Worksheet G-3
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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]
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| STATEMENT OF REVENUES AND EXPENSES | Provider CCN: 420004 | PERIOD: FROM 07/01/2021 TO 06/30/2022 |
WORKSHEET G-3 | ||
| Description | |||||
| 1 | Total patient revenues (from Worksheet G-2, Part I, column 3, line 28) | ### | 1 | ||
| 2 | Less contractual allowances and discounts on patients' accounts | ### | 2 | ||
| 3 | Net patient revenues (line 1 minus line 2) | ### | 3 | ||
| 4 | Less total operating expenses (from Worksheet G-2, Part II, line 43) | ### | 4 | ||
| 5 | Net income from service to patients (line 3 minus line 4) | ### | 5 | ||
| OTHER INCOME | |||||
| 6 | Contributions, donations, bequests, etc | ### | 6 | ||
| 7 | Income from investments | ### | 7 | ||
| 8 | Revenues from telephone and other miscellaneous communication services | 8 | |||
| 9 | Revenue from television and radio service | 9 | |||
| 10 | Purchase discounts | 10 | |||
| 11 | Rebates and refunds of expenses | 11 | |||
| 12 | Parking lot receipts | 12 | |||
| 13 | Revenue from laundry and linen service | 13 | |||
| 14 | Revenue from meals sold to employees and guests | ### | 14 | ||
| 15 | Revenue from rental of living quarters | 15 | |||
| 16 | Revenue from sale of medical and surgical supplies to other than patients | ### | 16 | ||
| 17 | Revenue from sale of drugs to other than patients | ### | 17 | ||
| 18 | Revenue from sale of medical records and abstracts | 18 | |||
| 19 | Tuition (fees, sale of textbooks, uniforms, etc.) | 19 | |||
| 20 | Revenue from gifts, flowers, coffee shops, and canteen | ### | 20 | ||
| 21 | Rental of vending machines | 21 | |||
| 22 | Rental of hospital space | ### | 22 | ||
| 23 | Governmental appropriations | 23 | |||
| 24 | Other (specify) OTHER OPERATING | ### | 24 | ||
| 24.50 | COVID-19 PHE Funding | ### | 24.50 | ||
| 25 | Total other income (sum of lines 6-24) | ### | 25 | ||
| 26 | Total (line 5 plus line 25) | ### | 26 | ||
| 27 | Other expenses (specify) OTHER NON OPERATING | ### | 27 | ||
| 28 | Total other expenses (sum of line 27 and subscripts) | ### | 28 | ||
| 29 | Net income (or loss) for the period (line 26 minus line 28) | ### | 29 | ||
| FORM CMS-2552-10 (01/2022) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 4040) | |||||
| 01-22 | Rev. 17 | ||||