute Hospitals	Scottsdale Healthcare	7,761,908	6,709,513	(1,052,395)	
30089	BANNER THUNDERBIRD MEDICA	Medium Pediatric Intensive General Acute Hospitals	Banner Health	9,488,253	18,193,083	8,704,831	
30118	YRMC EAST	Medium Pediatric Intensive General Acute Hospitals	Yavapai Regional Medical Center West Cam	1,780,107	3,587,203	1,807,096	
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	-	
30103	MAYO CLINIC HOSPITAL	High Medicare/Out-of State Patient Utilization Hospital  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	233,009,279	640,474,275	407,464,996	

State Share of Coverage Payments			
232,962,600	
Assessment Net of State Share:			46,679	

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	25,298,329 	48,153,268 	22,854,939	
Arizona Spine and Joint Hospital	- 	16,264 	16,264	
Aurora Behavioral Health System	545,113 	3,464,496 	2,919,383	
Banner Health	58,924,740 	134,803,751 	75,879,010	
Benson Hospital	103,113 	614,154 	511,041	
Cancer Treatment Centers of America - Western Regional Medical Cen	- 	- 	-	
Carondelet Health Network	11,507,505 	31,833,349 	20,325,844	
CHS	13,283,755 	27,879,010 	14,595,255	
Cobre Valley Regional Medical Center	640,956 	2,399,296 	1,758,340	
Community Counseling Centers, Inc at PineView Hospital	- 	416,158 	416,158	
Copper Queen Community Hospital	154,670 	1,402,282 	1,247,612	
Cornerstone Healthcare Group	12,422 	169,897 	157,476	
Dignity	26,594,441 	65,599,044 	39,004,603	
Ernest Health, Inc.	- 	525,448 	525,448	
FLORENCE HOSPITAL AT ANTHEM	429,638 	425,078 	(4,560)	
FREEDOM PAIN HOSPITAL	- 	- 	-	
Gilbert Hospital	957,933 	2,493,933 	1,536,001	
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	10,096,317 	34,946,869 	24,850,552	
John C. Lincoln Health Network	10,410,594 	31,042,142 	20,631,548	
Kindred Healthcare, Inc.	58,923 	1,281,259 	1,222,336	
Kingman Regional Medical Center	3,084,479 	10,616,148 	7,531,669	
La Paz Regional Hospital	225,321 	1,095,036 	869,715	
LifePoint Hospitals, Inc.	2,670,118 	10,598,265 	7,928,147	
Mayo	- 	2,601,196 	2,601,196	
MIHS	9,210,238 	44,075,468 	34,865,231	
Mt. Graham Regional Medical Center	1,010,762 	3,007,842 	1,997,080	
N. AZ	7,786,689 	24,854,715 	17,068,027	
Northern Cochise Community Hospital	184,585 	738,469 	553,884	
O.A.S.I.S. hospital, Partners are CHW and United Surgical Partners In	- 	- 	-	
Orthopedic & Surgical Specialty Company	- 	921,024 	921,024	
Phoenix Children's Hospital	- 	1,261,156 	1,261,156	
Promise Healthcare	19,906 	834,365 	814,459	
Regional Care Services Corporation	3,449,371 	8,806,152 	5,356,781	
Remuda Ranch Center for Anorexia and bulimia	- 	- 	-	
Restora	42,042 	557,440 	515,398	
Scottsdale Healthcare	14,864,612 	23,482,657 	8,618,046	
Select Specialty Hospital, Arizona, Inc.	98,098 	2,906,603 	2,808,505	
Sierra Vista Regional Health Center	2,084,538 	3,564,930 	1,480,393	
SONORA BEHAVIORAL HEALTH	336,973 	1,790,197 	1,453,224	
Southeast Arizona Medical Center	133,029 	1,019,029 	886,000	
State of Arizona	- 	520,267 	520,267	
Summit Healthcare	1,661,902 	5,475,007 	3,813,105	
Surgical Specialty Hospital of Arizona	- 	137,530 	137,530	
The Guidance Center, Inc.	- 	454,168 	454,168	

	
Estimated Hospital Net Gain/Loss - SFY 2015	

Hospital System	
Assessment Amount	
Total Projected
Coverage Payments	
Estimated Net
Gain/Loss	
TMC Healthcare	9,087,615 	18,317,245 	9,229,631	
UA Healthcare	10,473,805 	43,771,916 	33,298,112	
VALLEY HOSPITAL	- 	69,190 	69,190	
White Mountain Regional Medical Center	141,303 	594,273 	452,970	
Wickenburg Community Hospital	124,754 	391,788 	267,034	
WINDHAVEN PSYCHIATRIC HOS	- 	960,150 	960,150	
Yavapai Regional Medical Center West Campus	3,854,461 	8,838,794 	4,984,334	
Yuma Regional Medical Center	3,446,237 	13,101,926 	9,655,689	

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	233,009,279	640,474,275	407,464,996	

State Share of Coverage Payments			
232,962,600	
Assessment Net of State Share:			46,679