FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION. $25,000 Radiology Service Added

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1 FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION FACILITY: Example Facility For Change in Scope of Services PID # XXXXXXXX $25,000 Radiology Service Added Cost Reporting Period: 1999 and 2000 with inflation to 2005 and Change of Scope Rate Period : 1/1/05-12/31/05 1. Cost of FQHC Services (Excluding Overhead) MEDICARE 2. Cost Other Than FQHC Services (Excluding Overhead) MEDICARE 3. Cost of All Services (Excluding Overhead) - [Sum of Lines 1 and 2.] 4. Percentage of FQHC Services (Excluding Overhead) [Line 1 Divided by Line 3.] MEDICARE 5. Total Overhead 6. Overhead Applicable to FQHC Services [Multiply Line 4 X Line 5.] MEDICARE 7. Total Cost of FQHC Services [Sum of Line 1 and Line 6.] MEDICARE 8. Total Actual Visits. Includes Medicaid Only Service Encounters Except Dental Encounters 9. Cost Per Visit (Excluding Medicaid Only Services) [Line 7 Divided by Line 8.] 10. Cost from Line 2 to be covered by Medicaid. [Excluding Dental Cost to be Reported on Line D1 Below.] Rate COS Rate Computation Computation $2,796,670 $2,796,670 $312,376 Plus COS*2 $362,376 $3,109,046 $3,159, % % $824,856 No Change $824,856 $741,980 $730,236 $3,538,650 $3,526,906 34,170 No Change 34,170 $ $ $240,642 $290, Additional Overhead Applicable to Services Other Than FQHC Services to be Covered by Medicaid [(Line 10 Divided by Line 2) X (Line 5 Minus Line 6).] 12. Total Cost for Medicaid Add On [Sum of Lines 10 and 11.] 13. Total Actual Visits [Same as Line 8.] 14. Medicaid Add On Amount [Line 12 Divided by Line 13.] $63,844 $75,889 $304,486 $366,531 34,170 34,170 $8.91 $ Medicaid Payment Rate Including Add On Amount [Sum of Lines 9 and 14.] $ $ D1. Cost of FQHC Dental Services [W/S A, Line 52. Col. 7.] D2. Overhead Cost of FQHC Dental Services. [(Line D1 Divided by Line 2)X(Line 5 Minus Line 6).] D3. Total Cost of FQHC Dental Services. [Sum of Lines D1 and D2.] D4. Dental Encounters. [Per Provider] D5. FQHC Dental Cost Per Visit. [Line D3 Divided by Line D4.] 0 0 $0 $0 $0 $0 0 0 $0.00 $0.00 N1. Cost of Non-FQHC Services - Direct [Line 2 Minus Line 10 Minus D1] $71,734 $71,734 N2. Overhead Cost of Non-FQHC Services [(Line N1 Divided by Line 2)X(Line 5 Minus Line 6).] $19,032 $18,730 N3. Total Cost of Non-FQHC Services. $90,766 $90,464 04/20/2009 PJK

2 FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION FACILITY: Example Facility For Change in Scope of Services PID # xxxxxxxx Cost Reporting Period: PPS 2005 Adjusted for net change in MEI Plus 4% Rate Period : 8/01/05-12/31/05 1. Medicaid PPS Rate 2005 with Change of Scope Adjutment Impact. $ Alternative Payment Method II Percentage Alternative Payment Method II Rate $ D1. Medicaid PPS Dental Rate $0.00 D4. Alternative Payment Method II Percentage D5. Alternative Payment Method II Rate $0.00 Minnesota Medicaid FQHC Rate Computation Example /20/2009 PJK

3 FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION FACILITY: Example Facility For Change in Scope of Services PID # xxxxxxxx Cost Reporting Period: PPS 2005 Adjusted for net change in MEI Plus 2% Rate Period : 1/01/06-12/31/06 1. Medicaid PPS Rate $ Net change in MEI for [Percent] PPS Rate [Line 1. X (1+ Line 2.)] $ Alternative Payment Method II Percentage Alternative Payment Method II Rate $ D1. Medicaid PPS Dental Rate $0.00 D2. Net change in MEI for [Percent] D3. PPS Dental Rate $0.00 D4. Alternative Payment Method II Percentage D5. Alternative Payment Method II Rate $0.00 Minnesota Medicaid FQHC Rate Computation Rev /20/2009

