Worksheet A-8-1 Part A

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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.

The data in this report have been replaced because you do not own it or are not logged in.

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STATEMENT OF COSTS OF SERVICES FROM RELATED ORGANIZATIONS AND HOME OFFICE COSTS Provider CCN: 420004
PERIOD:
FROM 07/01/2021
TO 06/30/2022
 WORKSHEET A-8-1
A. COSTS INCURRED AND ADJUSTMENTS REQUIRED AS A RESULT OF TRANSACTIONS WITH RELATED ORGANIZATIONS OR CLAIMED HOME OFFICE COSTS:
  Line No. Cost Center Expense Items Amount of Allowable Cost Amount included in Wkst. A column 5 Net Adjustments (col. 4 minus col. 5) * Wkst. A-7 Ref.  
1 2 3 4 5 6 7
1 ### ### ### ### ### ### 1
2 ### ### ### ### ### 2
3 ### ### ### ### ### 3
4 4
4.01 ### ### ### ### ### 4.01
4.02 ### ### ### ### ### 4.02
4.03 ### ### ### ### ### 4.03
4.04 ### ### ### ### ### 4.04
4.05 ### ### ### ### ### 4.05
4.06 ### ### ### ### ### 4.06
4.07 ### ### ### ### ### 4.07
4.08 ### ### ### ### ### 4.08
4.09 ### ### ### ### ### 4.09
4.10 ### ### ### ### ### 4.10
4.11 ### ### ### ### ### 4.11
4.12 ### ### ### ### ### ### 4.12
4.13 ### ### ### ### ### 4.13
4.14 ### ### ### ### ### 4.14
4.15 ### ### ### ### ### 4.15
4.16 ### ### ### ### ### 4.16
4.17 ### ### ### ### ### 4.17
4.18 ### ### ### ### ### 4.18
4.19 ### ### ### ### ### 4.19
4.20 ### ### ### ### ### 4.20
4.21 ### ### ### ### ### 4.21
4.22 ### ### ### ### ### 4.22
4.23 ### ### ### ### ### 4.23
4.24 ### ### ### ### ### 4.24
4.25 ### ### ### ### ### 4.25
4.26 ### ### ### ### ### 4.26
4.27 ### ### ### ### ### 4.27
4.28 ### ### ### ### ### 4.28
4.29 ### ### ### ### ### 4.29
4.30 ### ### ### ### ### 4.30
4.31 ### ### ### ### ### 4.31
4.32 ### ### ### ### ### 4.32
4.33 ### ### ### ### ### 4.33
4.34 ### ### ### ### ### ### ### 4.34
4.35 ### ### ### ### ### ### ### 4.35
4.36 ### ### ### ### ### ### ### 4.36
4.37 ### ### ### ### ### ### 4.37
4.38 ### ### ### ### ### ### 4.38
4.39 ### ### ### ### ### 4.39
4.40 ### ### ### ### ### ### 4.40
4.41 ### ### ### ### ### 4.41
4.42 ### ### ### ### ### 4.42
4.43 ### ### ### ### ### 4.43
4.44 ### ### ### ### ### ### 4.44
4.45 ### ### ### ### ### 4.45
4.46 ### ### ### ### ### 4.46
4.47 ### ### ### ### ### ### 4.47
4.48 ### ### ### ### ### ### 4.48
4.49 ### ### ### ### ### ### 4.49
4.50 ### ### ### ### ### ### 4.50
4.51 ### ### ### ### ### ### 4.51
4.52 ### ### ### ### ### 4.52
4.53 ### ### ### ### ### ### 4.53
4.54 ### ### ### ### ### 4.54
4.55 ### ### ### ### ### 4.55
4.56 ### ### ### ### ### 4.56
4.57 ### ### ### ### ### 4.57
4.58 ### ### ### ### ### 4.58
4.59 ### ### ### ### ### 4.59
4.60 ### ### ### ### ### 4.60
4.61 ### ### ### ### ### 4.61
4.62 ### ### ### ### ### 4.62
4.63 ### ### ### ### ### 4.63
4.64 ### ### ### ### ### 4.64
4.65 ### ### ### ### ### 4.65
4.66 ### ### ### ### ### 4.66
4.67 ### ### ### ### ### 4.67
4.68 ### ### ### ### ### 4.68
4.69 ### ### ### ### ### 4.69
4.70 ### ### ### ### ### 4.70
4.71 ### ### ### ### ### 4.71
4.72 ### ### ### ### ### 4.72
4.73 ### ### ### ### ### 4.73
4.74 ### ### ### ### ### 4.74
4.75 ### ### ### ### ### 4.75
4.76 ### ### ### ### ### 4.76
4.77 ### ### ### ### ### 4.77
4.78 ### ### ### ### ### 4.78
5 TOTALS (sum of lines 1 through 4) Transfer column 6, line 5, to Worksheet A-8, column 2, line 12. ### ### ###   5
* The amounts on lines 1 through 4 (and subscripts as appropriate) are transferred in detail to Worksheet A, column 6, lines as appropriate. Positive amounts increase cost and negative amounts decrease cost. For related organization or home office cost which have not been posted to Worksheet A, columns 1 and/or 2, the amount allowable should be indicated in column 4 of this part.
FORM CMS-2552-10 (10/2012) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, §4017)
03-18   Rev. 14