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{"sheet":"Legend","index":0,"n_rows":9,"n_cols":3,"rows_kept":9,"cut":false,"hidden":false,"merged":[[38,1,38,2],[1,1,1,8],[2,1,2,8],[3,1,4,8],[29,1,29,2],[30,1,30,2],[31,1,31,2],[33,1,33,2],[34,1,34,2],[35,1,35,2],[26,1,26,2],[27,1,27,2],[37,1,37,2]]}
[]
[null,"2023 Community Health Center Cost Report"]
[null,"Legend"]
[null,"Select your Clinic Name in Tab 1, Cell C8"]
[]
[]
[]
[null,null,"Provider Input (Unlocked)"]
[null,null,"Calculated/Populated/Linked (Locked)"]

{"sheet":"1. Agency Information","index":1,"n_rows":42,"n_cols":9,"rows_kept":42,"cut":false,"hidden":false,"merged":[[1,1,1,5],[2,1,2,5],[3,1,3,5]]}
[]
[null,"Community Health Center Cost Report",null,null,null,null,null,null,"Version 7"]
[null,"Tab 1 - Agency Information"]
[null,{"$f":"C9","v":0}]
[]
[]
[null,"Organization"]
["Line"]
[1,"Provider Name"]
[2,"Federal Employee ID Number (FEIN)"]
[3,"MassHealth Provider ID"]
[4,"Medicare Provider Number:"]
[5,"Mailing Address"]
[6,"City"]
[7,"State"]
[8,"Zip Code"]
[9,"Main Phone Number"]
[10,"Fiscal Year Ending","2023-12-31"]
[]
[null,"Cost Report Contact Information"]
[11,"Name "]
[12,"Title"]
[13,"Phone Number"]
[14,"Extension"]
[15,"E-mail Address"]
[16,"Executive Director"]
[17,"Medical Director"]
[18,"Financial Manager"]
[]
[]
[null,"2023-01-31"]
[null,"2023-02-28"]
[null,"2023-03-31"]
[null,"2023-04-30"]
[null,"2023-05-31"]
[null,"2023-06-30"]
[null,"2023-07-31"]
[null,"2023-08-31"]
[null,"2023-09-30"]
[null,"2023-10-31"]
[null,"2023-11-30"]
[null,"2023-12-31"]

{"sheet":"2. Revenue","index":2,"n_rows":62,"n_cols":6,"rows_kept":62,"cut":false,"hidden":false,"merged":[[45,1,45,3],[46,1,46,3],[47,1,47,3],[48,1,48,3],[57,1,57,3],[53,1,53,3],[54,1,54,3],[55,1,55,3],[26,1,26,3],[30,1,30,3],[29,1,29,3],[44,1,44,3],[27,1,27,3],[31,1,31,3],[43,1,43,3],[32,1,32,3],[33,1,33,3],[35,1,35,3],[36,1,36,3],[34,1,34,3],[14,1,14,3],[15,1,15,3],[19,1,19,3],[23,1,23,3],[56,1,56,3],[37,1,37,3],[38,1,38,3],[39,1,39,3],[40,1,40,3],[52,1,52,3],[49,1,49,3],[50,1,50,3],[51,1,51,3],[28,1,28,3],[41,1,41,3],[42,1,42,3],[25,1,25,3],[18,1,18,3],[21,1,21,3],[22,1,22,3],[1,2,1,6],[2,2,2,6],[3,2,3,6],[17,1,17,3],[7,1,7,3],[24,1,24,3],[8,1,8,3],[9,1,9,3],[10,1,10,3],[20,1,20,3],[12,1,12,3],[13,1,13,3]]}
[]
[null,null,"Community Health Center Cost Report"]
[null,null,"Tab 2 - Revenue"]
[null,null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[]
[]
["Line","A. Third Party Revenues - NPSR",null,null,"Revenue","Total"]
[1,"Medicare"]
[2,"MassHealth - Fee For Service / PCC Plan"]
[3,"MassHealth - MCO"]
[4,"MassHealth - ACO"]
[5,"MassHealth - Dental"]
[6,"Massachusetts Behavioral Health Partnership"]
[7,"Commonwealth Care"]
[8,"Health Safety Net Trust Fund"]
[9,"Children's Medical Security Plan"]
[10,"Healthy Start"]
[11,"Commercial / Private Third Parties"]
[12,"Patient Fees / Self Pay"]
[13,"Other"]
[14,"TOTAL",null,null,{"$f":"SUM(E9:E21)","v":0}]
[15,"TOTAL NET PATIENT SERVICE REVENUE*",null,null,null,{"$f":"E22","v":0}]
[null,"B. Unrestricted Grants, Gifts, & Donations"]
[16,"Federal"]
[17,"State - Cost Reimbursement Contracts"]
[18,"State - Unit Rate Contracts"]
[19,"Local"]
[20,"Private"]
[21,"Donated"]
[22,"TOTAL UNRESTRICTED GRANTS, GIFTS, & DONATIONS**",null,null,null,{"$f":"SUM(E25:E30)","v":0}]
[null,"C. Restricted Grants, Gifts, & Donations"]
[23,"Federal"]
[24,"State - Cost Reimbursement Contracts"]
[25,"State - Unit Rate Contracts"]
[26,"Local"]
[27,"Private"]
[28,"Donated"]
[29,"TOTAL RESTRICTED GRANTS, GIFTS, & DONATIONS**",null,null,null,{"$f":"SUM(E33:E38)","v":0}]
[null,"D. Other Income"]
[30,"Contract Revenue **"]
[31,"Non-Operating Income"]
[32,"Investment Income"]
[33,"Capital Grants"]
[34,"Endowment Grants"]
[35,"Non-Operating Gains (Losses)"]
[null,"Other with Description"]
[36]
[37]
[38]
[39]
[40]
[41]
[42,"TOTAL OTHER INCOME",null,null,null,{"$f":"SUM(E41:E53)","v":0}]
[43,"TOTAL REVENUE",null,null,null,{"$f":"SUM(F23,F31,F39,F54)","v":0}]
[44,"E. Other Adjustments"]
[45,"TOTAL ***",null,null,null,{"$f":"F55-F56","v":0}]
[46,"Total (Part B + Part C + Contract Revenue)",null,null,null,{"$f":"SUM(F31,F39,E41)","v":0}]
[null,"NOTES:"]
[null,"* NPSR must agree with financial Statements and Include Prior Year 3rd Party Settlements"]
[null,"** Sum of Part B, C and Contract Revenue must tie to Total Grant and Contract Revenue reported on the Financial Statements."]
[null,"*** Must agree with Financial Statements, excluding Temporarily and Permanently Restricted"]

{"sheet":"3. Providers","index":3,"n_rows":108,"n_cols":7,"rows_kept":108,"cut":false,"hidden":false,"merged":[[7,2,7,6],[8,2,8,3],[8,4,8,5],[1,1,1,4],[2,1,2,4],[3,1,3,4]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 3 - Providers"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[null,"Please see accompanying Instructions document for guidance on data input."]
[]
[null,null,"Staffing"]
[null,"Service Category","Salary or Contractor Expense",null,"Salary or Contractor FTEs",null,"Billable Visits"]
[null,null,"Employee","Contracted","Employee","Contracted"]
[null,"HEALTHCARE"]
["Line","MEDICAL"]
[1,"Family Physicians"]
[2,"General Practitioners"]
[3,"Internists"]
[4,"Obstetrician/Gynecologists"]
[5,"Pediatricians"]
[6,"Licensed Medical Residents"]
[7,"Specialty Physicians"]
[8,"Physician - OBAT"]
[9,"Sub-Total Physicians",{"$f":"SUM(C13:C20)","v":0},{"$f":"SUM(D13:D20)","v":0},{"$f":"SUM(E13:E20)","v":0},{"$f":"SUM(F13:F20)","v":0},{"$f":"SUM(G13:G20)","v":0}]
[10,"Nurse Practitioners"]
[11,"Physician Assistants"]
[12,"Certified Nurse Midwives"]
[13,"Sub - Total Medical",{"$f":"SUM(C21:C24)","v":0},{"$f":"SUM(D21:D24)","v":0},{"$f":"SUM(E21:E24)","v":0},{"$f":"SUM(F21:F24)","v":0},{"$f":"SUM(G21:G24)","v":0}]
[null,"NURSES"]
[14,"Registered Nurses (RNs)"]
[15,"RN - OBAT"]
[16,"Licensed Practical Nurses"]
[17,"Sub - Total Nurses",{"$f":"SUM(C27:C29)","v":0},{"$f":"SUM(D27:D29)","v":0},{"$f":"SUM(E27:E29)","v":0},{"$f":"SUM(F27:F29)","v":0},{"$f":"SUM(G27:G29)","v":0}]
[null,"VISION"]
[18,"Ophthalmologists"]
[19,"Optometrists"]
[20,"Opticians"]
[21,"Sub - Total Vision",{"$f":"SUM(C32:C34)","v":0},{"$f":"SUM(D32:D34)","v":0},0,0,0]
[null,"OTHER PROFESSIONAL SERVICES"]
[22,"Audiologists"]
[23,"Acupuncturists"]
[24,"Chiropractors"]
[25,"Herbalists"]
[26,"Massage Therapists"]
[27,"Naturopaths"]
[28,"Nutritionists/Dieticians"]
[29,"Registered Dieticians"]
[30,"Occupational Therapists"]
[31,"Podiatrists"]
[32,"Physical Therapists"]
[33,"Respiratory Therapists"]
[34,"Speech Therapists/Pathologists"]
[35,"Traditional Healers"]
[36,"Other NON-BILLABLE Medical Providers not Listed Above (list below)",{"$f":"SUM(C52:C56)","v":0},{"$f":"SUM(D52:D56)","v":0},{"$f":"SUM(E52:E56)","v":0},{"$f":"SUM(F52:F56)","v":0},{"$f":"SUM(G52:G56)","v":0}]
[37,"Other Provider Type"]
[38,"Other Provider Type"]
[39,"Other Provider Type"]
[40,"Other Provider Type"]
[41,"Other Provider Type"]
[42,"Sub - Total Other Health Services",{"$f":"SUM(C37:C51)","v":0},{"$f":"SUM(D37:D51)","v":0},{"$f":"SUM(E37:E51)","v":0},{"$f":"SUM(F37:F51)","v":0},{"$f":"SUM(G37:G51)","v":0}]
[43,"SUB-TOTAL MEDICAL",{"$f":"C25+C35+C30+C57","v":0},{"$f":"D25+D35+D30+D57","v":0},{"$f":"E25+E35+E30+E57","v":0},{"$f":"F25+F35+F30+F57","v":0},{"$f":"G25+G35+G30+G57","v":0}]
[]
[null,"DENTAL  "]
[44,"General Dentists"]
[45,"Dental Specialist (DMD-DDS)"]
[46,"Dental Hygienists"]
[47,"Other NON-BILLABLE Dental Providers not Listed Above (list below)",{"$f":"SUM(C65:C69)","v":0},{"$f":"SUM(D65:D69)","v":0},{"$f":"SUM(E65:E69)","v":0},{"$f":"SUM(F65:F69)","v":0},{"$f":"SUM(G65:G69)","v":0}]
[48,"Other Provider Type"]
[49,"Other Provider Type"]
[50,"Other Provider Type"]
[51,"Other Provider Type"]
[52,"Other Provider Type"]
[53,"SUB - TOTAL DENTAL",{"$f":"SUM(C61:C64)","v":0},{"$f":"SUM(D61:D64)","v":0},{"$f":"SUM(E61:E64)","v":0},{"$f":"SUM(F61:F64)","v":0},{"$f":"SUM(G61:G64)","v":0}]
[]
[null,"BEHAVIORAL HEALTH"]
[null,"MENTAL HEALTH SERVICES"]
[54,"Psychiatrists"]
[55,"Psychologists"]
[56,"Social Workers ",0,0,0,0,0]
[57,"Licensed Independent Clinical Social Worker (LISCW)"]
[58,"Licensed Clinical Social Worker (LCSW)"]
[59,"Unlicensed Master of Social Worker (MSW)"]
[60,"Licensed Mental Health Counselor (LMHC)"]
[61,"Family Therapists"]
[62,"Other Licensed Mental Health Providers:",0,0,0,0,0]
[63,"Psychiatric Nurse Practitioner"]
[64,"RNs - Psychiatric and Mental Health"]
[65,"RN Nurse Counselors"]
[66,"Unlicensed Mental Health Providers, including trainees (interns or residents) and \"Certified\" staff"]
[67,"Sub - Total Mental Health",{"$f":"SUM(C74:C86)","v":0},{"$f":"SUM(D74:D86)","v":0},{"$f":"SUM(E74:E86)","v":0},{"$f":"SUM(F74:F86)","v":0},{"$f":"SUM(G74:G86)","v":0}]
[null,"SUBSTANCE ABUSE SERVICES"]
[68,"RN Nurse Counselors"]
[69,"Social Workers ",0,0,0,0,0]
[70,"Licensed Independent Clinical Social Worker (LISCW)"]
[71,"Licensed Clinical Social Worker (LCSW)"]
[72,"Unlicensed Master of Social Worker (MSW)"]
[73,"Licensed Mental Health Counselor (LMHC)"]
[74,"Family Therapists"]
[75,"LADAC/CADAC (if not included in other category above)"]
[76,"Harm Reduction Specialist"]
[77,"Recovery Coaches/Peer Support"]
[78,"Other NON-BILLABLE BH Providers not Listed Above (list below)",{"$f":"SUM(C100:C104)","v":0},{"$f":"SUM(D100:D104)","v":0},{"$f":"SUM(E100:E104)","v":0},{"$f":"SUM(F100:F104)","v":0},{"$f":"SUM(G100:G104)","v":0}]
[79,"Other Provider Type"]
[80,"Other Provider Type"]
[81,"Other Provider Type"]
[82,"Other Provider Type"]
[83,"Other Provider Type"]
[84,"Sub - Total Substance Abuse Services",{"$f":"SUM(C89:C99)","v":0},{"$f":"SUM(D89:D99)","v":0},{"$f":"SUM(E89:E99)","v":0},{"$f":"SUM(F89:F99)","v":0},{"$f":"SUM(G89:G99)","v":0}]
[85,"SUB-TOTAL BEHAVIORAL HEALTH",{"$f":"C105+C87","v":0},{"$f":"D105+D87","v":0},{"$f":"E105+E87","v":0},{"$f":"F105+F87","v":0},{"$f":"G105+G87","v":0}]
[]
[86,"TOTAL PROVIDERS",{"$f":"C106+C70+C58","v":0},{"$f":"D106+D70+D58","v":0},{"$f":"E106+E70+E58","v":0},{"$f":"F106+F70+F58","v":0},{"$f":"G106+G70+G58","v":0}]

