Worksheet A-7 Parts I, II & III

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FORM CMS-2552-10
INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV 1

MEDICAL UNIVERSITY OF SOUTH CAROLINA - CHARLESTON, SC
Cost report status - As Submitted
[Record Code 741780 - 2010]
This is a prior filing for this period.

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RECONCILIATION OF CAPITAL COSTS CENTERS Provider CCN: 420004
PERIOD:
FROM 07/01/2021
TO 06/30/2022
WORKSHEET A-7,
PARTS I, II & III
PART I - ANALYSIS OF CHANGES IN CAPITAL ASSET BALANCES
Description Beginning Balances Acquisitions Disposals and Retirements Ending Balance Fully Depreciated Assets  
Purchases Donation Total
1 2 3 4 5 6 7
1 Land ### ### 1
2 Land Improvements ### ### ### ### 2
3 Buildings and Fixtures ### ### ### ### ### 3
4 Building Improvements ### ### ### 4
5 Fixed Equipment ### ### ### ### ### 5
6 Movable Equipment ### ### ### ### ### 6
7 HIT-designated Assets ### ### 7
8 Subtotal (sum of lines 1-7) ### ### ### ### ### 8
9 Reconciling Items 9
10 Total (line 7 minus line 9) ### ### ### ### ### 10
PART II - RECONCILIATION OF AMOUNTS FROM WORKSHEET A, COLUMN 2, LINES 1 AND 2
Description SUMMARY OF CAPITAL  
Depreciation Lease Interest Insurance (see instructions) Taxes (see instructions) Other Capital- Related Costs (see instructions) Total (1) (sum of cols. 9 through 14)
      9 10 11 12 13 14 15
1 Capital Related Costs-Buildings and Fixtures 1
2 Capital Related Costs-Movable Equipment 2
3 Total (sum of lines 1-2) 3
(1) The amount in columns 9 through 14 must equal the amount on Worksheet A, column 2, lines 1 and 2. Enter in each column the appropriate amounts including any directly assigned cost that may have been included in Worksheet A, column 2, lines 1 and 2. All lines numbers are to be consistent with Worksheet A line numbers for capital cost centers.
PART III - RECONCILIATION OF CAPITAL COSTS CENTERS
Description COMPUTATION OF RATIOS ALLOCATION OF OTHER CAPITAL  
Gross Assets Capitalized Leases Gross Assets for Ratio (col. 1 - col. 2) Ratio (see instructions) Insurance Taxes Other Capital- Related Costs Total (sum of cols. 5 through 7)  
1 2 3 4 5 6 7 8  
1 Capital Related Costs-Buildings and Fixtures 1
2 Capital Related Costs-Movable Equipment 2
3 Total (sum of lines 1-2) 1.000000 3
Description SUMMARY OF CAPITAL  
Depreciation Lease Interest Insurance (see instructions) Taxes (see instructions) Other Capital- Related Costs (see instructions) Total (2) (sum of cols. 9 through 14)
9 10 11 12 13 14 15
1 Capital Related Costs-Buildings and Fixtures ### ### ### ### ### 1
2 Capital Related Costs-Movable Equipment ### ### ### ### ### 2
3 Total (sum of lines 1-2) ### ### ### ### ### 3
(2) The amounts on lines 1 and 2 must equal the corresponding amounts on Worksheet A, column 7, lines 1 and 2. Columns 9 through 14 should include related Worksheet A-6 reclassifications, Worksheet A-8 adjustments, and Worksheet A-8-1 related organizations and home office costs. (See instructions.)
FORM CMS-2552-10 (08/2011) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTIONS 4015)
10-12   Rev. 3