4 FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION FACILITY: Example Facility For Change in Scope of Services PID # xxxxxxxx Cost Reporting Period: PPS 2006 Adjusted for net change in MEI Plus 2% Rate Period : 1/01/07-12/31/07 1. Medicaid PPS Rate $ Net change in MEI for [Percent] PPS Rate [Line 1. X (1+ Line 2.)] $ Alternative Payment Method II Percentage Alternative Payment Method II Rate $ D1. Medicaid PPS Dental Rate $0.00 D2. Net change in MEI for [Percent] D3. PPS Dental Rate $0.00 D4. Alternative Payment Method II Percentage D5. Alternative Payment Method II Rate $0.00 Minnesota Medicaid FQHC Rate Computation Rev /20/2009

5 FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION FACILITY: Example Facility For Change in Scope of Services PID # xxxxxxxx Cost Reporting Period: PPS 2007 Adjusted for net change in MEI Plus 2% Rate Period : 1/01/08-12/31/08 1. Medicaid PPS Rate $ Net change in MEI for [Percent] PPS Rate [Line 1. X (1+ Line 2.)] $ Alternative Payment Method II Percentage Alternative Payment Method II Rate $ D1. Medicaid PPS Dental Rate $0.00 D2. Net change in MEI for [Percent] D3. PPS Dental Rate $0.00 D4. Alternative Payment Method II Percentage D5. Alternative Payment Method II Rate $0.00 Minnesota Medicaid FQHC Rate Computation Rev /20/2009

6 FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION FACILITY: Example Facility For Change in Scope of Services PID # xxxxxxxx Cost Reporting Period: PPS 2008 Adjusted for net change in MEI Plus 2% Rate Period : 1/01/09-12/31/09 1. Medicaid PPS Rate $ Net change in MEI for [Percent] PPS Rate [Line 1. X (1+ Line 2.)] $ Alternative Payment Method II Percentage Alternative Payment Method II Rate $ D1. Medicaid PPS Dental Rate $0.00 D2. Net change in MEI for [Percent] D3. PPS Dental Rate $0.00 D4. Alternative Payment Method II Percentage D5. Alternative Payment Method II Rate $0.00 Minnesota Medicaid FQHC Rate Computation Rev /20/2009

7 FEDERALLY QUALIFIED HEALTH CENTER MEDICAID PAYMENT RATES COMPUTATION FACILITY: Example Facility For Change in Scope of Services PID # xxxxxxxx Cost Reporting Period: PPS 2009 Adjusted for net change in MEI Plus 2% Rate Period : 1/01/10-12/31/10 1. Medicaid PPS Rate $ Net change in MEI for [Percent] PPS Rate [Line 1. X (1+ Line 2.)] $ Alternative Payment Method II Percentage Alternative Payment Method II Rate $ D1. Medicaid PPS Dental Rate $0.00 D2. Net change in MEI for [Percent] D3. PPS Dental Rate $0.00 D4. Alternative Payment Method II Percentage D5. Alternative Payment Method II Rate $0.00 Minnesota Medicaid FQHC Rate Computation Rev