{"sheet":"4. Non-Providers","index":4,"n_rows":317,"n_cols":6,"rows_kept":317,"cut":false,"hidden":false,"merged":[[10,4,10,5],[10,2,10,3],[1,1,1,4],[2,1,2,4],[3,1,3,4]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 4 - Non-Providers"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[null,"Please see accompanying Instructions document for guidance on data input."]
[]
[]
[]
[null,"Non-Provider Staff"]
[null,"Service  Category","Salary or Contractor Expense",null,"Salary or Contractor FTEs"]
[null,null,"Employee","Contracted","Employee","Contracted"]
["Line","MEDICAL"]
[null,"Other Medical Personnel"]
[1,"Nursing Director"]
[2,"Nurse Managers"]
[3,"Nurse Aides/Assistants (Certified and Uncertified)"]
[4,"Clinic Aides/Medical Assistants (Certified and Uncertified Medical Technologists)"]
[5,"Unlicensed Interns and Residents"]
[6,"EMS/EMT Staff (not credentialed as a nurse)"]
[7,"Co-op Practice Assistant"]
[8,"Other Medical Staff not Listed Above (list below)",{"$f":"SUM(C23:C27)","v":0},{"$f":"SUM(D23:D27)","v":0},{"$f":"SUM(E23:E27)","v":0},{"$f":"SUM(F23:F27)","v":0}]
[9,"Enter Other Staff Type"]
[10,"Enter Other Staff Type"]
[11,"Enter Other Staff Type"]
[12,"Enter Other Staff Type"]
[13,"Enter Other Staff Type"]
[14,"Sub-Total Other Medical Personnel",{"$f":"SUM(C15:C22)","v":0},{"$f":"SUM(D15:D22)","v":0},{"$f":"SUM(E15:E22)","v":0},{"$f":"SUM(F15:F22)","v":0}]
[null,"Other Vision Care Staff"]
[15,"Ophthalmologist/Optometric Assistants"]
[16,"Ophthalmologist/Optometric Aides"]
[17,"Ophthalmologist/Optometric Technicians"]
[18,"Other Vision Staff not Listed Above (list below)",{"$f":"SUM(C34:C38)","v":0},{"$f":"SUM(D34:D38)","v":0},{"$f":"SUM(E34:E38)","v":0},{"$f":"SUM(F34:F38)","v":0}]
[19,"Enter Other Staff Type"]
[20,"Enter Other Staff Type"]
[21,"Enter Other Staff Type"]
[22,"Enter Other Staff Type"]
[23,"Enter Other Staff Type"]
[24,"Sub-Total Other Vision Staff",{"$f":"SUM(C30:C33)","v":0},{"$f":"SUM(D30:D33)","v":0},{"$f":"SUM(E30:E33)","v":0},{"$f":"SUM(F30:F33)","v":0}]
[25,"SUB-TOTAL MEDICAL",{"$f":"C28+C39","v":0},{"$f":"D28+D39","v":0},{"$f":"E28+E39","v":0},{"$f":"F28+F39","v":0}]
[]
[null,"LABORATORY"]
[null,"Laboratory Personnel"]
[26,"Pathologists"]
[27,"Medical Technologists"]
[28,"Laboratory Technicians"]
[29,"Laboratory Assistants"]
[30,"Phlebotomists"]
[31,"Other Laboratory Staff not Listed Above (list below)",{"$f":"SUM(C50:C54)","v":0},{"$f":"SUM(D50:D54)","v":0},{"$f":"SUM(E50:E54)","v":0},{"$f":"SUM(F50:F54)","v":0}]
[32,"Enter Other Staff Type"]
[33,"Enter Other Staff Type"]
[34,"Enter Other Staff Type"]
[35,"Enter Other Staff Type"]
[36,"Enter Other Staff Type"]
[37,"Sub-Total Laboratory Personnel",{"$f":"SUM(C44:C49)","v":0},{"$f":"SUM(D44:D49)","v":0},{"$f":"SUM(E44:E49)","v":0},{"$f":"SUM(F44:F49)","v":0}]
[]
[null,"X-RAY"]
[null,"X-Ray Personnel"]
[38,"Radiologists"]
[39,"X-Ray Technologists"]
[40,"X-Ray Technicians"]
[41,"Radiology Assistants"]
[42,"Other Radiology Staff not Listed Above (list below)",{"$f":"SUM(C64:C68)","v":0},{"$f":"SUM(D64:D68)","v":0},{"$f":"SUM(E64:E68)","v":0},{"$f":"SUM(F64:F68)","v":0}]
[43,"Enter Other Staff Type"]
[44,"Enter Other Staff Type"]
[45,"Enter Other Staff Type"]
[46,"Enter Other Staff Type"]
[47,"Enter Other Staff Type"]
[48,"Sub-Total X-Ray Personnel",{"$f":"SUM(C59:C63)","v":0},{"$f":"SUM(D59:D63)","v":0},{"$f":"SUM(E59:E63)","v":0},{"$f":"SUM(F59:F63)","v":0}]
[]
[null,"PHARMACY"]
[null,"Pharmacy Personnel"]
[49,"Pharmacists, Clinical Pharmacists"]
[50,"Pharmacy Technicians"]
[51,"Pharmacist Assistants"]
[52,"Pharmacy Clerks"]
[53,"Other Pharmacy Staff not Listed Above (list below)",{"$f":"SUM(C78:C82)","v":0},{"$f":"SUM(D78:D82)","v":0},{"$f":"SUM(E78:E82)","v":0},{"$f":"SUM(F78:F82)","v":0}]
[54,"Enter Other Staff Type"]
[55,"Enter Other Staff Type"]
[56,"Enter Other Staff Type"]
[57,"Enter Other Staff Type"]
[58,"Enter Other Staff Type"]
[59,"Sub-Total Pharmacy Personnel",{"$f":"SUM(C73:C77)","v":0},{"$f":"SUM(D73:D77)","v":0},{"$f":"SUM(E73:E77)","v":0},{"$f":"SUM(F73:F77)","v":0}]
[60,"SUB-TOTAL PHARMACY",{"$f":"C83","v":0},{"$f":"D83","v":0},{"$f":"E83","v":0},{"$f":"F83","v":0}]
[]
[null,"DENTAL"]
[61,"Other Dental"]
[62,"Director - Dental"]
[63,"Managers - Dental"]
[64,"Dental Assistants, Advanced Practice Dental Assistants"]
[65,"Dental Technicians"]
[66,"Dental Aides"]
[67,"Dental Students"]
[68,"Other Dental Staff not Listed Above (list below)",{"$f":"SUM(C95:C99)","v":0},{"$f":"SUM(D95:D99)","v":0},{"$f":"SUM(E95:E99)","v":0},{"$f":"SUM(F95:F99)","v":0}]
[69,"Enter Other Staff Type"]
[70,"Enter Other Staff Type"]
[71,"Enter Other Staff Type"]
[72,"Enter Other Staff Type"]
[73,"Enter Other Staff Type"]
[74,"Sub-Total Other Dental",{"$f":"SUM(C88:C94)","v":0},{"$f":"SUM(D88:D94)","v":0},{"$f":"SUM(E88:E94)","v":0},{"$f":"SUM(F88:F94)","v":0}]
[75,"SUB-TOTAL DENTAL",{"$f":"C100","v":0},{"$f":"D100","v":0},{"$f":"E100","v":0},{"$f":"F100","v":0}]
[]
[null,"BEHAVIORAL HEALTH"]
[76,"Other Behavioral Health "]
[77,"Director - Mental Health"]
[78,"Managers - Mental Health"]
[79,"Director - Substance Use Disorder"]
[80,"Managers - Substance Use Disorder"]
[81,"Other BH Staff not Listed Above (list below)",{"$f":"SUM(C110:C114)","v":0},{"$f":"SUM(D110:D114)","v":0},{"$f":"SUM(E110:E114)","v":0},{"$f":"SUM(F110:F114)","v":0}]
[82,"Enter Other Staff Type"]
[83,"Enter Other Staff Type"]
[84,"Enter Other Staff Type"]
[85,"Enter Other Staff Type"]
[86,"Enter Other Staff Type"]
[87,"Sub Total Other Behavioral Health",{"$f":"SUM(C105:C109)","v":0},{"$f":"SUM(D105:D109)","v":0},{"$f":"SUM(E105:E109)","v":0},{"$f":"SUM(F105:F109)","v":0}]
[88,"SUB-TOTAL BEHAVIORAL HEALTH",{"$f":"C115","v":0},{"$f":"D115","v":0},{"$f":"E115","v":0},{"$f":"F115","v":0}]
[]
[null,"ENABLING"]
[null,"Case Managers"]
[89,"Case Managers"]
[90,"Care/Referral Coordinators"]
[91,"Patient Advocates"]
[92,"Social Workers"]
[93,"Public Health Nurses"]
[94,"Home Health Nurses"]
[95,"Visiting Nurses"]
[96,"RN Case Manager"]
[97,"LPN Case Manager"]
[98,"Sub-Total Case Managers",{"$f":"SUM(C120:C128)","v":0},{"$f":"SUM(D120:D128)","v":0},{"$f":"SUM(E120:E128)","v":0},{"$f":"SUM(F120:F128)","v":0}]
[]
[null,"Health Educators"]
[99,"Family Planning Counselors"]
[100,"Health Educators"]
[101,"Social Workers"]
[102,"Public Health Nurses"]
[103,"Home Health Nurses"]
[104,"Visiting Nurses"]
[105,"Registered Nurses"]
[106,"Licensed Practical Nurses"]
[107,"Sub-Total Health Educators",{"$f":"SUM(C132:C139)","v":0},{"$f":"SUM(D132:D139)","v":0},{"$f":"SUM(E132:E139)","v":0},{"$f":"SUM(F132:F139)","v":0}]
[]
[108,"Outreach Workers"]
[109,"Sub-Total Outreach Workers",{"$f":"C142","v":0},{"$f":"D142","v":0},{"$f":"E142","v":0},{"$f":"F142","v":0}]
[]
[null,"Patient Transportation Workers"]
[110,"Patient Transportation Coordinators"]
[111,"Drivers"]
[112,"Sub-Total Patient Transportation Workers",{"$f":"SUM(C146:C147)","v":0},{"$f":"SUM(D146:D147)","v":0},{"$f":"SUM(E146:E147)","v":0},{"$f":"SUM(F146:F147)","v":0}]
[]
[null,"Eligibility Assistance Workers"]
[113,"Benefit Assistance Workers"]
[114,"Pharmacy Assistance Program Eligibility Workers"]
[115,"Eligibility Workers"]
[116,"Patient Navigators"]
[117,"Patient Advocates"]
[118,"Registration Clerks"]
[119,"Sub-Total Eligibility Assistance Workers",{"$f":"SUM(C151:C156)","v":0},{"$f":"SUM(D151:D156)","v":0},{"$f":"SUM(E151:E156)","v":0},{"$f":"SUM(F151:F156)","v":0}]
[]
[null,"Interpretation"]
[120,"Interpreters"]
[121,"Translators"]
[122,"Sub-Total Interpretation",{"$f":"SUM(C160:C161)","v":0},{"$f":"SUM(D160:D161)","v":0},{"$f":"SUM(E160:E161)","v":0},{"$f":"SUM(F160:F161)","v":0}]
[]
[null,"Community Health Workers"]
[123,"Community Health Workers"]
[124,"Community Health Advisors or Representatives"]
[125,"Lay Health Advocates"]
[126,"Promotoras"]
[127,"Public Health Advocates (needle exchange)"]
[128,"Sub-Total Community Health Workers",{"$f":"SUM(C165:C169)","v":0},{"$f":"SUM(D165:D169)","v":0},{"$f":"SUM(E165:E169)","v":0},{"$f":"SUM(F165:F169)","v":0}]
[]
[129,"Other Enabling Staff not Listed Above (list below)",{"$f":"SUM(C173:C177)","v":0},{"$f":"SUM(D173:D177)","v":0},{"$f":"SUM(E173:E177)","v":0},{"$f":"SUM(F173:F177)","v":0}]
[130,"Other Enabling  Staff "]
[131,"Other Enabling  Staff "]
[132,"Other Enabling  Staff "]
[133,"Other Enabling  Staff "]
[134,"Other Enabling  Staff "]
[135,"SUB-TOTAL ENABLING ",{"$f":"C129+C140+C143+C148+C157+C162+C170+C172","v":0},{"$f":"D129+D140+D143+D148+D157+D162+D170+D172","v":0},{"$f":"E129+E140+E143+E148+E157+E162+E170+E172","v":0},{"$f":"F129+F140+F143+F148+F157+F162+F170+F172","v":0}]
[]
[null,"ADMINSTRATIVE"]
[null,"Quality Improvement Staff"]
[136,"QI Director"]
[137,"QI Nurses"]
[138,"QI Technicians"]
[139,"QI Data Specialists"]
[140,"Statisticians, Analysts"]
[141,"Quality Assurance/Quality Improvement and HIT/EHR Design and Operation Staff"]
[142,"Sub-Total Quality Improvement Staff",{"$f":"SUM(C182:C187)","v":0},{"$f":"SUM(D182:D187)","v":0},{"$f":"SUM(E182:E187)","v":0},{"$f":"SUM(F182:F187)","v":0}]
[]
[null,"Executive Management Team"]
[143,"Chief Executive Officer/Executive Director"]
[144,"Chief Financial Officer"]
[145,"Chief Information Officer"]
[146,"Chief Medical Officer"]
[147,"Directors of Planning And Evaluation"]
[148,"Project Directors COO"]
[149,"General Counsel"]
[150,"Chief HR Officer"]
[151,"Compliance Officer"]
[152,"Directors of Marketing"]
[153,"     Sub-Total - Executive Management Team",{"$f":"SUM(C191:C200)","v":0},{"$f":"SUM(D191:D200)","v":0},0,0]
[]
[null,"Human Resources Staff"]
[154,"HR Director"]
[155,"HR Managers"]
[156,"Credentialing Staff"]
[157,"     Sub-Total - Human Resources Team",{"$f":"SUM(C204:C206)","v":0},{"$f":"SUM(D204:D206)","v":0},{"$f":"SUM(E204:E206)","v":0},{"$f":"SUM(F204:F206)","v":0}]
[]
[null,"Management Support Staff"]
[158,"Secretaries"]
[159,"Administrators"]
[160,"Clerk Typists"]
[161,"Receptionist"]
[162,"Mail Room Staff"]
[163,"Marketing Representatives"]
[164,"     Sub-Total - Management Support Staff",{"$f":"SUM(C210:C215)","v":0},{"$f":"SUM(D210:D215)","v":0},{"$f":"SUM(E210:E215)","v":0},{"$f":"SUM(F210:F215)","v":0}]
[]
[null,"Fiscal and Billing Staff"]
[165,"Finance Directors"]
[166,"Accountants"]
[167,"Bookkeepers"]
[168,"Billing Manager"]
[169,"Billing Clerks"]
[170,"Coders"]
[171,"Cashiers"]
[172,"Purchasing Staff"]
[173,"Data Entry Clerks"]
[174,"     Sub-Total Fiscal & Billing Staff",{"$f":"SUM(C219:C227)","v":0},{"$f":"SUM(D219:D227)","v":0},{"$f":"SUM(E219:E227)","v":0},{"$f":"SUM(F219:F227)","v":0}]
[]
[null,"IT Staff"]
[175,"IT Directors"]
[176,"IT Managers"]
[177,"Directors of Data Processing"]
[178,"Application Analysts "]
[179,"Reporting Analysts"]
[180,"Programmers"]
[181,"PC Technicians"]
[182,"IT Help Desk Technicians"]
[183,"IT Help Desk Staff - Other than Technicians"]
[184,"Telecom Staff"]
[185,"Data Entry Clerks"]
[186,"     Sub-Total - IT Staff",{"$f":"SUM(C231:C241)","v":0},{"$f":"SUM(D231:D241)","v":0},{"$f":"SUM(E231:E241)","v":0},{"$f":"SUM(F231:F241)","v":0}]
[]
[null,"Patient Services Support Staff"]
[187,"Director - Patient Services"]
[188,"Managers - Patient Services"]
[189,"Medical and Dental Team Clerks"]
[190,"Medical and Dental Team Secretaries"]
[191,"Medical and Dental Appointment Clerks"]
[192,"Medical and Dental Patient Records Clerks"]
[193,"Patient Records Supervisors"]
[194,"Patient Records Technicians"]
[195,"Patient Record Clerks"]
[196,"Patient Records Transcriptionist"]
[197,"Registration Clerks"]
[198,"Enrollment/Service Representatives"]
[199,"Call/Contact Center Staff"]
[200,"Appointment Clerks"]
[201,"Sub-Total Patient Services Support Staff",{"$f":"SUM(C245:C258)","v":0},{"$f":"SUM(D245:D258)","v":0},0,0]
[]
[202,"Other Administrative Staff not Listed Above (list below)",{"$f":"SUM(C262:C269)","v":0},{"$f":"SUM(D262:D269)","v":0},{"$f":"SUM(E262:E269)","v":0},{"$f":"SUM(F262:F269)","v":0}]
[203,"Enter Other Staff Type"]
[204,"Enter Other Staff Type"]
[205,"Enter Other Staff Type"]
[206,"Enter Other Staff Type"]
[207,"Enter Other Staff Type"]
[208,"Enter Other Staff Type"]
[209,"Enter Other Staff Type"]
[210,"Enter Other Staff Type"]
[211,"SUB-TOTAL ADMINISTRATIVE",{"$f":"C188+C201+C207+C216+C228+C242+C259+C261","v":0},{"$f":"D188+D201+D207+D216+D228+D242+D259+D261","v":0},{"$f":"E188+E201+E207+E216+E228+E242+E259+E261","v":0},{"$f":"F188+F201+F207+F216+F228+F242+F259+F261","v":0}]
[]
[null,"FACILITY"]
[null,"Facility Staff"]
[212,"Director - Facilities"]
[213,"Manager - Facilities"]
[214,"Janitors/Custodians"]
[215,"Security Guards"]
[216,"Groundskeepers"]
[217,"Equipment Maintenance Personnel"]
[218,"Housekeeping Personnel"]
[219,"Other Facility Staff not Listed Above (list below)",{"$f":"SUM(C282:C286)","v":0},{"$f":"SUM(D282:D286)","v":0},{"$f":"SUM(E282:E286)","v":0},{"$f":"SUM(F282:F286)","v":0}]
[220,"Enter Other Staff Type"]
[221,"Enter Other Staff Type"]
[222,"Enter Other Staff Type"]
[223,"Enter Other Staff Type"]
[224,"Enter Other Staff Type"]
[225,"Sub-Total Facility Staff",{"$f":"SUM(C274:C281)","v":0},{"$f":"SUM(D274:D281)","v":0},{"$f":"SUM(E274:E281)","v":0},{"$f":"SUM(F274:F281)","v":0}]
[226,"SUB-TOTAL FACILITY",{"$f":"C287","v":0},{"$f":"D287","v":0},{"$f":"E287","v":0},{"$f":"F287","v":0}]
[227,"TOTAL OF ALL ALLOWABLE STAFF",{"$f":"C40+C55+C69+C84+C101+C116+C178+C270+C288","v":0},{"$f":"D40+D55+D69+D84+D101+D116+D178+D270+D288","v":0},{"$f":"E40+E55+E69+E84+E101+E116+E178+E270+E288","v":0},{"$f":"F40+F55+F69+F84+F101+F116+F178+F270+F288","v":0}]
[]
[null,"NON- ALLOWABLE PROGRAMS / SERVICES"]
[null,"Other Programs/Services"]
[228,"WIC Workers"]
[229,"Head Start Workers"]
[230,"Housing Assistance Workers"]
[231,"Child Care Workers"]
[232,"Food Bank/Meal Delivery Workers"]
[233,"Employment/Educational Counselors"]
[234,"Exercise Trainers/Fitness Center staff"]
[235,"Adult Day Health Care, Frail Elderly Support staff"]
[236,"Fundraising/Development Staff"]
[237,"PACE Personnel"]
[238,"SCO Personnel"]
[239,"Non-FQHC Sites"]
[240,"Other Non-Allowable not Listed Above (list below)",{"$f":"SUM(C306:C310)","v":0},{"$f":"SUM(D306:D310)","v":0},{"$f":"SUM(E306:E310)","v":0},{"$f":"SUM(F306:F310)","v":0}]
[241,"Enter Other Staff Type"]
[242,"Enter Other Staff Type"]
[243,"Enter Other Staff Type"]
[244,"Enter Other Staff Type"]
[245,"Enter Other Staff Type"]
[246,"Sub-Total Other Program/Services",{"$f":"SUM(C293:C305)","v":0},{"$f":"SUM(D293:D305)","v":0},{"$f":"SUM(E293:E305)","v":0},{"$f":"SUM(F293:F310)","v":0}]
[247,"TOTAL OF ALL NON ALLOWABLE STAFF",{"$f":"C311","v":0},{"$f":"D311","v":0},{"$f":"E311","v":0},{"$f":"F311","v":0}]
[]
[248,"Total of All Allowable Staff - Tab 4 and Tab 5",{"$f":"C289+'3. Providers'!C108","v":0},{"$f":"D289+'3. Providers'!D108","v":0},{"$f":"E289+'3. Providers'!E108","v":0},{"$f":"F289+'3. Providers'!F108","v":0}]
[249,"Total of Non-Allowable Staff - Tab 5",{"$f":"C312","v":0},{"$f":"D312","v":0},{"$f":"E312","v":0},{"$f":"F312","v":0}]
[]
[250,"ALL ALLOWABLE + NON-ALLOWABLE STAFF",{"$f":"C314+C315","v":0},{"$f":"D314+D315","v":0},{"$f":"E314+E315","v":0},{"$f":"F314+F315","v":0}]