8 FACILITY: Example Facility For Change in Scope of Services Occuring in 2005 PID # : EXAMPLE COST REPORTING PERIOD: 1999 Line MA ADJUST MA RECLASS 7 REVISED MA Reason Line 1 $613,000 $115,000 $728,000 $728,000 $728,000 $728, $103,000 $103,000 $103,000 $103,000 $103, $216,000 $216,000 $216,000 $216,000 $216, $0 $0 $0 $0 4 5 $76,000 $76,000 ($18,000) $58,000 ($10,000) $48,000 $48, $0 $0 $0 $0 6 7 $0 $0 $0 $0 7 8 $38,000 $38,000 ($38,000) $0 $0 $0 8 9 $9,000 $9,000 $9,000 $9,000 $9, $11,000 $11,000 $11,000 $11,000 $11, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $1,066,000 $115,000 $1,181,000 ($56,000) $1,125,000 ($10,000) $1,115,000 $0 $0 $1,115, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $89,000 $89,000 ($46,000) $43,000 $43,000 $43, $0 $0 $0 $ $17,000 $17,000 ($17,000) $0 $0 $ $5,000 $5,000 $5,000 $5,000 $5, $5,000 $5,000 $5,000 $5,000 $5, $11,000 $11,000 $11,000 $11,000 $11, $11,000 $11,000 ($11,000) $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $138,000 $138,000 ($74,000) $64,000 $0 $64,000 $0 $0 $64, $1,066,000 $253,000 $1,319,000 ($130,000) $1,189,000 ($10,000) $1,179,000 $0 $0 $1,179, $23,000 $23,000 $23,000 ($23,000) $0 $ $10,000 $10,000 $10,000 $10,000 $10, $21,000 $21,000 $21,000 $21,000 $21, $9,000 $9,000 $9,000 $9,000 $9, $0 $0 $0 $ $4,000 $4,000 $4,000 $4,000 $4, $8,000 $8,000 $8,000 $8,000 $8, $0 $0 $0 $ $11,000 $11,000 $11,000 $11,000 $11, $2,000 $2,000 $2,000 $2,000 $2, $0 $0 $0 $ $11,000 $77,000 $88,000 $0 $88,000 ($23,000) $65,000 $0 $0 $65, /06/2010 PJK

9 FACILITY: Example Facility For Change in Scope of Services Occuring in 2005 PID # : EXAMPLE COST REPORTING PERIOD: 1999 Line MA ADJUST MA RECLASS 7 REVISED MA Reason Line 38 $124,000 $124,000 $124,000 ($10,000) $114,000 $114, $13,000 $13,000 $13,000 $13,000 $13, $11,000 $11,000 $11,000 $11,000 $11, $0 $0 $0 $ $3,000 $3,000 $3,000 $3,000 $3, $2,000 $2,000 $2,000 $2,000 $2, $13,000 $13,000 $13,000 $13,000 $13, $80,000 $80,000 $80,000 $80,000 $80, $9,000 $9,000 $9,000 $9,000 $9, $7,000 $7,000 $7,000 $7,000 $7, $20,000 $4,000 $24,000 $24,000 $24,000 $24, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $144,000 $142,000 $286,000 $0 $286,000 ($10,000) $276,000 $0 $0 $276, $155,000 $219,000 $374,000 $0 $374,000 ($33,000) $341,000 $0 $0 $341, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $20,000 $20,000 $20,000 $20, $0 $110,000 $110,000 $110,000 $110, $0 $0 $0 $ $0 $0 $0 $130,000 $130,000 $0 $130,000 $0 $0 $130, $7,000 $7,000 $7,000 ($7,000) $0 $ $40,000 $40,000 $40,000 ($40,000) $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $47,000 $47,000 $0 $47,000 ($47,000) $0 $0 $0 $ $1,221,000 $519,000 $1,740,000 $0 $1,740,000 ($90,000) $1,650,000 $0 $0 $1,650, /06/2010 PJK

10 FACILITY: Example Facility For Change in Scope of Services Occuring in 2005 PID # : EXAMPLE COST REPORTING PERIOD: 2000 Line MA ADJUST MA RECLASS 7 REVISED MA Reason Line 1 $654,000 $115,000 $769,000 $769,000 ($3,000) $766,000 $766, $141,000 $141,000 $141,000 ($3,000) $138,000 $138, $200,000 $200,000 $200,000 $200,000 $200, $0 $0 $0 $0 4 5 $83,000 $83,000 ($18,000) $65,000 ($4,000) $61,000 $61, $0 $0 $0 $0 6 7 $0 $0 $0 $0 7 8 $40,000 $40,000 ($40,000) $0 $0 $0 8 9 $10,000 $10,000 $10,000 $10,000 $10, $7,000 $7,000 $7,000 $7,000 $7, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $1,135,000 $115,000 $1,250,000 ($58,000) $1,192,000 ($10,000) $1,182,000 $0 $0 $1,182, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $100,000 $100,000 ($64,000) $36,000 $36,000 $36, $0 $0 $0 $ $10,000 $10,000 ($10,000) $0 $0 $ $4,000 $4,000 $4,000 $4,000 $4, $5,000 $5,000 $5,000 $5,000 $5, $11,000 $11,000 $11,000 $11,000 $11, $8,000 $8,000 ($8,000) $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $138,000 $138,000 ($82,000) $56,000 $0 $56,000 $0 $0 $56, $1,135,000 $253,000 $1,388,000 ($140,000) $1,248,000 ($10,000) $1,238,000 $0 $0 $1,238, $24,000 $24,000 $24,000 ($8,000) $16,000 $16, $10,000 $10,000 $10,000 $10,000 $10, $23,000 $23,000 $23,000 $23,000 $23, $7,000 $7,000 $7,000 $7,000 $7, $0 $0 $0 $ $4,000 $4,000 $4,000 $4,000 $4, $5,000 $5,000 $5,000 $5,000 $5, $0 $0 $0 $ $12,000 $12,000 $12,000 $12,000 $12, $2,000 $2,000 $2,000 $2,000 $2, $0 $0 $0 $ $12,000 $75,000 $87,000 $0 $87,000 ($8,000) $79,000 $0 $0 $79, /06/2010 PJK