{"sheet":"5. Cost Information","index":5,"n_rows":63,"n_cols":26,"rows_kept":63,"cut":false,"hidden":false,"merged":[[1,1,1,4],[2,1,2,4],[3,1,3,4],[59,19,59,20],[9,1,9,2],[31,22,32,22],[21,1,21,2],[31,15,31,20],[31,3,31,13],[62,19,62,21]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 5 - Cost Information"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[null,"Fringe Benefits"]
[]
[null,"Please see accompanying Instructions document for guidance on data input."]
[]
[]
["Line","Benefit",null,"Annual Benefit Amount","Percentage of Total Allowable and Non-Allowable Staff Costs"]
[1,"FICA",null,null,{"$f":"IFERROR(D11/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[2,"Health Insurance",null,null,{"$f":"IFERROR(D12/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[3,"Retirement Plan",null,null,{"$f":"IFERROR(D13/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[4,"Workman's Comp",null,null,{"$f":"IFERROR(D14/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[5,"Unemployment",null,null,{"$f":"IFERROR(D15/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[6,"Disability ",null,null,{"$f":"IFERROR(D16/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[7,"Other Union Benefits",null,null,{"$f":"IFERROR(D17/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[8,"Other (Metropolitan Commuter Trans)",null,null,{"$f":"IFERROR(D18/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[9,"Other (Uniform Allowance)",null,null,{"$f":"IFERROR(D19/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[10,"Other (Life Insurance)",null,null,{"$f":"IFERROR(D20/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[11,"Other (please specify)",null,null,{"$f":"IFERROR(D21/('4. Non-Providers'!$C$317), \"0\")","v":"0"}]
[12,"TOTAL BENEFITS",null,{"$f":"SUM(D11:D21)","v":0},{"$f":"SUM(E11:E21)","v":0}]
[]
[]
[null,"Cost Information"]
[]
[null,"Please see accompanying Instructions document for guidance on data input."]
[]
[]
[]
[]
[null,null,null,"Allowable Expenses",null,null,null,null,null,null,null,null,null,null,null,"Non-Allowable Expenses",null,null,null,null,null,null,"Total Allowable + Non-Allowable"]
[null,"Trial Balance",null,"Medical","Behavioral Health & Substance Abuse","Dental","Vision","Laboratory","X-Ray","Pharmacy","Enabling","Admin","Facility","Total Allowable",null,"WIC","Non-FQHC Sites","PACE Program","SCO","Other\n(Specify)","Total Non-Allowable"]
[null,"Operating Expenses"]
[13,"Insurance",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D35:M35)","v":0},null,null,null,null,null,null,{"$f":"SUM(P35:T35)","v":0},null,{"$f":"N35+U35","v":0}]
[14,"Consumable Supplies",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D36:M36)","v":0},null,null,null,null,null,null,{"$f":"SUM(P36:T36)","v":0},null,{"$f":"N36+U36","v":0}]
[15,"Repairs and Maintenance",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[16,"Travel, Conference and Meeting Expenses",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[17,"Dues and Subscriptions",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[18,"Utilities",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[19,"Interest Expense (Operating)",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[20,"Postage & Supplies",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[21,"Professional Services",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[22,"Staff Training",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[23,"Contracted Services",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[24,"Publishing, Printing and Mailing",null,null,null,null,null,null,null,null,null,null,null,0,null,null,null,null,null,null,0,null,0]
[25,"Telephone & Pagers/Communications",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D47:M47)","v":0},null,null,null,null,null,null,{"$f":"SUM(P47:T47)","v":0},null,{"$f":"N47+U47","v":0}]
[26,"Personnel Recruitment",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D48:M48)","v":0},null,null,null,null,null,null,{"$f":"SUM(P48:T48)","v":0},null,{"$f":"N48+U48","v":0}]
[27,"Promotion/Advertising",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D49:M49)","v":0},null,null,null,null,null,null,{"$f":"SUM(P49:T49)","v":0},null,{"$f":"N49+U49","v":0}]
[28,"Other Operating Costs",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D50:M50)","v":0},null,null,null,null,null,null,{"$f":"SUM(P50:T50)","v":0},null,{"$f":"N50+U50","v":0}]
[null,"Capital Expenses"]
[29,"Rent",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D52:M52)","v":0},null,null,null,null,null,null,{"$f":"SUM(P52:T52)","v":0},null,{"$f":"N52+U52","v":0}]
[30,"Depreciation",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D53:M53)","v":0},null,null,null,null,null,null,{"$f":"SUM(P53:T53)","v":0},null,{"$f":"N53+U53","v":0}]
[31,"Occupancy Taxes",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D54:M54)","v":0},null,null,null,null,null,null,{"$f":"SUM(P54:T54)","v":0},null,{"$f":"N54+U54","v":0}]
[32,"Interest Expense (Capital)",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D55:M55)","v":0},null,null,null,null,null,null,{"$f":"SUM(P55:T55)","v":0},null,{"$f":"N55+U55","v":0}]
[33,"Equipment Rental",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D56:M56)","v":0},null,null,null,null,null,null,{"$f":"SUM(P56:T56)","v":0},null,{"$f":"N56+U56","v":0}]
[34,"Other Capital Costs",null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D57:M57)","v":0},null,null,null,null,null,null,{"$f":"SUM(P57:T57)","v":0},null,{"$f":"N57+U57","v":0}]
[35,"TOTAL",null,{"$f":"SUM(D35:D57)","v":0},0,0,0,0,0,0,0,0,0,0,null,{"$f":"SUM(P35:P57)","v":0},0,0,0,0,0,null,{"$f":"SUM(W35:W57)","v":0},null,null,"`"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total Other than Personnel Services (OTPS) Expenses",null,null,{"$f":"W58","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total Fringe",null,null,{"$f":"D22","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total Personnel/Contracted",null,null,{"$f":"'4. Non-Providers'!C317+'4. Non-Providers'!D317","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total",null,null,{"$f":"W60+W61+W62","v":0}]

{"sheet":"6. Reclass Template","index":6,"n_rows":63,"n_cols":12,"rows_kept":63,"cut":false,"hidden":false,"merged":[[1,1,1,4],[2,1,2,4],[3,1,3,4],[62,1,66,8],[8,3,8,5],[8,6,8,8],[8,2,9,2],[8,1,9,1]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 6 - Reclass Template"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[null,"Please see accompanying Instructions document for guidance on data input."]
[]
[]
[null,"Description of Reclassification(s)",null,"Increases",null,null,"Decreases"]
["Line",null,null,"Cost Center","Line #","Amount","Cost Center","Line #","Amount"]
[1]
[2]
[3]
[4,null,null,null,null,null,null,null,null,null,null,"Cost Center"]
[5,null,null,null,null,null,null,null,null,null,"A","Medical"]
[6,null,null,null,null,null,null,null,null,null,"B","Dental "]
[7,null,null,null,null,null,null,null,null,null,"C","Behavioral Health"]
[8,null,null,null,null,null,null,null,null,null,"D","Non-Allowable Cost"]
[9,null,null,null,null,null,null,null,null,null,"E","Overhead - Facility "]
[10,null,null,null,null,null,null,null,null,null,"F","Overhead - Administrative"]
[11,null,null,null,null,null,null,null,null,null,"G","Enabling "]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
[36]
[37]
[38]
[39]
[40]
[41]
[42]
[43]
[44]
[45]
[46]
[47]
[48]
[49]
[50]
[51,"TOTAL",null,null,null,{"$f":"SUM(F11:F60)","v":0},null,null,{"$f":"SUM(I11:I60)","v":0}]
[]
[null,{"$f":"IF(F61 = I61, \"\", \"ERROR:INCREASES/DECREASES DO NOT EQUAL. PLEASE ADJUST\")","v":""}]

{"sheet":"7. Adjustment Template","index":7,"n_rows":29,"n_cols":9,"rows_kept":29,"cut":false,"hidden":false,"merged":[[8,1,8,5],[1,1,1,3],[2,1,2,3],[3,1,3,3]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 7 - Adjustment Template"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[null,"Please see accompanying Instructions document for guidance on data input."]
[null,"Note: Bad Debt should be reflected as a positive dollar value."]
[]
[null,"Adjustments to Expenses"]
["Line","Description of Adjustment to Expenses","Basis for Adjustment","Worksheet Line Number","Cost Center","Amount"]
[1,"Bad Debt",null,null,null,null,null,null,"Cost Center"]
[2,null,null,null,null,null,null,"A","Medical"]
[3,null,null,null,null,null,null,"B","Dental "]
[4,null,null,null,null,null,null,"C","Behavioral Health"]
[5,null,null,null,null,null,null,"D","Non-Allowable Cost"]
[6,null,null,null,null,null,null,"E","Overhead - Facility "]
[7,null,null,null,null,null,null,"F","Overhead - Administrative"]
[8,null,null,null,null,null,null,"G","Enabling "]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19,"TOTAL",null,null,null,{"$f":"SUM(F11:F28)","v":0}]

{"sheet":"8. Other Information","index":8,"n_rows":19,"n_cols":3,"rows_kept":19,"cut":false,"hidden":false,"merged":[[1,1,1,4],[2,1,2,4],[3,1,3,4]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 8 - Other Information"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[null,"Facility Square Footage"]
[]
[]
["Line","Description of Area","Square Feet"]
[1,"Medical"]
[2,"Vision"]
[3,"Dental"]
[4,"Laboratory"]
[5,"X-Ray"]
[6,"Pharmacy"]
[7,"Administration"]
[8,"Enabling"]
[9,"Behavioral Health/Substance Abuse"]
[10,"Non-Allowable Services"]
[11,"TOTAL SQUARE FOOTAGE",{"$f":"SUM(C9:C18)","v":0}]

{"sheet":"Cost Breakdown","index":9,"n_rows":42,"n_cols":16,"rows_kept":42,"cut":false,"hidden":false,"merged":[[37,2,37,13],[29,2,29,13],[1,1,1,5],[2,1,2,5],[3,1,3,5]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Cost Breakdown"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[null,"Worksheet - Allocation of Costs by Services"]
[null,"Costs"]
[null,"Description","Tab","Totals","Medical","Behavioral Health & Substance Abuse","Dental","Laboratory","X-Ray","Pharmacy","Enabling","Admin","Facility","Non-Allowable",null,"Allocation Method"]
[]
[null,"Salaries - Provider",3,{"$f":"SUM($E$9:$N$9)","v":0},{"$f":"'3. Providers'!C58","v":0},{"$f":"'3. Providers'!C106","v":0},{"$f":"'3. Providers'!C70","v":0},null,null,null,null,null,null,null,null,"Direct"]
[null,"Salaries - Non-Provider",4,{"$f":"SUM($E$10:$N$10)","v":0},{"$f":"'4. Non-Providers'!C40","v":0},{"$f":"'4. Non-Providers'!C116","v":0},{"$f":"'4. Non-Providers'!C101","v":0},{"$f":"'4. Non-Providers'!C55","v":0},{"$f":"'4. Non-Providers'!C69","v":0},{"$f":"'4. Non-Providers'!C84","v":0},{"$f":"'4. Non-Providers'!C178","v":0},{"$f":"'4. Non-Providers'!C270","v":0},{"$f":"'4. Non-Providers'!C288","v":0},{"$f":"'4. Non-Providers'!C312","v":0},null,"Direct"]
[null,"Subtotal - Salaries",null,{"$f":"SUM($D$9:$D$10)","v":0},{"$f":"SUM($E$9:$E$10)","v":0},{"$f":"SUM(F9:F10)","v":0},0,{"$f":"SUM($H$10:$H$10)","v":0},{"$f":"SUM(I10:I10)","v":0},0,0,0,0,{"$f":"SUM(N9:N10)","v":0}]
[null,"Fringe Benefits",5,{"$f":"'5. Cost Information'!D22","v":0},{"$f":"IFERROR((D12/$D$11)*E$11,0)","v":0},{"$f":"IFERROR(($D$12/$D$11)*F$11,0)","v":0},0,0,0,0,0,0,{"$f":"IFERROR(($D$12/$D$11)*M$11,0)","v":0},{"$f":"IFERROR(($D$12/$D$11)*N$11,0)","v":0},null,"% of Salaries"]
[null,"Total Compensation",null,{"$f":"D11+D12","v":0},{"$f":"E11+E12","v":0},0,0,0,0,0,0,0,0,0]
[null,"Contractors - Provider",3,{"$f":"SUM($E$14:$N$14)","v":0},{"$f":"'3. Providers'!D58","v":0},{"$f":"'3. Providers'!D106","v":0},{"$f":"'3. Providers'!D70","v":0},null,null,null,null,null,null,null,null,"Direct"]
[null,"Contractors - Non-Providers",4,{"$f":"SUM($E$15:$N$15)","v":0},{"$f":"'4. Non-Providers'!D40","v":0},{"$f":"'4. Non-Providers'!D116","v":0},{"$f":"'4. Non-Providers'!D101","v":0},{"$f":"'4. Non-Providers'!D55","v":0},{"$f":"'4. Non-Providers'!D69","v":0},{"$f":"'4. Non-Providers'!D84","v":0},{"$f":"'4. Non-Providers'!D178","v":0},{"$f":"'4. Non-Providers'!D270","v":0},{"$f":"'4. Non-Providers'!D288","v":0},{"$f":"'4. Non-Providers'!D312","v":0},null,"Direct"]
[null,"OTPS",5,{"$f":"SUM(E16:N16)","v":0},{"$f":"'5. Cost Information'!D58+'5. Cost Information'!G58","v":0},{"$f":"'5. Cost Information'!E58","v":0},{"$f":"'5. Cost Information'!F58","v":0},{"$f":"'5. Cost Information'!H58","v":0},{"$f":"'5. Cost Information'!I58","v":0},{"$f":"'5. Cost Information'!J58","v":0},{"$f":"'5. Cost Information'!K58","v":0},{"$f":"'5. Cost Information'!L58","v":0},{"$f":"'5. Cost Information'!M58","v":0},{"$f":"'5. Cost Information'!U58","v":0},null,"Direct"]
[]
[null,"TOTAL EXPENSES",null,{"$f":"SUM(D13:D16)","v":0},{"$f":"SUM(E13:E16)","v":0},0,0,0,0,0,0,0,0,{"$f":"SUM(N13:N16)","v":0}]
[]
[null,"Facility Cost Allocation",null,{"$f":"SUM(E20:N20)","v":0},{"$f":"IFERROR(E40*$M$18,0)","v":0},{"$f":"IFERROR(F40*$M$18,0)","v":0},0,0,0,0,0,0,{"$f":"-SUM(E20:L20)-N20","v":0},0,null,"Square Foot %"]
[null,"Subtotal - After Facility Allocation",null,{"$f":"SUM(E21:N21)","v":0},{"$f":"E18+E20","v":0},{"$f":"F18+F20","v":0},0,0,0,0,0,0,0,{"$f":"N18+N20","v":0}]
[null,"Enabling Services Allocation",null,{"$f":"IFERROR(SUM(E22:L22), \"\")","v":0},{"$f":"IFERROR(E42*$K$21,0)","v":0},{"$f":"IFERROR(F42*$K$21,0)","v":0},0,null,null,null,{"$f":"-SUM(E22:G22)","v":0},null,null,null,null,"Visits"]
[null,"Subtotal - Accumulated Costs",null,{"$f":"SUM(E23:N23)","v":0},{"$f":"E21+E22","v":0},{"$f":"F21+F22","v":0},0,0,0,0,0,0,0,0]
[]
[null,"Administrative Allocation",null,{"$f":"SUM(E25:N25)","v":0},{"$f":"IFERROR(E41*$L$23,0)","v":0},{"$f":"IFERROR(F41*$L$23,0)","v":0},0,0,0,0,null,{"$f":"-SUM(E25:K25)-N25","v":0},null,0,null,"Accumulated Costs"]
[]
[null,"Total",null,{"$f":"SUM(E27:N27)","v":0},{"$f":"SUM(E23:E25)","v":0},{"$f":"SUM(F23:F25)","v":0},0,0,0,0,0,0,0,0]
[]
[]
[null,null,"Statistical Bases/Allocations"]
["Line","Allocation Basis",null,"Total","Medical","Behavioral Health & Substance Abuse","Dental","Laboratory","X-Ray","Pharmacy","Enabling","Admin","Facility","Non-Allowable"]
[1,"Square Footage","Facility",{"$f":"SUM(E32:N32)","v":0},{"$f":"'8. Other Information'!C9+'8. Other Information'!C10","v":0},{"$f":"'8. Other Information'!C17","v":0},{"$f":"'8. Other Information'!C11","v":0},{"$f":"'8. Other Information'!C12","v":0},{"$f":"'8. Other Information'!C13","v":0},{"$f":"'8. Other Information'!C14","v":0},{"$f":"'8. Other Information'!C16","v":0},{"$f":"'8. Other Information'!C15","v":0},0,{"$f":"'8. Other Information'!C18","v":0}]
[2,"Accumulated Cost (Worksheets ____)","Admin",{"$f":"SUM(E33:N33)","v":0},{"$f":"E23","v":0},{"$f":"F23","v":0},0,0,0,0,null,null,null,{"$f":"N23","v":0}]
[3,"Total Visits (Worksheet __)","Enabling",{"$f":"SUM(E34:N34)","v":0},{"$f":"'3. Providers'!G58","v":0},{"$f":"'3. Providers'!G106","v":0},{"$f":"'3. Providers'!G70","v":0}]
[]
[]
[]
[null,null,"Percentage Allocated"]
["Line","Allocation Basis",null,"Total","Medical","Behavioral Health & Substance Abuse","Dental","Laboratory","X-Ray","Pharmacy","Enabling","Admin","Facility","Non-Allowable"]
[1,"Square Footage","Facility",{"$f":"SUM(E40:N40)","v":0},{"$f":"IFERROR(E32/$D32,0)","v":0},{"$f":"IFERROR(F32/$D32,0)","v":0},0,0,0,0,0,0,null,0]
[2,"Accumulated Cost","Admin",{"$f":"SUM(E41:N41)","v":0},{"$f":"IFERROR(E33/$D33,0)","v":0},0,0,0,0,0,0,null,null,0]
[3,"Total Visits","Enabling",{"$f":"SUM(E42:N42)","v":0},0,0,0]