11 FACILITY: Example Facility For Change in Scope of Services Occuring in 2005 PID # : EXAMPLE COST REPORTING PERIOD: 2000 Line MA ADJUST MA RECLASS 7 REVISED MA Reason Line 38 $127,000 $127,000 $127,000 ($4,000) $123,000 $123, $8,000 $8,000 $8,000 $8,000 $8, $9,000 $9,000 $9,000 $9,000 $9, $0 $0 $0 $ $3,000 $3,000 $3,000 $3,000 $3, $2,000 $2,000 $2,000 $2,000 $2, $11,000 $11,000 $11,000 $11,000 $11, $97,000 $97,000 $97,000 $97,000 $97, $8,000 $8,000 $8,000 $8,000 $8, $6,000 $6,000 $6,000 $6,000 $6, $22,000 $4,000 $26,000 $26,000 $26,000 $26, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $149,000 $148,000 $297,000 $0 $297,000 ($4,000) $293,000 $0 $0 $293, $161,000 $223,000 $384,000 $0 $384,000 ($12,000) $372,000 $0 $0 $372, $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $18,000 $18,000 $18,000 $18, $0 $122,000 $122,000 $122,000 $122, $0 $0 $0 $ $0 $0 $0 $140,000 $140,000 $0 $140,000 $0 $0 $140, $6,000 $6,000 $6,000 ($6,000) $0 $ $18,000 $18,000 $18,000 ($18,000) $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $0 $0 $ $0 $24,000 $24,000 $0 $24,000 ($24,000) $0 $0 $0 $ $1,296,000 $500,000 $1,796,000 $0 $1,796,000 ($46,000) $1,750,000 $0 $0 $1,750, /06/2010 PJK

12 FACILITY: Example Facility For Change in Scope of Services Occuring in 2005 PID # : EXAMPLE PPS Rate Computation COST REPORTING PERIOD: 1999 and 2000 combined with inflation Line MA ADJUST MA RECLASS 7 REVISED Line 1 $1,307,528 $237,427 $1,544,955 $0 $1,544,955 ($3,069) $1,541,887 $0 $0 $1,541, $251,520 $0 $251,520 $0 $251,520 ($3,069) $248,452 $0 $0 $248, $429,585 $0 $429,585 $0 $429,585 $0 $429,585 $0 $0 $429, $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 4 5 $164,068 $0 $164,068 ($37,163) $126,906 ($14,509) $112,397 $0 $0 $112, $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 6 7 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 7 8 $80,500 $0 $80,500 ($80,500) $0 $0 $0 $0 $0 $0 8 9 $19,604 $0 $19,604 $0 $19,604 $0 $19,604 $0 $0 $19, $18,619 $0 $18,619 $0 $18,619 $0 $18,619 $0 $0 $18, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $2,271,425 $237,427 $2,508,852 ($117,662) $2,391,189 ($20,646) $2,370,544 $0 $0 $2,370, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $194,999 $194,999 ($113,382) $81,617 $0 $81,617 $0 $0 $81, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $27,938 $27,938 ($27,938) $0 $0 $0 $0 $0 $ $0 $9,300 $9,300 $0 $9,300 $0 $9,300 $0 $0 $9, $0 $10,323 $10,323 $0 $10,323 $0 $10,323 $0 $0 $10, $0 $22,710 $22,710 $0 $22,710 $0 $22,710 $0 $0 $22, $0 $19,642 $19,642 ($19,642) $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $284,913 $284,913 ($160,962) $123,951 $0 $123,951 $0 $0 $123, $2,271,425 $522,340 $2,793,765 ($278,625) $2,515,140 ($20,646) $2,494,494 $0 $0 $2,494, $0 $48,508 $48,508 $0 $48,508 ($32,143) $16,365 $0 $0 $16, $0 $20,646 $20,646 $0 $20,646 $0 $20,646 $0 $0 $20, $0 $45,402 $45,402 $0 $45,402 $0 $45,402 $0 $0 $45, $0 $16,536 $16,536 $0 $16,536 $0 $16,536 $0 $0 $16, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $8,258 $8,258 $0 $8,258 $0 $8,258 $0 $0 $8, $0 $13,448 $13,448 $0 $13,448 $0 $13,448 $0 $0 $13, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $23,733 $0 $23,733 $0 $23,733 $0 $23,733 $0 $0 $23, $0 $4,129 $4,129 $0 $4,129 $0 $4,129 $0 $0 $4, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $23,733 $156,927 $180,661 $0 $180,661 ($32,143) $148,518 $0 $0 $148, /06/2010 PJK