{"sheet":"Form 1 - Direct Medical Cost","index":10,"n_rows":49,"n_cols":12,"rows_kept":49,"cut":false,"hidden":false,"merged":[[7,5,9,5],[1,1,1,5],[2,1,2,5],[3,1,3,5]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form 1 - Direct Medical Cost"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
["RECLASSIFICATIONS AND ADJUSTMENTS OF TRIAL BALANCE OF EXPENSES",null,null,null,null,null,null,null,null,null,null,"Form 1 (Direct Medical Care Cost)"]
[]
[null,null,null,null,null,"Compensation"," ",null,"","Reclassified","Adjustments","Net Expenses"]
["COST CENTER",null,null,"Salaried","Fringe",null,"Other",null,"Reclass-","Trial Balance","Increase","w Cost Changes"]
[null,null,null,"Personnel","Benefits",null,"Costs","Total","ifications","(Col 3 & 4)","(Decrease)","(Col 5 + 6)"]
["A.","DIRECT MEDICAL COST",null,"IA","IB","I","II","III","IV","V","VI","VII"]
[null,"(Excluding Dental and Behavioral Health)"]
["1.","Staff Cost"]
[100,"Physician",null,{"$f":"'3. Providers'!C21","v":0},{"$f":"IFERROR((D14/D$29)*E$29,\"0\")","v":"0"},{"$f":"D14+E14","v":0},{"$f":"'3. Providers'!D21","v":0},{"$f":"SUM(F14:G14)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A14,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A14,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H14+I14","v":0},{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A14, '7. Adjustment Template'!F$11:F$28)","v":0},{"$f":"J14+K14","v":0}]
[101,"Nurse Practitioners",null,{"$f":"'3. Providers'!C22","v":0},"0",{"$f":"D15+E15","v":0},{"$f":"'3. Providers'!D22","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A15,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A15,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H15+I15","v":0},{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A15, '7. Adjustment Template'!F$11:F$28)","v":0},{"$f":"J15+K15","v":0}]
[102,"Physician Assistants",null,{"$f":"'3. Providers'!C23","v":0},"0",0,{"$f":"'3. Providers'!D23","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A16,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A16,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A16, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[103,"Certified Nurse Midwives",null,{"$f":"'3. Providers'!C24","v":0},"0",0,{"$f":"'3. Providers'!D24","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A17,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A17,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A17, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[104,"Registered Nurses (RNs)",null,{"$f":"'3. Providers'!C27+'3. Providers'!C28","v":0},"0",{"$f":"D18+E18","v":0},{"$f":"'3. Providers'!D27+'3. Providers'!D28","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A18,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A18,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H18+I18","v":0},{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A18, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[105,"Licensed Practical Nurses",null,{"$f":"'3. Providers'!C29","v":0},"0",0,{"$f":"'3. Providers'!D29","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A19,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A19,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A19, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[106,"Opthalmologists",null,{"$f":"'3. Providers'!C32","v":0},"0",0,{"$f":"'3. Providers'!D32","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A20,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A20,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A20, '7. Adjustment Template'!F$11:F$28)","v":0},0]
["e.1","In-Bundle Direct Medical Staff Costs",null,{"$f":"SUM(D14:D20)","v":0},{"$f":"SUM(E14:E20)","v":0},{"$f":"SUM(F14:F20)","v":0},0,0,0,0,0,0]
[107,"Other Professional Services",null,{"$f":"'3. Providers'!C57-'3. Providers'!C51","v":0},{"$f":"IFERROR((D22/D$29)*E$29,\"0\")","v":"0"},{"$f":"D22+E22","v":0},{"$f":"'3. Providers'!D57-'3. Providers'!D51","v":0},{"$f":"SUM(F22:G22)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A22,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A22,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H22+I22","v":0},{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A22, '7. Adjustment Template'!F$11:F$28)","v":0},{"$f":"J22+K22","v":0}]
[108,"Optometrists",null,{"$f":"'3. Providers'!C33","v":0},{"$f":"IFERROR((D23/D$29)*E$29,\"0\")","v":"0"},0,{"$f":"'3. Providers'!D33","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A23,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A23,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A23, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[109,"Optician",null,{"$f":"'3. Providers'!C34","v":0},{"$f":"IFERROR((D24/D$29)*E$29,\"0\")","v":"0"},0,{"$f":"'3. Providers'!D34","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A24,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A24,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A24, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[110,"Other NON-BILLABLE Medical Providers",null,{"$f":"'3. Providers'!C51","v":0},{"$f":"IFERROR((D25/D$29)*E$29,\"0\")","v":"0"},0,{"$f":"'3. Providers'!D51","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A25,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A25,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A25, '7. Adjustment Template'!F$11:F$28)","v":0},0]
["e.2","Out-of-Bundle Direct Medical Staff Costs",null,{"$f":"SUM(D22:D25)","v":0},{"$f":"SUM(E22:E25)","v":0},{"$f":"SUM(F22:F25)","v":0},0,0,0,0,0,0]
[111,"Other Non-Provider Medical Staff",null,{"$f":"'4. Non-Providers'!C40","v":0},{"$f":"IFERROR((D27/D$29)*E$29,\"0\")","v":"0"},0,{"$f":"'4. Non-Providers'!D40","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A27,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A27,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A27, '7. Adjustment Template'!F$11:F$28)","v":0},0]
["e.3","Non-Provider Direct Medical Staff Costs",null,{"$f":"D27","v":0},{"$f":"E27","v":"0"},{"$f":"F27","v":0},0,0,0,0,0,0]
["e.4","Subtotal Direct Medical Staff Cost",null,{"$f":"SUM(D21,D26,D28)","v":0},{"$f":"'Cost Breakdown'!E$12","v":0},{"$f":"SUM(F21,F26,F28)","v":0},0,0,0,0,0,0]
["2.","Other Direct Medical Cost"]
[112,"Insurance",null,null,null,null,{"$f":"'5. Cost Information'!D35+'5. Cost Information'!G35","v":0},{"$f":"SUM(D31:G31)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A31,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A31,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H31+I31","v":0},{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A31, '7. Adjustment Template'!F$11:F$28)","v":0},{"$f":"J31+K31","v":0}]
[113,"Consumable Supplies",null,null,null,null,{"$f":"'5. Cost Information'!D36+'5. Cost Information'!G36","v":0},{"$f":"SUM(D32:G32)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A32,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A32,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A32, '7. Adjustment Template'!F$11:F$28)","v":0},{"$f":"J32+K32","v":0}]
[114,"Repairs and Maintenance",null,null,null,null,{"$f":"'5. Cost Information'!D37+'5. Cost Information'!G37","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A33,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A33,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A33, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[115,"Equipment Rental",null,null,null,null,{"$f":"'5. Cost Information'!D56+'5. Cost Information'!G56","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A34,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A34,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A34, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[116,"Travel, Conference and Meeting Expenses",null,null,null,null,{"$f":"'5. Cost Information'!D38+'5. Cost Information'!G38","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A35,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A35,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A35, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[117,"Dues and Subscriptions",null,null,null,null,{"$f":"'5. Cost Information'!D39+'5. Cost Information'!G39","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A36,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A36,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A36, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[118,"Interest Expense (Operating)",null,null,null,null,{"$f":"'5. Cost Information'!D41+'5. Cost Information'!G41","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A37,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A37,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A37, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[119,"Interest Expense (Capital)",null,null,null,null,{"$f":"'5. Cost Information'!D55+'5. Cost Information'!G55","v":0},{"$f":"SUM(D38:G38)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A38,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A38,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H38+I38","v":0},{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A38, '7. Adjustment Template'!F$11:F$28)","v":0},{"$f":"J38+K38","v":0}]
[120,"Professional Services",null,null,null,null,{"$f":"'5. Cost Information'!D43+'5. Cost Information'!G43","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A39,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A39,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A39, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[121,"Staff Training",null,null,null,null,{"$f":"'5. Cost Information'!D44+'5. Cost Information'!G44","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A40,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A40,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A40, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[122,"Contracted Services",null,null,null,null,{"$f":"'5. Cost Information'!D45+'5. Cost Information'!G45","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A41,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A41,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A41, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[123,"Publishing, Printing and Mailing",null,null,null,null,{"$f":"'5. Cost Information'!D46+'5. Cost Information'!G46","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A42,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A42,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A42, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[124,"Depreciation",null,null,null,null,{"$f":"'5. Cost Information'!D53+'5. Cost Information'!G53","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A43,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A43,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A43, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[125,"Personnel Recruitment",null,null,null,null,{"$f":"'5. Cost Information'!D48+'5. Cost Information'!G48","v":0},{"$f":"SUM(D44:G44)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A44,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A44,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A44, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[126,"Other Operating Expense ",null,null,null,null,{"$f":"'5. Cost Information'!D50+'5. Cost Information'!G50","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A45,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A45,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A45, '7. Adjustment Template'!F$11:F$28)","v":0},0]
[127,"Other Capital Expense",null,null,null,null,{"$f":"'5. Cost Information'!D57+'5. Cost Information'!G57","v":0},{"$f":"SUM(D46:G46)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,'Form 1 - Direct Medical Cost'!A46,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,'Form 1 - Direct Medical Cost'!A46,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H46+I46","v":0},{"$f":"SUMIF('7. Adjustment Template'!D$11:D$28, 'Form 1 - Direct Medical Cost'!A46, '7. Adjustment Template'!F$11:F$28)","v":0},{"$f":"J46+K46","v":0}]
["i.1","Subtotal Other Direct Medical Cost",null,null,null,null,{"$f":"SUM(G31:G46)","v":0},0,0,0,0,0]
[]
["3.","TOTAL DIRECT MEDICAL COST (1.e.4 & 2.i.1)",null,{"$f":"D47+D29","v":0},0,0,0,0,0,0,0,0]

{"sheet":"Form 2 - Direct Dental Cost","index":11,"n_rows":40,"n_cols":12,"rows_kept":40,"cut":false,"hidden":false,"merged":[[7,5,9,5],[1,1,1,4],[2,1,2,4],[3,1,3,4]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form 2 - Direct Dental Cost"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
["RECLASSIFICATIONS AND ADJUSTMENTS OF TRIAL BALANCE OF EXPENSES",null,null,null,null,null,null,null,null,null,null,"Form 2 (Direct Dental Care Cost)"]
[]
[null,null,null,null,null,"Compensation"," ",null,"","Reclassified","Adjustments","Net Expenses"]
["COST CENTER",null,null,"Salaried","Fringe",null,"Other",null,"Reclass-","Trial Balance","Increase","w Cost Changes"]
[null,null,null,"Personnel","Benefits",null,"Costs","Total","ifications","(Col 3 & 4)","(Decrease)","(Col 5 + 6)"]
["B.","DIRECT DENTAL CARE COST",null,"IA","IB","I","II","III","IV","V","VI","VII"]
["1.","Staff Cost"]
[200,"Dentist",null,{"$f":"'3. Providers'!C61","v":0},{"$f":"IFERROR((D13/D$20)*E$20, \"0\")","v":"0"},{"$f":"D13+E13","v":0},{"$f":"'3. Providers'!D61","v":0},{"$f":"SUM(F13:G13)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A13,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A13,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H13+I13","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A13,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J13+K13","v":0}]
[201,"Dental Specialist",null,{"$f":"'3. Providers'!C62","v":0},{"$f":"IFERROR((D14/D$20)*E$20, \"0\")","v":"0"},{"$f":"D14+E14","v":0},{"$f":"'3. Providers'!D62","v":0},{"$f":"SUM(F14:G14)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A14,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A14,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H14+I14","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A14,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J14+K14","v":0}]
[202,"Dental Hygienist",null,{"$f":"'3. Providers'!C63","v":0},{"$f":"IFERROR((D15/D$20)*E$20, \"0\")","v":"0"},0,{"$f":"'3. Providers'!D63","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A15,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A15,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H15+I15","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A15,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[203,"Other NON-BILLABLE Dental Providers",null,{"$f":"'3. Providers'!C64","v":0},{"$f":"IFERROR((D16/D$20)*E$20, \"0\")","v":"0"},{"$f":"D16+E16","v":0},{"$f":"'3. Providers'!D64","v":0},{"$f":"SUM(F16:G16)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A16,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A16,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A16,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
["d.1","In-Bundle Direct Dental Staff Costs",null,{"$f":"SUM(D13:D16)","v":0},0,0,0,0,0,0,0,0]
[204,"Other Non-Provider Staff",null,{"$f":"'4. Non-Providers'!C101","v":0},{"$f":"IFERROR((D18/D$20)*E$20, \"0\")","v":"0"},{"$f":"D18+E18","v":0},{"$f":"'4. Non-Providers'!D101","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A18,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A18,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A18,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
["d.2","Non-Provider Direct Dental Staff Costs",null,{"$f":"D18","v":0},{"$f":"E18","v":"0"},{"$f":"F18","v":0},0,0,0,0,0,0]
["d.3","Subtotal Direct Dental Staff Cost",null,{"$f":"SUM(D19,D17)","v":0},{"$f":"'Cost Breakdown'!G12","v":0},{"$f":"SUM(F19,F17)","v":0},0,0,0,0,0,0]
["2.","Other Direct Dental Care Cost"]
[205,"Insurance",null,null,null,null,{"$f":"'5. Cost Information'!F35","v":0},{"$f":"SUM(F22:G22)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A22,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A22,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H22+I22","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A22,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J22+K22","v":0}]
[206,"Consumable Supplies",null,null,null,null,{"$f":"'5. Cost Information'!F36","v":0},{"$f":"SUM(F23:G23)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A23,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A23,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A23,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[207,"Repairs and Maintenance",null,null,null,null,{"$f":"'5. Cost Information'!F37","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A24,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A24,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A24,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[208,"Equipment Rental",null,null,null,null,{"$f":"'5. Cost Information'!F56","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A25,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A25,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A25,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[209,"Travel, Conference and Meeting Expenses",null,null,null,null,{"$f":"'5. Cost Information'!F38","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A26,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A26,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A26,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[210,"Dues and Subscriptions",null,null,null,null,{"$f":"'5. Cost Information'!F39","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A27,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A27,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A27,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[211,"Interest Expense (Operating)",null,null,null,null,{"$f":"'5. Cost Information'!F41","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A28,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A28,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A28,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[212,"Interest Expense (Capital)",null,null,null,null,{"$f":"'5. Cost Information'!F55","v":0},{"$f":"SUM(F29:G29)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A29,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A29,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H29+I29","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A29,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J29+K29","v":0}]
[213,"Professional Services",null,null,null,null,{"$f":"'5. Cost Information'!F43","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A30,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A30,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A30,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[214,"Staff Training",null,null,null,null,{"$f":"'5. Cost Information'!F44","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A31,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A31,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A31,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[215,"Contracted Services",null,null,null,null,{"$f":"'5. Cost Information'!F45","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A32,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A32,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A32,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[216,"Publishing, Printing and Mailing",null,null,null,null,{"$f":"'5. Cost Information'!F46","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A33,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A33,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A33,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[217,"Depreciation",null,null,null,null,{"$f":"'5. Cost Information'!F53","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A34,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A34,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A34,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[218,"Personnel Recruitment",null,null,null,null,{"$f":"'5. Cost Information'!F48","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A35,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A35,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A35,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[219,"Other Operating Expense ",null,null,null,null,{"$f":"'5. Cost Information'!F50","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A36,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A36,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A36,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[220,"Other Capital Expense",null,null,null,null,{"$f":"'5. Cost Information'!F57","v":0},{"$f":"SUM(F37:G37)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A37,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A37,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H37+I37","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 2 - Direct Dental Cost'!A37,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J37+K37","v":0}]
["f.1","Subtotal Other Direct Dental Care Costs",null,null,null,null,{"$f":"SUM(G22:G37)","v":0},0,0,0,0,0]
[]
["3.","TOTAL DIRECT DENTAL CARE COST (1.d.3 & 2.f.1)",null,{"$f":"D38+D20","v":0},{"$f":"E38+E20","v":0},{"$f":"F38+F20","v":0},{"$f":"G38+G20","v":0},0,0,0,0,0]

{"sheet":"Form 3 - Direct BH Cost","index":12,"n_rows":63,"n_cols":12,"rows_kept":63,"cut":false,"hidden":false,"merged":[[7,5,9,5],[1,1,1,4],[2,1,2,4],[3,1,3,4]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form 3 - Direct BH Cost"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
["RECLASSIFICATIONS AND ADJUSTMENTS OF TRIAL BALANCE OF EXPENSES",null,null,null,null,null,null,null,null,null,null,"Form 3 (Direct Behavioral Health Care Cost)"]
[]
[null,null,null,null,null,"Compensation"," ",null,"","Reclassified","Adjustments","Net Expenses"]
["COST CENTER",null,null,"Salaried","Fringe",null,"Other",null,"Reclass-","Trial Balance","Increase","w Cost Changes"]
[null,null,null,"Personnel","Benefits",null,"Costs","Total","ifications","(Col 3 & 4)","(Decrease)","(Col 5 + 6)"]
["C.","DIRECT BEHAVIORAL HEALTH CARE COST",null,"IA","IB","I","II","III","IV","V","VI","VII"]
["1.","Staff Cost"]
["Mental Health "]
[300,"Psychiatrists",null,{"$f":"'3. Providers'!C74","v":0},{"$f":"IFERROR((D14/D$41)*E$41, \"0\")","v":"0"},{"$f":"D14+E14","v":0},{"$f":"'3. Providers'!D74","v":0},{"$f":"SUM(F14:G14)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A14,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A14,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H14+I14","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A14,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J14+K14","v":0}]
[301,"Psychologists",null,{"$f":"'3. Providers'!C75","v":0},"0",0,{"$f":"'3. Providers'!D75","v":0},{"$f":"SUM(F15:G15)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A15,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A15,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A15,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J15+K15","v":0}]
[302,"Licensed Independent Clinical Social Worker (LISCW)",null,{"$f":"'3. Providers'!C77","v":0},"0",0,{"$f":"'3. Providers'!D77","v":0},{"$f":"SUM(F16:G16)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A16,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A16,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A16,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[303,"Licensed Clinical Social Worker (LCSW)",null,{"$f":"'3. Providers'!C78","v":0},"0",0,{"$f":"'3. Providers'!D78","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A17,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A17,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A17,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[304,"Unlicensed Master of Social Worker (MSW)",null,{"$f":"'3. Providers'!C79","v":0},"0",0,{"$f":"'3. Providers'!D79","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A18,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A18,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A18,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[305,"Licensed Mental Health Counselor (LMHC)",null,{"$f":"'3. Providers'!C80","v":0},"0",0,{"$f":"'3. Providers'!D80","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A19,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A19,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A19,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[306,"Family Therapists",null,{"$f":"'3. Providers'!C81","v":0},"0",0,{"$f":"'3. Providers'!D81","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A20,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A20,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A20,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[307,"Psychiatric Nurse Practitioner",null,{"$f":"'3. Providers'!C83","v":0},"0",0,{"$f":"'3. Providers'!D83","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A21,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A21,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A21,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[308,"Nurses - Psychiatric and Mental Health",null,{"$f":"'3. Providers'!C84","v":0},"0",0,{"$f":"'3. Providers'!D84","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A22,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A22,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A22,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[309,"RN Nurse Counselors",null,{"$f":"'3. Providers'!C85","v":0},"0",0,{"$f":"'3. Providers'!D85","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A23,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A23,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A23,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[310,"Unlicensed Mental Health Providers, including trainees (interns or residents) and \"Certified\" staff",null,{"$f":"'3. Providers'!C86","v":0},"0",0,{"$f":"'3. Providers'!D86","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A24,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A24,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A24,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
["Substance Use Disorder "]
[311,"RN Nurse Counselors",null,{"$f":"'3. Providers'!C89","v":0},{"$f":"IFERROR((D26/D$41)*E$41, \"0\")","v":"0"},{"$f":"D26+E26","v":0},{"$f":"'3. Providers'!D89","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A26,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A26,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A26,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[312,"Licensed Independent Clinical Social Worker (LISCW)",null,{"$f":"'3. Providers'!C91","v":0},"0",{"$f":"D27+E27","v":0},{"$f":"'3. Providers'!D91","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A27,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A27,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A27,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[313,"Licensed Clinical Social Worker (LCSW)",null,{"$f":"'3. Providers'!C92","v":0},"0",0,{"$f":"'3. Providers'!D92","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A28,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A28,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A28,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[314,"Unlicensed Master of Social Worker (MSW)",null,{"$f":"'3. Providers'!C93","v":0},"0",0,{"$f":"'3. Providers'!D93","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A29,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A29,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A29,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[315,"Licensed Mental Health Counselor (LMHC)",null,{"$f":"'3. Providers'!C94","v":0},"0",0,{"$f":"'3. Providers'!D94","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A30,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A30,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A30,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[316,"LADAC/CADAC",null,{"$f":"'3. Providers'!C96","v":0},"0",0,{"$f":"'3. Providers'!D96","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A31,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A31,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A31,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[317,"Family Therapists",null,{"$f":"'3. Providers'!C95","v":0},"0",0,{"$f":"'3. Providers'!D95","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A32,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A32,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A32,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[318,"Recovery Coaches/Peer Support",null,{"$f":"'3. Providers'!C98","v":0},"0",0,{"$f":"'3. Providers'!D98","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A33,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A33,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A33,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
["d.1","In-Bundle Direct Behavioral Health Staff Costs",null,{"$f":"SUM(D14:D33)","v":0},{"$f":"SUM(E14:E33)","v":0},{"$f":"SUM(F14:F33)","v":0},0,0,0,0,0,0]
["Substance Use Disorder "]
[319,"Harm Reduction Specialist",null,{"$f":"'3. Providers'!C97","v":0},{"$f":"IFERROR((D36/D$41)*E$41, \"0\")","v":"0"},0,{"$f":"'3. Providers'!D97","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A36,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A36,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A36,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[320,"Other NON-BILLABLE MH/SUD Providers",null,{"$f":"'3. Providers'!C99","v":0},{"$f":"IFERROR((D37/D$41)*E$41, \"0\")","v":"0"},{"$f":"D37+E37","v":0},{"$f":"'3. Providers'!D99","v":0},{"$f":"SUM(F37:G37)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A37,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A37,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A37,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
["d.2","Out-of-Bundle Direct Behavioral Health Staff Costs",null,{"$f":"SUM(D36:D37)","v":0},0,0,0,0,0,0,0,0]
[321,"Other MH/SUD Non-Provider Staff",null,{"$f":"'4. Non-Providers'!C116","v":0},{"$f":"IFERROR((D39/D$41)*E$41, \"0\")","v":"0"},0,{"$f":"'4. Non-Providers'!D116","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A39,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A39,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A39,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
["d.3","Non-Provider Direct Behavioral Health Staff Costs",null,{"$f":"D39","v":0},{"$f":"E39","v":"0"},{"$f":"F39","v":0},0,0,0,0,0,0]
["d.4","Subtotal Direct Behavioral Health Staff Cost",null,{"$f":"SUM(D34,D38,D40)","v":0},{"$f":"'Cost Breakdown'!F12","v":0},{"$f":"SUM(F34,F38,F40)","v":0},0,0,0,0,0,0]
["2.","Other Direct Behavioral Health Care Cost"]
[322,"Insurance",null,null,null,null,{"$f":"'5. Cost Information'!E35","v":0},{"$f":"SUM(D43:G43)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A43,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A43,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H43+I43","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A43,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J43+K43","v":0}]
[323,"Consumable Supplies",null,null,null,null,{"$f":"'5. Cost Information'!E36","v":0},{"$f":"SUM(D44:G44)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A44,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A44,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A44,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[324,"Repairs and Maintenance",null,null,null,null,{"$f":"'5. Cost Information'!E37","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A45,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A45,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A45,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[325,"Equipment Rental",null,null,null,null,{"$f":"'5. Cost Information'!E56","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A46,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A46,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A46,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[326,"Travel, Conference and Meeting Expenses",null,null,null,null,{"$f":"'5. Cost Information'!E38","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A47,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A47,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A47,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[327,"Dues and Subscriptions",null,null,null,null,{"$f":"'5. Cost Information'!E39","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A48,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A48,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A48,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[328,"Interest Expense (Operating)",null,null,null,null,{"$f":"'5. Cost Information'!E41","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A49,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A49,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A49,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[329,"Interest Expense (Capital)",null,null,null,null,{"$f":"'5. Cost Information'!E55","v":0},{"$f":"SUM(D50:G50)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A50,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A50,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H50+I50","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A50,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J50+K50","v":0}]
[330,"Professional Services",null,null,null,null,{"$f":"'5. Cost Information'!E43","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A51,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A51,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A51,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[331,"Staff Training",null,null,null,null,{"$f":"'5. Cost Information'!E44","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A52,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A52,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A52,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[332,"Contracted Services",null,null,null,null,{"$f":"'5. Cost Information'!E45","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A53,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A53,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A53,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[333,"Publishing, Printing and Mailing",null,null,null,null,{"$f":"'5. Cost Information'!E46","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A54,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A54,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A54,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[334,"Depreciation",null,null,null,null,{"$f":"'5. Cost Information'!E53","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A55,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A55,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A55,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[335,"Personnel Recruitment",null,null,null,null,{"$f":"'5. Cost Information'!E48","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A56,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A56,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A56,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[336,"Other Operating Expense ",null,null,null,null,{"$f":"'5. Cost Information'!E50","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A57,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A57,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A57,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[337,"Other Capital Expense",null,null,null,null,{"$f":"'5. Cost Information'!E57","v":0},{"$f":"SUM(D58:G58)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A58,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A58,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H58+I58","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,'Form 3 - Direct BH Cost'!A58,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J58+K58","v":0}]
["f.1","Subtotal Other Direct Behavioral Health Care Costs",null,null,null,null,{"$f":"SUM(G43:G58)","v":0},0,0,0,0,0]
[]
["3.","TOTAL DIRECT BEHAVIORAL HEALTH CARE COST (1.d.4 & 2.f.1)",null,{"$f":"D59+D41","v":0},{"$f":"E59+E41","v":0},{"$f":"F59+F41","v":0},{"$f":"G59+G41","v":0},0,0,0,0,0]
[]
["D. ","TOTAL DIRECT COST BEFORE NON-ALLOWABLE SERVICES",null,{"$f":"D61+'Form 2 - Direct Dental Cost'!D40+'Form 1 - Direct Medical Cost'!D49","v":0},{"$f":"E61+'Form 2 - Direct Dental Cost'!E40+'Form 1 - Direct Medical Cost'!E49","v":0},{"$f":"D63+E63","v":0},{"$f":"G61+'Form 2 - Direct Dental Cost'!G40+'Form 1 - Direct Medical Cost'!G49","v":0},{"$f":"H61+'Form 2 - Direct Dental Cost'!H40+'Form 1 - Direct Medical Cost'!H49","v":0},{"$f":"I61+'Form 2 - Direct Dental Cost'!I40+'Form 1 - Direct Medical Cost'!I49","v":0},{"$f":"J61+'Form 2 - Direct Dental Cost'!J40+'Form 1 - Direct Medical Cost'!J49","v":0},{"$f":"K61+'Form 2 - Direct Dental Cost'!K40+'Form 1 - Direct Medical Cost'!K49","v":0},{"$f":"L61+'Form 2 - Direct Dental Cost'!L40+'Form 1 - Direct Medical Cost'!L49","v":0}]

{"sheet":"Form 4 - NonAllowable","index":13,"n_rows":33,"n_cols":12,"rows_kept":33,"cut":false,"hidden":false,"merged":[[1,1,1,4],[2,1,2,4],[3,1,3,4]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form 4 - NonAllowable"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
["RECLASSIFICATIONS AND ADJUSTMENTS OF TRIAL BALANCE OF EXPENSES",null,null,null,null,null,null,null,null,null,null,"Form 4 (Non-Allowable Other Direct Service Cost)"]
[]
[null,null,null,null,null,null," ",null,"","Reclassified","Adjustments","Net Expenses"]
["COST CENTER",null,null,"Salaried","Fringe",null,"Other",null,"Reclass-","Trial Balance","Increase","w Cost Changes"]
[null,null,null,"Personnel","Benefits","Compensation","Costs","Total","ifications","(Col 3 & 4)","(Decrease)","(Col 5 + 6)"]
["E.","NON-ALLOWABLE DIRECT OTHER SERVICE COST",null,"IA","IB","I","II","III","IV","V","VI","VII"]
["1.","Service"]
[400,"WIC",null,{"$f":"'4. Non-Providers'!C293","v":0},{"$f":"IFERROR(E$32*(D13/(D$32-D$27-D$26-D$25)), \"0\")","v":"0"},{"$f":"D13+E13","v":0},{"$f":"'4. Non-Providers'!D293+'5. Cost Information'!P58","v":0},{"$f":"SUM(F13:G13)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A13,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A13,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H13+I13","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A13,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J13+K13","v":0}]
[401,"Head Start",null,{"$f":"'4. Non-Providers'!C294","v":0},"0",{"$f":"D14+E14","v":0},{"$f":"'4. Non-Providers'!D294","v":0},{"$f":"SUM(F14:G14)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A14,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A14,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A14,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J14+K14","v":0}]
[402,"Housing Assistance ",null,{"$f":"'4. Non-Providers'!C295","v":0},"0",0,{"$f":"'4. Non-Providers'!D295","v":0},{"$f":"SUM(F15:G15)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A15,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A15,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A15,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[403,"Child Care Services",null,{"$f":"'4. Non-Providers'!C296","v":0},"0",0,{"$f":"'4. Non-Providers'!D296","v":0},{"$f":"SUM(F16:G16)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A16,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A16,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A16,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[404,"Food Bank/Meal Delivery ",null,{"$f":"'4. Non-Providers'!C297","v":0},"0",0,{"$f":"'4. Non-Providers'!D297","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A17,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A17,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A17,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[405,"Employment/Educational Services",null,{"$f":"'4. Non-Providers'!C298","v":0},"0",0,{"$f":"'4. Non-Providers'!D298","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A18,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A18,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A18,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[406,"Exercise Trainers/Fitness Center ",null,{"$f":"'4. Non-Providers'!C299","v":0},"0",0,{"$f":"'4. Non-Providers'!D299","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A19,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A19,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A19,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[407,"Adult Day Health Care",null,{"$f":"'4. Non-Providers'!C300","v":0},"0",0,{"$f":"'4. Non-Providers'!D300","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A20,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A20,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A20,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[408,"Fundraising/Development ",null,{"$f":"'4. Non-Providers'!C301","v":0},"0",0,{"$f":"'4. Non-Providers'!D301","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A21,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A21,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A21,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[409,"PACE ",null,{"$f":"'4. Non-Providers'!C302","v":0},"0",0,{"$f":"'4. Non-Providers'!D302+'5. Cost Information'!R58","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A22,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A22,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A22,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[410,"SCO ",null,{"$f":"'4. Non-Providers'!C303","v":0},"0",0,{"$f":"'4. Non-Providers'!D303+'5. Cost Information'!S58","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A23,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A23,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A23,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[411,"Non-FQHC Sites",null,{"$f":"'4. Non-Providers'!C304","v":0},"0",0,{"$f":"'4. Non-Providers'!D304+'5. Cost Information'!Q58","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A24,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A24,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A24,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[412,"Laboratory ",null,{"$f":"'4. Non-Providers'!C55","v":0},{"$f":"'Cost Breakdown'!H12","v":0},0,{"$f":"'4. Non-Providers'!D55+'5. Cost Information'!H58","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A25,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A25,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A25,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[413,"Radiology",null,{"$f":"'4. Non-Providers'!C69","v":0},{"$f":"'Cost Breakdown'!I12","v":0},0,{"$f":"'4. Non-Providers'!D69+'5. Cost Information'!I58","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A26,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A26,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A26,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[414,"Pharmacy",null,{"$f":"'4. Non-Providers'!C84","v":0},{"$f":"'Cost Breakdown'!J12","v":0},0,{"$f":"'4. Non-Providers'!D84+'5. Cost Information'!J58","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A27,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A27,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A27,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[415,"Other Non-Allowable",null,{"$f":"'4. Non-Providers'!C305","v":0},{"$f":"IFERROR(E$32*(D28/(D$32-D$27-D$26-D$25)), \"0\")","v":"0"},0,{"$f":"'4. Non-Providers'!D305+'5. Cost Information'!T58","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A28,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A28,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A28,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
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["e.","Total Non-Allowable Direct Other Service Cost",null,{"$f":"SUM(D13:D31)","v":0},{"$f":"'Cost Breakdown'!N12","v":0},{"$f":"SUM(F13:F31)","v":0},{"$f":"SUM(G13:G31)","v":0},{"$f":"SUM(H13:H31)","v":0},0,0,0,0]
["F.","TOTAL DIRECT COST",null,{"$f":"D32+'Form 3 - Direct BH Cost'!D63","v":0},{"$f":"E32+'Form 3 - Direct BH Cost'!E63","v":0},{"$f":"F32+'Form 3 - Direct BH Cost'!F63","v":0},{"$f":"G32+'Form 3 - Direct BH Cost'!G63","v":0},{"$f":"H32+'Form 3 - Direct BH Cost'!H63","v":0},{"$f":"I32+'Form 3 - Direct BH Cost'!I63","v":0},{"$f":"J32+'Form 3 - Direct BH Cost'!J63","v":0},{"$f":"K32+'Form 3 - Direct BH Cost'!K63","v":0},{"$f":"L32+'Form 3 - Direct BH Cost'!L63","v":0}]