13 FACILITY: Example Facility For Change in Scope of Services Occuring in 2005 PID # : EXAMPLE PPS Rate Computation COST REPORTING PERIOD: 1999 and 2000 combined with inflation Line MA ADJUST MA RECLASS 7 REVISED Line 38 $259,077 $0 $259,077 $0 $259,077 ($14,509) $244,568 $0 $0 $244, $0 $21,725 $21,725 $0 $21,725 $0 $21,725 $0 $0 $21, $0 $20,665 $20,665 $0 $20,665 $0 $20,665 $0 $0 $20, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $6,194 $6,194 $0 $6,194 $0 $6,194 $0 $0 $6, $0 $4,129 $4,129 $0 $4,129 $0 $4,129 $0 $0 $4, $0 $24,794 $24,794 $0 $24,794 $0 $24,794 $0 $0 $24, $0 $182,555 $182,555 $0 $182,555 $0 $182,555 $0 $0 $182, $0 $17,558 $17,558 $0 $17,558 $0 $17,558 $0 $0 $17, $0 $13,429 $13,429 $0 $13,429 $0 $13,429 $0 $0 $13, $43,337 $8,258 $51,596 $0 $51,596 $0 $51,596 $0 $0 $51, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $302,415 $299,308 $601,723 $0 $601,723 ($14,509) $587,214 $0 $0 $587, $326,148 $456,236 $782,384 $0 $782,384 ($46,652) $735,732 $0 $0 $735, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $39,246 $39,246 $0 $39,246 $0 $0 $39, $0 $0 $0 $239,379 $239,379 $0 $239,379 $0 $0 $239, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $278,625 $278,625 $0 $278,625 $0 $0 $278, $0 $13,429 $13,429 $0 $13,429 ($13,429) $0 $0 $0 $ $0 $60,081 $60,081 $0 $60,081 ($60,081) $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $73,510 $73,510 $0 $73,510 ($73,510) $0 $0 $0 $ $2,597,572 $1,052,086 $3,649,659 ($0) $3,649,659 ($140,808) $3,508,851 $0 $0 $3,508, /06/2010 PJK

14 FACILITY: Example Facility For Change in Scope of Services Occuring in 2005 PID # : EXAMPLE PPS Rate Computation COST REPORTING PERIOD: 1999 and 2000 combined with inflation to 2005 Line MA ADJUST MA RECLASS 7 REVISED Line 1 $1,465,917 $266,189 $1,732,106 $0 $1,732,106 ($3,440) $1,728,666 $0 $0 $1,728, $281,988 $0 $281,988 $0 $281,988 ($3,440) $278,548 $0 $0 $278, $481,624 $0 $481,624 $0 $481,624 $0 $481,624 $0 $0 $481, $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 4 5 $183,943 $0 $183,943 ($41,664) $142,279 ($16,266) $126,012 $0 $0 $126, $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 6 7 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 7 8 $90,251 $0 $90,251 ($90,251) $0 $0 $0 $0 $0 $0 8 9 $21,979 $0 $21,979 $0 $21,979 $0 $21,979 $0 $0 $21, $20,875 $0 $20,875 $0 $20,875 $0 $20,875 $0 $0 $20, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $2,546,578 $266,189 $2,812,766 ($131,916) $2,680,851 ($23,147) $2,657,704 $0 $0 $2,657, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $218,621 $218,621 ($127,117) $91,504 $0 $91,504 $0 $0 $91, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $31,322 $31,322 ($31,322) $0 $0 $0 $0 $0 $ $0 $10,427 $10,427 $0 $10,427 $0 $10,427 $0 $0 $10, $0 $11,573 $11,573 $0 $11,573 $0 $11,573 $0 $0 $11, $0 $25,462 $25,462 $0 $25,462 $0 $25,462 $0 $0 $25, $0 $22,021 $22,021 ($22,021) $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $319,426 $319,426 ($180,460) $138,966 $0 $138,966 $0 $0 $138, $2,546,578 $585,615 $3,132,193 ($312,376) $2,819,816 ($23,147) $2,796,670 $0 $0 $2,796, $0 $54,384 $54,384 $0 $54,384 ($36,037) $18,348 $0 $0 $18, $0 $23,147 $23,147 $0 $23,147 $0 $23,147 $0 $0 $23, $0 $50,902 $50,902 $0 $50,902 $0 $50,902 $0 $0 $50, $0 $18,539 $18,539 $0 $18,539 $0 $18,539 $0 $0 $18, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $9,259 $9,259 $0 $9,259 $0 $9,259 $0 $0 $9, $0 $15,077 $15,077 $0 $15,077 $0 $15,077 $0 $0 $15, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $26,608 $0 $26,608 $0 $26,608 $0 $26,608 $0 $0 $26, $0 $4,629 $4,629 $0 $4,629 $0 $4,629 $0 $0 $4, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $26,608 $175,937 $202,545 $0 $202,545 ($36,037) $166,509 $0 $0 $166, pjk 04/20/09

15 38 $290,461 $0 $290,461 $0 $290,461 ($16,266) $274,195 $0 $0 $274, $0 $24,357 $24,357 $0 $24,357 $0 $24,357 $0 $0 $24, $0 $23,168 $23,168 $0 $23,168 $0 $23,168 $0 $0 $23, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $6,944 $6,944 $0 $6,944 $0 $6,944 $0 $0 $6, $0 $4,629 $4,629 $0 $4,629 $0 $4,629 $0 $0 $4, $0 $27,797 $27,797 $0 $27,797 $0 $27,797 $0 $0 $27, $0 $204,669 $204,669 $0 $204,669 $0 $204,669 $0 $0 $204, $0 $19,685 $19,685 $0 $19,685 $0 $19,685 $0 $0 $19, $0 $15,056 $15,056 $0 $15,056 $0 $15,056 $0 $0 $15, $48,587 $9,259 $57,846 $0 $57,846 $0 $57,846 $0 $0 $57, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $339,048 $335,566 $674,614 $0 $674,614 ($16,266) $658,347 $0 $0 $658, $365,656 $511,503 $877,159 $0 $877,159 ($52,303) $824,856 $0 $0 $824, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $44,000 $44,000 $0 $44,000 $0 $0 $44, $0 $0 $0 $268,376 $268,376 $0 $268,376 $0 $0 $268, $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $312,376 $312,376 $0 $312,376 $0 $0 $312, $0 $15,056 $15,056 $0 $15,056 ($15,056) $0 $0 $0 $ $0 $67,359 $67,359 $0 $67,359 ($67,359) $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $0 $0 $0 $0 $0 $0 $0 $0 $ $0 $82,415 $82,415 $0 $82,415 ($82,415) $0 $0 $0 $ $2,912,234 $1,179,533 $4,091,767 ($0) $4,091,767 ($157,865) $3,933,902 $0 $0 $3,933, Total PPS "2001" Costs $3,508,851 Reflect 2002 MEI % % $3,600,081 Reflect 2003 MEI % % $3,708,083 Reflect 2004 MEI % % $3,815,618 Reflect 2005 MEI % % $3,933,902 pjk 04/20/09