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[]
[null,"Community Health Center Cost Report"]
[null,"Form 5 - Overhead & Enabling"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
["RECLASSIFICATIONS AND ADJUSTMENTS OF TRIAL BALANCE OF EXPENSES",null,null,null,null,null,null,null,null,null,null,"Form 5 (Overhead & Enabling Cost)"]
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[503,"Repairs and Maintenance",null,null,null,null,{"$f":"'5. Cost Information'!M37","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A15,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A15,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A15,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
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[505,"Travel, Conference and Meeting Expenses",null,null,null,null,{"$f":"'5. Cost Information'!M38","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A17,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A17,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A17,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[506,"Dues and Subscriptions",null,null,null,null,{"$f":"'5. Cost Information'!M39","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A18,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A18,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A18,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[507,"Utilities",null,null,null,null,{"$f":"'5. Cost Information'!M40","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A19,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A19,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A19,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[508,"Interest Expense (Operating)",null,null,null,null,{"$f":"'5. Cost Information'!M41","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A20,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A20,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A20,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[509,"Interest Expense (Capital)",null,null,null,null,{"$f":"'5. Cost Information'!M55","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A21,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A21,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H21+I21","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A21,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J21+K21","v":0}]
[510,"Professional Services",null,null,null,null,{"$f":"'5. Cost Information'!M43","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A22,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A22,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A22,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[511,"Staff Training",null,null,null,null,{"$f":"'5. Cost Information'!M44","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A23,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A23,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A23,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[512,"Contracted Services",null,null,null,null,{"$f":"'5. Cost Information'!M45","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A24,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A24,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A24,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[513,"Publishing, Printing and Mailing",null,null,null,null,{"$f":"'5. Cost Information'!M46","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A25,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A25,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A25,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[514,"Rent",null,null,null,null,{"$f":"'5. Cost Information'!M52","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A26,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A26,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A26,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[515,"Depreciation",null,null,null,null,{"$f":"'5. Cost Information'!M53","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A27,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A27,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A27,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[516,"Occupancy Taxes",null,null,null,null,{"$f":"'5. Cost Information'!M54","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A28,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A28,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A28,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[517,"Personnel Recruitment",null,null,null,null,{"$f":"'5. Cost Information'!M48","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A29,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A29,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A29,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[518,"Other Operating Expense ",null,null,null,null,{"$f":"'5. Cost Information'!M50","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A30,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A30,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A30,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[519,"Other Capital Expense",null,null,null,null,{"$f":"'5. Cost Information'!M57","v":0},{"$f":"SUM(F31:G31)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A31,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A31,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H31+I31","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A31,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J31+K31","v":0}]
["i.","Subtotal Overhead - Facility Cost",null,{"$f":"SUM(D12:D30)","v":0},{"$f":"'Cost Breakdown'!M12","v":0},{"$f":"SUM(F12:F31)","v":0},0,0,0,0,0,0]
["H.","OVERHEAD - ADMINISTRATIVE COST",null,"IA","IB","I","II","III","IV","V","VI","VII"]
[520,"Office/Admin Personnel",null,{"$f":"'4. Non-Providers'!C270","v":0},{"$f":"'Cost Breakdown'!L12","v":0},{"$f":"D34+E34","v":0},{"$f":"'4. Non-Providers'!D270","v":0},{"$f":"SUM(F34:G34)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A34,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A34,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H34+I34","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A34,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J34+K34","v":0}]
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[522,"Consumable Supplies",null,null,null,null,{"$f":"'5. Cost Information'!L36","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A36,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A36,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A36,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[523,"Repairs and Maintenance",null,null,null,null,{"$f":"'5. Cost Information'!L37","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A37,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A37,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A37,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[524,"Equipment Rental",null,null,null,null,{"$f":"'5. Cost Information'!L56","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A38,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A38,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A38,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
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[535,"Telephone & Pagers/Communications",null,null,null,null,{"$f":"'5. Cost Information'!L47","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A49,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A49,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A49,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
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[545,"Travel, Conference and Meeting Expenses",null,null,null,null,{"$f":"'5. Cost Information'!K38","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A61,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A61,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A61,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
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[547,"Interest Expense (Operating)",null,null,null,null,{"$f":"'5. Cost Information'!K41","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A63,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A63,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A63,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
[548,"Interest Expense (Capital)",null,null,null,null,{"$f":"'5. Cost Information'!K55","v":0},{"$f":"SUM(D64:G64)","v":0},{"$f":"SUMIF('6. Reclass Template'!$E:$E,A64,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A64,'6. Reclass Template'!$I:$I)","v":0},{"$f":"H64+I64","v":0},{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A64,'7. Adjustment Template'!$F$11:$F$28)","v":0},{"$f":"J64+K64","v":0}]
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[550,"Staff Training",null,null,null,null,{"$f":"'5. Cost Information'!K44","v":0},0,{"$f":"SUMIF('6. Reclass Template'!$E:$E,A66,'6. Reclass Template'!$F:$F)-SUMIF('6. Reclass Template'!$H:$H,A66,'6. Reclass Template'!$I:$I)","v":0},0,{"$f":"SUMIF('7. Adjustment Template'!$D$11:$D$28,A66,'7. Adjustment Template'!$F$11:$F$28)","v":0},0]
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["i.","Subtotal - Enabling Cost",null,{"$f":"SUM(D56:D72)","v":0},{"$f":"SUM(E56:E72)","v":0},{"$f":"SUM(F56:F72)","v":0},{"$f":"SUM(G56:G72)","v":0},{"$f":"SUM(H56:H72)","v":0},{"$f":"SUM(I56:I72)","v":0},{"$f":"SUM(J56:J72)","v":0},0,0]
["l.","TOTAL OVERHEAD AND ENABLING COST (Gi + Hi + Ii)",null,{"$f":"D32+D54+D73","v":0},{"$f":"E32+E54+E73","v":0},0,0,0,0,0,0,0]
[]
[null,"TOTAL EXPENSES",null,null,null,{"$f":"F74+'Form 4 - NonAllowable'!F33","v":0},{"$f":"G74+'Form 4 - NonAllowable'!G33","v":0},{"$f":"H74+'Form 4 - NonAllowable'!H33","v":0},{"$f":"I74+'Form 4 - NonAllowable'!I33","v":0},{"$f":"J74+'Form 4 - NonAllowable'!J33","v":0},{"$f":"K74+'Form 4 - NonAllowable'!K33","v":0},{"$f":"L74+'Form 4 - NonAllowable'!L33","v":0}]

{"sheet":"Form 6A - Reclassification","index":15,"n_rows":59,"n_cols":9,"rows_kept":59,"cut":false,"hidden":false,"merged":[[6,6,6,8],[6,1,7,1],[1,1,1,3],[2,1,2,3],[6,2,7,2],[6,3,6,5],[3,1,3,3]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form 6A - Reclassification"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
["RECLASSIFICATION OF TRIAL BALANCE OF EXPENSES",null,null,null,null,null,null,null,"Form 6A (Reclassification)"]
[]
[null,"Description of Reclassification(s)",null,"Increases",null,null,"Decreases"]
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{"sheet":"Form 6B - Adjustments","index":16,"n_rows":27,"n_cols":9,"rows_kept":27,"cut":false,"hidden":false,"merged":[[6,1,6,5],[1,1,1,2],[2,1,2,2],[3,1,3,2]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form 6B - Adjustments"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
["ADJUSTMENT OF TRIAL BALANCE OF EXPENSES",null,null,null,null,"Form 6B (Adjustment)"]
[]
[null,"Adjustments to Expenses"]
["Line","Description of Adjustment to Expenses","Basis for Adjustment","Worksheet Line Number","Cost Center","Amount"]
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[2,{"$f":"IF('7. Adjustment Template'!B12 = 0, \"\", '7. Adjustment Template'!B12)","v":""},{"$f":"IF('7. Adjustment Template'!C12 = 0, \"\", '7. Adjustment Template'!C12)","v":""},{"$f":"IF('7. Adjustment Template'!D12 = 0, \"\", '7. Adjustment Template'!D12)","v":""},{"$f":"IF('7. Adjustment Template'!E12 = 0, \"\", '7. Adjustment Template'!E12)","v":""},{"$f":"IF('7. Adjustment Template'!F12 = 0, \"\", '7. Adjustment Template'!F12)","v":""},null,"A","Medical"]
[3,{"$f":"IF('7. Adjustment Template'!B13 = 0, \"\", '7. Adjustment Template'!B13)","v":""},{"$f":"IF('7. Adjustment Template'!C13 = 0, \"\", '7. Adjustment Template'!C13)","v":""},{"$f":"IF('7. Adjustment Template'!D13 = 0, \"\", '7. Adjustment Template'!D13)","v":""},{"$f":"IF('7. Adjustment Template'!E13 = 0, \"\", '7. Adjustment Template'!E13)","v":""},{"$f":"IF('7. Adjustment Template'!F13 = 0, \"\", '7. Adjustment Template'!F13)","v":""},null,"B","Dental "]
[4,{"$f":"IF('7. Adjustment Template'!B14 = 0, \"\", '7. Adjustment Template'!B14)","v":""},{"$f":"IF('7. Adjustment Template'!C14 = 0, \"\", '7. Adjustment Template'!C14)","v":""},{"$f":"IF('7. Adjustment Template'!D14 = 0, \"\", '7. Adjustment Template'!D14)","v":""},{"$f":"IF('7. Adjustment Template'!E14 = 0, \"\", '7. Adjustment Template'!E14)","v":""},{"$f":"IF('7. Adjustment Template'!F14 = 0, \"\", '7. Adjustment Template'!F14)","v":""},null,"C","Behavioral Health"]
[5,{"$f":"IF('7. Adjustment Template'!B15 = 0, \"\", '7. Adjustment Template'!B15)","v":""},{"$f":"IF('7. Adjustment Template'!C15 = 0, \"\", '7. Adjustment Template'!C15)","v":""},{"$f":"IF('7. Adjustment Template'!D15 = 0, \"\", '7. Adjustment Template'!D15)","v":""},{"$f":"IF('7. Adjustment Template'!E15 = 0, \"\", '7. Adjustment Template'!E15)","v":""},{"$f":"IF('7. Adjustment Template'!F15 = 0, \"\", '7. Adjustment Template'!F15)","v":""},null,"D","Non-Allowable Cost"]
[6,{"$f":"IF('7. Adjustment Template'!B16 = 0, \"\", '7. Adjustment Template'!B16)","v":""},{"$f":"IF('7. Adjustment Template'!C16 = 0, \"\", '7. Adjustment Template'!C16)","v":""},{"$f":"IF('7. Adjustment Template'!D16 = 0, \"\", '7. Adjustment Template'!D16)","v":""},{"$f":"IF('7. Adjustment Template'!E16 = 0, \"\", '7. Adjustment Template'!E16)","v":""},{"$f":"IF('7. Adjustment Template'!F16 = 0, \"\", '7. Adjustment Template'!F16)","v":""},null,"E","Overhead - Facility "]
[7,{"$f":"IF('7. Adjustment Template'!B17 = 0, \"\", '7. Adjustment Template'!B17)","v":""},{"$f":"IF('7. Adjustment Template'!C17 = 0, \"\", '7. Adjustment Template'!C17)","v":""},{"$f":"IF('7. Adjustment Template'!D17 = 0, \"\", '7. Adjustment Template'!D17)","v":""},{"$f":"IF('7. Adjustment Template'!E17 = 0, \"\", '7. Adjustment Template'!E17)","v":""},{"$f":"IF('7. Adjustment Template'!F17 = 0, \"\", '7. Adjustment Template'!F17)","v":""},null,"F","Overhead - Administrative"]
[8,{"$f":"IF('7. Adjustment Template'!B18 = 0, \"\", '7. Adjustment Template'!B18)","v":""},{"$f":"IF('7. Adjustment Template'!C18 = 0, \"\", '7. Adjustment Template'!C18)","v":""},{"$f":"IF('7. Adjustment Template'!D18 = 0, \"\", '7. Adjustment Template'!D18)","v":""},{"$f":"IF('7. Adjustment Template'!E18 = 0, \"\", '7. Adjustment Template'!E18)","v":""},{"$f":"IF('7. Adjustment Template'!F18 = 0, \"\", '7. Adjustment Template'!F18)","v":""},null,"G","Enabling "]
[9,{"$f":"IF('7. Adjustment Template'!B19 = 0, \"\", '7. Adjustment Template'!B19)","v":""},{"$f":"IF('7. Adjustment Template'!C19 = 0, \"\", '7. Adjustment Template'!C19)","v":""},{"$f":"IF('7. Adjustment Template'!D19 = 0, \"\", '7. Adjustment Template'!D19)","v":""},{"$f":"IF('7. Adjustment Template'!E19 = 0, \"\", '7. Adjustment Template'!E19)","v":""},{"$f":"IF('7. Adjustment Template'!F19 = 0, \"\", '7. Adjustment Template'!F19)","v":""}]
[10,{"$f":"IF('7. Adjustment Template'!B20 = 0, \"\", '7. Adjustment Template'!B20)","v":""},{"$f":"IF('7. Adjustment Template'!C20 = 0, \"\", '7. Adjustment Template'!C20)","v":""},{"$f":"IF('7. Adjustment Template'!D20 = 0, \"\", '7. Adjustment Template'!D20)","v":""},{"$f":"IF('7. Adjustment Template'!E20 = 0, \"\", '7. Adjustment Template'!E20)","v":""},{"$f":"IF('7. Adjustment Template'!F20 = 0, \"\", '7. Adjustment Template'!F20)","v":""}]
[11,{"$f":"IF('7. Adjustment Template'!B21 = 0, \"\", '7. Adjustment Template'!B21)","v":""},{"$f":"IF('7. Adjustment Template'!C21 = 0, \"\", '7. Adjustment Template'!C21)","v":""},{"$f":"IF('7. Adjustment Template'!D21 = 0, \"\", '7. Adjustment Template'!D21)","v":""},{"$f":"IF('7. Adjustment Template'!E21 = 0, \"\", '7. Adjustment Template'!E21)","v":""},{"$f":"IF('7. Adjustment Template'!F21 = 0, \"\", '7. Adjustment Template'!F21)","v":""}]
[12,{"$f":"IF('7. Adjustment Template'!B22 = 0, \"\", '7. Adjustment Template'!B22)","v":""},{"$f":"IF('7. Adjustment Template'!C22 = 0, \"\", '7. Adjustment Template'!C22)","v":""},{"$f":"IF('7. Adjustment Template'!D22 = 0, \"\", '7. Adjustment Template'!D22)","v":""},{"$f":"IF('7. Adjustment Template'!E22 = 0, \"\", '7. Adjustment Template'!E22)","v":""},{"$f":"IF('7. Adjustment Template'!F22 = 0, \"\", '7. Adjustment Template'!F22)","v":""}]
[13,{"$f":"IF('7. Adjustment Template'!B23 = 0, \"\", '7. Adjustment Template'!B23)","v":""},{"$f":"IF('7. Adjustment Template'!C23 = 0, \"\", '7. Adjustment Template'!C23)","v":""},{"$f":"IF('7. Adjustment Template'!D23 = 0, \"\", '7. Adjustment Template'!D23)","v":""},{"$f":"IF('7. Adjustment Template'!E23 = 0, \"\", '7. Adjustment Template'!E23)","v":""},{"$f":"IF('7. Adjustment Template'!F23 = 0, \"\", '7. Adjustment Template'!F23)","v":""}]
[14,{"$f":"IF('7. Adjustment Template'!B24 = 0, \"\", '7. Adjustment Template'!B24)","v":""},{"$f":"IF('7. Adjustment Template'!C24 = 0, \"\", '7. Adjustment Template'!C24)","v":""},{"$f":"IF('7. Adjustment Template'!D24 = 0, \"\", '7. Adjustment Template'!D24)","v":""},{"$f":"IF('7. Adjustment Template'!E24 = 0, \"\", '7. Adjustment Template'!E24)","v":""},{"$f":"IF('7. Adjustment Template'!F24 = 0, \"\", '7. Adjustment Template'!F24)","v":""}]
[15,{"$f":"IF('7. Adjustment Template'!B25 = 0, \"\", '7. Adjustment Template'!B25)","v":""},{"$f":"IF('7. Adjustment Template'!C25 = 0, \"\", '7. Adjustment Template'!C25)","v":""},{"$f":"IF('7. Adjustment Template'!D25 = 0, \"\", '7. Adjustment Template'!D25)","v":""},{"$f":"IF('7. Adjustment Template'!E25 = 0, \"\", '7. Adjustment Template'!E25)","v":""},{"$f":"IF('7. Adjustment Template'!F25 = 0, \"\", '7. Adjustment Template'!F25)","v":""}]
[16,{"$f":"IF('7. Adjustment Template'!B26 = 0, \"\", '7. Adjustment Template'!B26)","v":""},{"$f":"IF('7. Adjustment Template'!C26 = 0, \"\", '7. Adjustment Template'!C26)","v":""},{"$f":"IF('7. Adjustment Template'!D26 = 0, \"\", '7. Adjustment Template'!D26)","v":""},{"$f":"IF('7. Adjustment Template'!E26 = 0, \"\", '7. Adjustment Template'!E26)","v":""},{"$f":"IF('7. Adjustment Template'!F26 = 0, \"\", '7. Adjustment Template'!F26)","v":""}]
[17,{"$f":"IF('7. Adjustment Template'!B27 = 0, \"\", '7. Adjustment Template'!B27)","v":""},{"$f":"IF('7. Adjustment Template'!C27 = 0, \"\", '7. Adjustment Template'!C27)","v":""},{"$f":"IF('7. Adjustment Template'!D27 = 0, \"\", '7. Adjustment Template'!D27)","v":""},{"$f":"IF('7. Adjustment Template'!E27 = 0, \"\", '7. Adjustment Template'!E27)","v":""},{"$f":"IF('7. Adjustment Template'!F27 = 0, \"\", '7. Adjustment Template'!F27)","v":""}]
[18,{"$f":"IF('7. Adjustment Template'!B28 = 0, \"\", '7. Adjustment Template'!B28)","v":""},{"$f":"IF('7. Adjustment Template'!C28 = 0, \"\", '7. Adjustment Template'!C28)","v":""},{"$f":"IF('7. Adjustment Template'!D28 = 0, \"\", '7. Adjustment Template'!D28)","v":""},{"$f":"IF('7. Adjustment Template'!E28 = 0, \"\", '7. Adjustment Template'!E28)","v":""},{"$f":"IF('7. Adjustment Template'!F28 = 0, \"\", '7. Adjustment Template'!F28)","v":""}]
[19,{"$f":"IF('7. Adjustment Template'!B29 = 0, \"\", '7. Adjustment Template'!B29)","v":"TOTAL"},null,null,null,{"$f":"SUM(F9:F26)","v":0}]

{"sheet":"Form 7 - Visits by FTE","index":17,"n_rows":48,"n_cols":7,"rows_kept":48,"cut":false,"hidden":false,"merged":[[3,1,3,4],[8,0,9,2],[1,1,1,4],[2,1,2,4]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form 7 - Visits by FTE"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
["HEALTH CARE VISITS AND FTEs BY PRACTITIONER",null,null,null,null,null,"Form 7 (Visits by FTE)"]
[]
[]
["HEALTH CARE VISITS AND FTEs",null,null,"Visits","Total"]
[null,null,null,null,"FTEs"]
["A","MEDICAL PROVIDERS",null,"I","II"]
[1,"Physician (Note - includes OBAT per keeping in Med)",null,{"$f":"'3. Providers'!G21","v":0},{"$f":"'3. Providers'!E21+'3. Providers'!F21","v":0}]
[2,"Nurse Practitioners",null,{"$f":"'3. Providers'!G22","v":0},{"$f":"'3. Providers'!E22+'3. Providers'!F22","v":0}]
[3,"Physician Assistants",null,{"$f":"'3. Providers'!G23","v":0},{"$f":"'3. Providers'!E23+'3. Providers'!F23","v":0}]
[4,"Certified Nurse Midwives",null,{"$f":"'3. Providers'!G24","v":0},{"$f":"'3. Providers'!E24+'3. Providers'!F24","v":0}]
[5,"Registered Nurses (Note - includes OBAT as keeping in Med)",null,{"$f":"'3. Providers'!G27+'3. Providers'!G28","v":0},{"$f":"'3. Providers'!E27+'3. Providers'!F27+'3. Providers'!E28+'3. Providers'!F28","v":0}]
[6,"Licensed Practical Nurses",null,{"$f":"'3. Providers'!G29","v":0},{"$f":"'3. Providers'!E28+'3. Providers'!F28+'3. Providers'!E29+'3. Providers'!F29","v":0}]
[7,"Ophthalmologists",null,{"$f":"'3. Providers'!G32","v":0},{"$f":"'3. Providers'!E32+'3. Providers'!F32","v":0}]
[null,"Total Medical Visits and FTEs",null,{"$f":"SUM(D12:D18)","v":0},{"$f":"SUM(E12:E18)","v":0}]
["B","DENTAL PROVIDERS",null,"I","II"]
[1,"General Dentists",null,{"$f":"'3. Providers'!G61","v":0},{"$f":"'3. Providers'!E61+'3. Providers'!F61","v":0}]
[2,"Dental Specialist (DMD-DDS)",null,{"$f":"'3. Providers'!G62","v":0},{"$f":"'3. Providers'!E62+'3. Providers'!F62","v":0}]
[3,"Dental Hygienists",null,{"$f":"'3. Providers'!G63","v":0},{"$f":"'3. Providers'!E63+'3. Providers'!F63","v":0}]
[null,"Total Dental Visits and FTEs",null,{"$f":"SUM(D21:D23)","v":0},{"$f":"SUM(E21:E23)","v":0}]
["C","BEHAVIORAL HEALTH PROVIDERS",null,"I","II"]
["Mental Health Providers"]
[1,"Psychiatrists",null,{"$f":"'3. Providers'!G74","v":0},{"$f":"'3. Providers'!E74+'3. Providers'!F74","v":0}]
[2,"Psychologists",null,{"$f":"'3. Providers'!G75","v":0},{"$f":"'3. Providers'!E75+'3. Providers'!F75","v":0}]
[3,"Licensed Independent Clinical Social Worker (LISCW)",null,{"$f":"'3. Providers'!G77","v":0},{"$f":"'3. Providers'!E77+'3. Providers'!F77","v":0}]
[4,"Licensed Clinical Social Worker (LCSW)",null,{"$f":"'3. Providers'!G78","v":0},{"$f":"'3. Providers'!E78+'3. Providers'!F78","v":0}]
[5,"Unlicensed Master of Social Worker (MSW)",null,{"$f":"'3. Providers'!G79","v":0},{"$f":"'3. Providers'!E79+'3. Providers'!F79","v":0}]
[6,"Licensed Mental Health Counselor (LMHC)",null,{"$f":"'3. Providers'!G80","v":0},{"$f":"'3. Providers'!E80+'3. Providers'!F80","v":0}]
[7,"Family Therapists",null,{"$f":"'3. Providers'!G81","v":0},{"$f":"'3. Providers'!E81+'3. Providers'!F81","v":0}]
[8,"Psychiatric Nurse Practitioner",null,{"$f":"'3. Providers'!G83","v":0},{"$f":"'3. Providers'!E83+'3. Providers'!F83","v":0}]
[9,"Nurses - Psychiatric and Mental Health",null,{"$f":"'3. Providers'!G84","v":0},{"$f":"'3. Providers'!E84+'3. Providers'!F84","v":0}]
[10,"RN Nurse Counselors",null,{"$f":"'3. Providers'!G85","v":0},{"$f":"'3. Providers'!E85+'3. Providers'!F85","v":0}]
[11,"Unlicensed Mental Health Providers, including trainees (interns or residents) and \"Certified\" staff",null,{"$f":"'3. Providers'!G86","v":0},{"$f":"'3. Providers'!E86+'3. Providers'!F86","v":0}]
["Substance Use Providers"]
[12,"RN Nurse Counselors",null,{"$f":"'3. Providers'!G89","v":0},{"$f":"'3. Providers'!E89+'3. Providers'!F89","v":0}]
[13,"Licensed Independent Clinical Social Worker (LISCW)",null,{"$f":"'3. Providers'!G91","v":0},{"$f":"'3. Providers'!E91+'3. Providers'!F91","v":0}]
[14,"Licensed Clinical Social Worker (LCSW)",null,{"$f":"'3. Providers'!G92","v":0},{"$f":"'3. Providers'!E92+'3. Providers'!F92","v":0}]
[15,"Unlicensed Master of Social Worker (MSW)",null,{"$f":"'3. Providers'!G93","v":0},{"$f":"'3. Providers'!E93+'3. Providers'!F93","v":0}]
[16,"Licensed Mental Health Counselor (LMHC)",null,{"$f":"'3. Providers'!G94","v":0},{"$f":"'3. Providers'!E94+'3. Providers'!F94","v":0}]
[17,"LADAC/CADAC ",null,{"$f":"'3. Providers'!G96","v":0},{"$f":"'3. Providers'!E96+'3. Providers'!F96","v":0}]
[18,"Family Therapists",null,{"$f":"'3. Providers'!G95","v":0},{"$f":"'3. Providers'!E95+'3. Providers'!F95","v":0}]
[19,"Recovery Coaches/Peer Support",null,{"$f":"'3. Providers'!G98","v":0},{"$f":"'3. Providers'!E98+'3. Providers'!F98","v":0}]
[null,"Total Behavioral Health Visits and FTEs",null,{"$f":"SUM(D27:D46)","v":0},{"$f":"SUM(E27:E46)","v":0}]
["l.","TOTAL VISITS AND FTEs",null,{"$f":"D47+D24+D19","v":0},{"$f":"E47+E24+E19","v":0}]

{"sheet":"Form A - Allocations","index":18,"n_rows":33,"n_cols":20,"rows_kept":33,"cut":false,"hidden":false,"merged":[[1,1,1,4],[2,1,2,4],[3,1,3,4],[27,1,27,2],[29,1,29,2],[10,1,10,2],[16,1,16,2],[22,1,22,2],[23,1,23,2]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form A - Allocations"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Form A (Statistical Basis/Allocations)"]
[]
["BASIS FOR ALLOCATIONS"]
[]
["Costs"]
["Line","Allocation Basis",null,"Total","Medical\n(In-Bundle)","Behavioral Health\n(In-Bundle)","Dental\n(100% In-Bundle)","Laboratory","X-Ray","Pharmacy","Medical\n(Out-of-Bundle)","Behavioral Health\n(Out-of-Bundle)","Medical Non-Providers Staff Costs","Behavrioral Health Non-Providers Staff Costs","Medical Other Direct Costs","Behavioral Health Other Direct Costs","Facility","Enabling","Admin","Non-Allowable"]
[1,"In-Bundle & Out-of-Bundle FTEs (Tab 3)","Non-Provider & Other Direct Costs",{"$f":"SUM(E12:T12)","v":0},{"$f":"('3. Providers'!E21+'3. Providers'!F21)+('3. Providers'!E22+'3. Providers'!F22)+('3. Providers'!E23+'3. Providers'!F23)+('3. Providers'!E24+'3. Providers'!F24)+('3. Providers'!E27+'3. Providers'!F27)+('3. Providers'!E28+'3. Providers'!F28)+('3. Providers'!E29+'3. Providers'!F29)+('3. Providers'!E32+'3. Providers'!F32)","v":0},{"$f":"('3. Providers'!E74+'3. Providers'!F74)+('3. Providers'!E75+'3. Providers'!F75)+('3. Providers'!E77+'3. Providers'!F77)+('3. Providers'!E78+'3. Providers'!F78)+('3. Providers'!E79+'3. Providers'!F79)+('3. Providers'!E80+'3. Providers'!F80)+('3. Providers'!E81+'3. Providers'!F81)+('3. Providers'!E83+'3. Providers'!F83)+('3. Providers'!E84+'3. Providers'!F84)+('3. Providers'!E85+'3. Providers'!F85)+('3. Providers'!E86+'3. Providers'!F86)+('3. Providers'!E89+'3. Providers'!F89)+('3. Providers'!E91+'3. Providers'!F91)+('3. Providers'!E92+'3. Providers'!F92)+('3. Providers'!E93+'3. Providers'!F93)+('3. Providers'!E94+'3. Providers'!F94)+('3. Providers'!E95+'3. Providers'!F95)+('3. Providers'!E96+'3. Providers'!F96)+('3. Providers'!E98+'3. Providers'!F98)","v":0},{"$f":"('3. Providers'!E61+'3. Providers'!F61)+('3. Providers'!E62+'3. Providers'!F62)+('3. Providers'!E63+'3. Providers'!F63)+('3. Providers'!E64+'3. Providers'!F64)","v":0},null,null,null,{"$f":"('3. Providers'!E33+'3. Providers'!F33)+('3. Providers'!E34+'3. Providers'!F34)+('3. Providers'!E57+'3. Providers'!F57)","v":0},{"$f":"('3. Providers'!E97+'3. Providers'!F97)+('3. Providers'!E99+'3. Providers'!F99)","v":0}]
[2,"Square Footage","Facility",{"$f":"SUM(E13:T13)","v":0},{"$f":"('8. Other Information'!C9+'8. Other Information'!C10)*E18","v":0},{"$f":"('8. Other Information'!C17)*F18","v":0},{"$f":"('8. Other Information'!C11)*G18","v":0},{"$f":"'8. Other Information'!C12","v":0},{"$f":"'8. Other Information'!C13","v":0},{"$f":"'8. Other Information'!C14","v":0},{"$f":"('8. Other Information'!C9+'8. Other Information'!C10)*K18","v":0},{"$f":"('8. Other Information'!C17)*L18","v":0},null,null,null,null,null,{"$f":"'8. Other Information'!C16","v":0},{"$f":"'8. Other Information'!C15","v":0},{"$f":"'8. Other Information'!C18","v":0}]
[3,"Total Visits (Form 7 & Tab 3)","Enabling",{"$f":"SUM(E14:T14)","v":0},{"$f":"'Form 7 - Visits by FTE'!D19","v":0},{"$f":"'Form 7 - Visits by FTE'!D47","v":0},{"$f":"'Form 7 - Visits by FTE'!D24","v":0},null,null,null,{"$f":"'3. Providers'!G33+'3. Providers'!G34+'3. Providers'!G57","v":0},{"$f":"'3. Providers'!G97+'3. Providers'!G99","v":0}]
[4,"Accumulated Cost (Line 16)","Admin",{"$f":"SUM(E15:T15)","v":0},{"$f":"E31","v":0},{"$f":"F31","v":0},0,0,0,0,0,0,null,null,null,null,null,null,null,{"$f":"T31","v":0}]
[]
["Line","% Allocated",null,"Total","Medical\n(In-Bundle)","Behavioral Health\n(In-Bundle)","Dental\n(100% In-Bundle)","Laboratory","X-Ray","Pharmacy","Medical\n(Out-of-bundle)","Behavioral Health\n(Out-of-bundle)","Medical Non-Providers Staff Costs","Behavrioral Health Non-Providers Staff Costs","Medical Other Direct Costs","Behavioral Health Other Direct Costs","Facility","Enabling","Admin","Non-Allowable"]
[5,"In-Bundle & Out-of-Bundle FTEs","Non-Provider & Other Direct Costs",null,{"$f":"IFERROR(E12/(E12+K12),0)","v":0},{"$f":"IFERROR(F12/(F12+L12),0)","v":0},{"$f":"IFERROR(G12/G12,0)","v":0},null,null,null,{"$f":"IFERROR(K12/(E12+K12),0)","v":0},{"$f":"IFERROR(L12/(F12+L12),0)","v":0}]
[6,"Square Footage","Facility",{"$f":"SUM(E19:T19)","v":0},{"$f":"IFERROR(E13/$D13,0)","v":0},0,0,0,0,0,{"$f":"IFERROR(K13/$D13,0)","v":0},0,null,null,null,null,null,{"$f":"IFERROR(R13/$D13,0)","v":0},{"$f":"IFERROR(S13/$D13,0)","v":0},{"$f":"IFERROR(T13/$D13,0)","v":0}]
[7,"Total Visits","Enabling",{"$f":"SUM(E20:T20)","v":0},{"$f":"IFERROR(E14/$D14,0)","v":0},{"$f":"IFERROR(F14/$D14,0)","v":0},{"$f":"IFERROR(G14/$D14,0)","v":0},null,null,null,{"$f":"IFERROR(K14/$D14,0)","v":0},{"$f":"IFERROR(L14/$D14,0)","v":0}]
[8,"Accumulated Cost","Admin",{"$f":"SUM(E21:T21)","v":0},{"$f":"IFERROR(E15/$D15, \"0\")","v":"0"},"0","0","0","0","0","0","0",null,null,null,null,null,null,null,{"$f":"IFERROR(T15/$D15, \"0\")","v":"0"}]
[]
["Line","Cost Allocations",null,"Total","Medical\n(In-Bundle)","Behavioral Health\n(In-Bundle)","Dental\n(100% In-Bundle)","Laboratory","X-Ray","Pharmacy","Medical\n(Out-of-bundle)","Behavioral Health\n(Out-of-bundle)","Medical Non-Providers Staff Costs","Behavrioral Health Non-Providers Staff Costs","Medical Other Direct Costs","Behavioral Health Other Direct Costs","Facility","Enabling","Admin","Non-Allowable"]
[9,"Net Direct Expenses (Forms 1-5)",null,{"$f":"SUM(E24:T24)","v":0},{"$f":"'Form 1 - Direct Medical Cost'!L21","v":0},{"$f":"'Form 3 - Direct BH Cost'!L34","v":0},{"$f":"'Form 2 - Direct Dental Cost'!L40","v":0},{"$f":"'Form 4 - NonAllowable'!L25","v":0},{"$f":"'Form 4 - NonAllowable'!L26","v":0},{"$f":"'Form 4 - NonAllowable'!L27","v":0},{"$f":"'Form 1 - Direct Medical Cost'!L26","v":0},{"$f":"'Form 3 - Direct BH Cost'!L38","v":0},{"$f":"'Form 1 - Direct Medical Cost'!L28","v":0},{"$f":"'Form 3 - Direct BH Cost'!L40","v":0},{"$f":"'Form 1 - Direct Medical Cost'!L47","v":0},{"$f":"'Form 3 - Direct BH Cost'!L59","v":0},{"$f":"'Form 5 - Overhead & Enabling'!L32","v":0},{"$f":"'Form 5 - Overhead & Enabling'!L73","v":0},{"$f":"'Form 5 - Overhead & Enabling'!L54","v":0},{"$f":"'Form 4 - NonAllowable'!L32-'Form 4 - NonAllowable'!L27-'Form 4 - NonAllowable'!L26-'Form 4 - NonAllowable'!L25","v":0}]
[10,"Allocation of Medical and Behavioral Health Non-Provider Staff Costs (by FTEs)",null,0,{"$f":"E$18*$M$24","v":0},{"$f":"F$18*$N$24","v":0},null,null,null,null,{"$f":"K$18*$M$24","v":0},{"$f":"L$18*$N$24","v":0},{"$f":"-M24","v":0},{"$f":"-N24","v":0}]
[11,"Allocation of Medical and Behavioral Health Other Direct Costs (by FTEs)",null,0,{"$f":"E$18*$O$24","v":0},{"$f":"F$18*$P$24","v":0},null,null,null,null,{"$f":"K$18*$O$24","v":0},{"$f":"L$18*$P$24","v":0},null,null,{"$f":"-O24","v":0},{"$f":"-P24","v":0}]
[12,"Direct Expenses, After Non-Provider Staff Cost and Other Direct Cost Allocation (Line 9+10+11)",null,0,{"$f":"SUM(E24:E26)","v":0},0,0,0,0,0,0,0,0,{"$f":"SUM(N24:N26)","v":0},0,{"$f":"SUM(P24:P26)","v":0},0,0,0,0]
[13,"Allocation of Facility Costs (by Square Footage)","Enabling",0,{"$f":"$Q24*E19","v":0},0,0,0,0,0,0,0,null,null,null,null,{"$f":"-Q24","v":0},{"$f":"$Q24*R19","v":0},{"$f":"$Q24*S19","v":0},{"$f":"$Q24*T19","v":0}]
[14,"Direct Expenses, After Facility Allocation (Line 12+13)",null,0,{"$f":"E27+E28","v":0},{"$f":"F27+F28","v":0},0,0,0,0,0,0,null,null,null,null,{"$f":"Q24+Q28","v":0},{"$f":"R24+R28","v":0},{"$f":"S24+S28","v":0},{"$f":"T24+T28","v":0}]
[15,"Allocation of Enabling Services Costs (by Visits)","Enabling",0,{"$f":"$R$29*E20","v":0},{"$f":"$R$29*F20","v":0},{"$f":"$R$29*G20","v":0},null,null,null,{"$f":"$R$29*K20","v":0},{"$f":"$R$29*L20","v":0},null,null,null,null,null,{"$f":"-R29","v":0}]
[16,"Direct Expenses, After Allocation of Facility and Enabling (Line 14+15)",null,0,{"$f":"E29+E30","v":0},{"$f":"F29+F30","v":0},{"$f":"G29+G30","v":0},0,0,0,0,0,null,null,null,null,null,{"$f":"R29+R30","v":0},{"$f":"S29+S30","v":0},{"$f":"T29+T30","v":0}]
[17,"Allocation of Administrative Expenses (by Accumulated Cost)",null,0,{"$f":"$S31*E21","v":0},0,{"$f":"$S31*G21","v":0},0,{"$f":"$S31*I21","v":0},0,{"$f":"$S31*K21","v":0},{"$f":"$S31*L21","v":0},null,null,null,null,null,null,{"$f":"-S31","v":0},{"$f":"$S31*T21","v":0}]
[18,"Total Adjusted Net Expenses (Line 16+17)",null,{"$f":"SUM(E33:T33)","v":0},{"$f":"E31+E32","v":0},{"$f":"F31+F32","v":0},0,0,0,0,0,0,null,null,null,null,null,null,{"$f":"S31+S32","v":0},{"$f":"T31+T32","v":0}]

{"sheet":"Form B - Cost per Visit","index":19,"n_rows":20,"n_cols":4,"rows_kept":20,"cut":false,"hidden":false,"merged":[[11,1,11,2],[1,1,1,3],[2,1,2,3],[3,1,3,3]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Form B - Cost per Visit"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[null,null,null,"Form B (Allowable Cost per Visit)"]
[]
["COST ADJUSTMENT AND ALLOCATION"]
[]
[]
[]
[null,null,null,"Costs"]
["I","Medical + Behavioral Health (Dental Carved Out)"]
["A.","Total Adjusted Allowable Costs (Form A, Line 18)",null,{"$f":"'Form A - Allocations'!E33+'Form A - Allocations'!F33","v":0}]
["B.","Visits (Form 7)",null,{"$f":"'Form 7 - Visits by FTE'!D19+'Form 7 - Visits by FTE'!D47","v":0}]
["C.","Allowable Medical + BH Cost per Visit (A/B)",null,{"$f":"IFERROR(D14/D15, \"\")","v":""}]
["II","Dental Costs"]
["A.","Total Adjusted Allowable Costs (Form A, Line 18)",null,{"$f":"'Form A - Allocations'!G33","v":0}]
["B.","Visits (Form 7)",null,{"$f":"'Form 7 - Visits by FTE'!D24","v":0}]
["C.","Allowable Dental Cost per Visit (A/B)",null,{"$f":"IFERROR(D18/D19, \"\")","v":""}]

{"sheet":"Tab 9. Reconciliation","index":20,"n_rows":37,"n_cols":4,"rows_kept":37,"cut":false,"hidden":false,"merged":[[32,1,32,2],[36,1,36,2],[1,1,1,5],[2,1,2,5],[3,1,3,5],[7,1,7,2],[5,1,5,3],[13,1,13,2],[18,1,18,2],[23,1,23,2]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 9 - Reconciliation"]
[null,{"$f":"'1. Agency Information'!C9","v":0}]
[]
[null,"RECONCILIATION OF COST REPORT NET INCOME TO FINANCIAL STATEMENT (BOOK) NET INCOME"]
[]
["Line #","Cost Report Net Income"]
[1,"Total Cost Report Revenue (Tab 2, line 45)",{"$f":"ROUND('2. Revenue'!F57,0)","v":0}]
[2,"Total Cost Report Expenses (Form A, Line 18 plus Tab 7, Line 19)",{"$f":"ROUND(SUM('Form A - Allocations'!$D$33,'7. Adjustment Template'!$F$11),0)","v":0}]
[3,"Net Income (Loss) Cost Report",{"$f":"C9-C10","v":0}]
[4,"Profitability",{"$f":"IFERROR(((C9-C10)/C9),\"0\")","v":"0"}]
[]
[null,"Financial Statement Net Income"]
[5,"Total Financial Statement Revenue"]
[6,"Total Financial Statement Expenses"]
[7,"Net Income (Loss) Financial Statement",{"$f":"C15-C16","v":0}]
[]
[null,"Variance"]
[8,"Variance Between Cost Report and Financial Statements: Revenue",{"$f":"C9-C15","v":0}]
[9,"Variance Between Cost Report and Financial Statements: Expenses",{"$f":"C10-C16","v":0}]
[10,"Variance Between Cost Report and Financial Statements: Net Income",{"$f":"C11-C17","v":0}]
[]
[null,"Reconciling Items"]
[null,null,"Description","Amount ($)"]
[11,"Reconciling Item #1"]
[12,"Reconciling Item #2"]
[13,"Reconciling Item #3"]
[14,"Reconciling Item #4"]
[15,"Reconciling Item #5"]
[null,null,"Total Reconciling Items",{"$f":"SUM(D26:D30)","v":0}]
[]
[null,"Reconciliation"]
[16,"Difference Between Total Reconciling Items and Variance Between Cost Report and Financial Statements: Net Income *",{"$f":"C22-D31","v":0}]
[]
[null,"Footnote Legend"]
[null,"* This should be zero. The variance in the net income should be accounted for by the reconciling items. "]

{"sheet":"Tab 10. Accuracy of Report","index":21,"n_rows":42,"n_cols":6,"rows_kept":42,"cut":false,"hidden":false,"merged":[[33,2,33,3],[35,2,35,3],[41,2,41,3],[28,2,28,3],[29,2,29,3],[37,2,37,3],[40,2,40,3],[38,2,38,3],[39,2,39,3],[34,2,34,3],[36,2,36,3],[31,2,31,3],[32,2,32,3],[22,2,22,6],[23,2,23,3],[24,2,24,3],[26,2,26,3],[27,2,27,3],[25,2,25,3],[1,1,1,5],[2,1,2,5],[3,2,3,4],[4,1,4,5],[5,2,5,5],[11,1,11,5],[6,2,6,5],[7,1,7,5],[8,2,8,5],[9,1,9,5],[10,1,10,5]]}
[]
[null,"Community Health Center Cost Report"]
[null,"Tab 10 - Accuracy of Report"]
[null,null,null,null,null,"R.5-0 Industries Inc."]
[null,{"$f":"'1. Agency Information'!B4","v":0}]
[]
[]
[null,"CERTIFICATION BY PROVIDER"]
[]
[null,"I declare and affirm under the penalties of perjury that this report thas been examined by me, and to the best of my knowledge and belief, is true and correct statement."]
[null,"This payment reporting form is subject to audit and verification by the Center for Health Informtion and Analysis."]
[null,"By filling out the boxes below I hereby certify that I am authorized by the provider to submit this information."]
[]
[null,null,null,"Total Revenue",{"$f":"'2. Revenue'!F57","v":0}]
[null,null,null,"Total Expense",{"$f":"'Tab 9. Reconciliation'!C10","v":0}]
[null,null,null,"Profit/Loss",{"$f":"E14-E15","v":0}]
[null,null,null,"Profitability ",{"$f":"IFERROR(((E14-E15)/E14), \"0\")","v":"0"}]
[]
[null,null,null,"Signature of Authorized Submitter\n(Type electronic signature):"]
[null,null,null,"Date of Submission (mm/dd/yyyy):"]
[null,null,null,"Submitter's Acknowledgement:"]
[]
[null,null,"You may submit when each line says \"No Action Required\". You will not be able to successfully submit if you see an \"Error\" message below. "]
[null,null,"Provider name is chosen (Tab 1)",null,{"$f":"IF(ProviderName=\"\",\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"MassHealth ID is entered (Tab 1)",null,{"$f":"IF(MassHealthProviderID=\"\",\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Medicare Provider Number (Tab 1)",null,{"$f":"IF('1. Agency Information'!C12=\"\",\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Fiscal year ending date is selected (Tab 1)",null,{"$f":"IF('1. Agency Information'!C18=\"\",\"ERROR\",\"No Action Required\")","v":"No Action Required"}]
[null,null,"Contact Information is complete (Name, Phone Number, and Email Address) (Tab 1)",null,{"$f":"IF(OR('1. Agency Information'!C21=\"\",'1. Agency Information'!C23=\"\",'1. Agency Information'!C25=\"\"),\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Total Revenue amount is entered (Tab 2)",null,{"$f":"IF('2. Revenue'!F57=0,\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Total Benefit amount is entered (Tab 5)",null,{"$f":"IF('5. Cost Information'!D22<=0,\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Medical Expense amount is entered",null,{"$f":"IF('Cost Breakdown'!E18<=0,\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Total Other Than Personnel Services (OTPS) Expense is entered (Tab 5)",null,{"$f":"IF('5. Cost Information'!W60<=0,\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Provider Salary Expense is entered if Provider Salary FTE is Entered (Tab 3)",null,{"$f":"IF(AND('3. Providers'!C108>0,'3. Providers'!E108<=0), \"ERROR\", \"No Action Required\")","v":"No Action Required"}]
[null,null,"Provider Contractor Expense is entered if Provider Contractor FTE is Entered (Tab 3)",null,{"$f":"IF(AND('3. Providers'!D108>0,'3. Providers'!F108<=0), \"ERROR\", \"No Action Required\")","v":"No Action Required"}]
[null,null,"Non-Provider Salary Expense is entered if Non-Provider Salary FTE is Entered (Tab 4)",null,{"$f":"IF(AND(('4. Non-Providers'!C312+'4. Non-Providers'!C289)>0,('4. Non-Providers'!E312+'4. Non-Providers'!E289)<=0), \"ERROR\", \"No Action Required\")","v":"No Action Required"}]
[null,null,"Non-Provider Contractor Expense is entered if Non-Provider Contractor FTE is Entered (Tab 4)",null,{"$f":"IF(AND(('4. Non-Providers'!D312+'4. Non-Providers'!D289)>0,('4. Non-Providers'!F312+'4. Non-Providers'!F289)<=0), \"ERROR\", \"No Action Required\")","v":"No Action Required"}]
[null,null,"Non-Provider Salary/Contractor Expense and/or Non-Provider Salary/Contractor FTEs are entered (Tab 4)",null,{"$f":"IF(AND(('4. Non-Providers'!C312+'4. Non-Providers'!C289)<=0,('4. Non-Providers'!D312+'4. Non-Providers'!D289)<=0,('4. Non-Providers'!E312+'4. Non-Providers'!E289)<=0,('4. Non-Providers'!F312+'4. Non-Providers'!F289)<=0),\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Total Expense amount is entered (Cost Breakdown Tab)",null,{"$f":"IF('Cost Breakdown'!D18<=0,\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Square Footage is entered (Tab 8)",null,{"$f":"IF('8. Other Information'!C19<=0,\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"Total Billable Vist amount is entered (Tab 3)",null,{"$f":"IF('3. Providers'!G108<=0,\"ERROR\",\"No Action Required\")","v":"ERROR"}]
[null,null,"The reported differences between your cost report and financial statement must equal the sum of the variances reported in the Reconcilliation tab.",null,{"$f":"IF('Tab 9. Reconciliation'!C34=0,\"No Action Required\",\"ERROR\")","v":"No Action Required"}]
[null,null,"Above Certification by Provider is complete.",null,{"$f":"IF(OR(E19=0,E20=0,E21=0),\"ERROR\",\"No Action Required\")","v":"ERROR"}]

{"sheet":"Flat Data Tab","index":22,"n_rows":2,"n_cols":16,"rows_kept":2,"cut":false,"hidden":true,"merged":[]}
["CMS2 ID","MassHealth Provider ID","Provider Name","Fiscal Year Ending","Total Revenue","Total Expense","Financial Statement Total Revenue","Financial Statement Total Expense","Variance Between Cost Report and Financial Statements: Net Income","Total Reconciling Items","Medical + Behavioral Health Total Adjusted Allowable Costs","Medical + Behavioral Health Visits","Allowable Medical + BH Cost per Visit","Dental Total Adjusted Allowable Costs","Dental Visits","Allowable Dental Cost per Visit"]
[{"$f":"INDEX('Provider List'!$B:$B,MATCH($C2,'Provider List'!$C:$C,0))","v":{"$error":"#N/A"}},{"$f":"MassHealthProviderID","v":0},{"$f":"ProviderName","v":0},{"$f":"'1. Agency Information'!C18","v":"2023-12-31"},{"$f":"'Tab 9. Reconciliation'!C9","v":0},{"$f":"'Tab 9. Reconciliation'!C10","v":0},{"$f":"'Tab 9. Reconciliation'!C15","v":0},{"$f":"'Tab 9. Reconciliation'!C16","v":0},{"$f":"'Tab 9. Reconciliation'!C22","v":0},{"$f":"'Tab 9. Reconciliation'!D31","v":0},{"$f":"'Form B - Cost per Visit'!D14","v":0},{"$f":"'Form B - Cost per Visit'!D15","v":0},{"$f":"'Form B - Cost per Visit'!D16","v":""},{"$f":"'Form B - Cost per Visit'!D18","v":0},{"$f":"'Form B - Cost per Visit'!D19","v":0},{"$f":"'Form B - Cost per Visit'!D20","v":""}]

{"sheet":"Provider List","index":23,"n_rows":38,"n_cols":3,"rows_kept":38,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,"CMS2 ID","Provider Name"]
[null,"-"]
[null,15,"Boston Health Care for the Homeless Program"]
[null,26,"Brockton Neighborhood Health Center"]
[null,125,"Caring Health Center, Inc."]
[null,80,"Charles River Community Health"]
[null,6798,"Community Health Center of Cape Cod"]
[null,3104,"Community Health Center of Franklin County"]
[null,4051,"Community Health Connections Family Health Center (Fitchburg CHC)"]
[null,9416,"Community Health Programs Health Center"]
[null,11086,"Community HealthLink"]
[null,55,"Dimock Community Health Center"]
[null,1472,"Duffy Health Center"]
[null,63,"Edward M. Kennedy Community Health Center Inc."]
[null,58,"Family Health Center of Worcester"]
[null,60,"Fenway Community Health Center"]
[null,64,"Greater Lawrence Family Health Center"]
[null,65,"Greater New Bedford Community Health Center "]
[null,4461,"Harbor Health Services, Inc. "]
[null,69,"Harvard Street Neighborhood Health Center"]
[null,72,"HealthFirst Family Care Center, Inc"]
[null,74,"Hilltown Community Health Centers, Inc."]
[null,76,"Holyoke Health Center"]
[null,7972,"Island Health Care"]
[null,84,"Lowell Community Health Center"]
[null,86,"Lynn Community Health Center"]
[null,87,"Manet Community Health Center, Inc. at North Quincy"]
[null,90,"Mattapan Community Health Center"]
[null,108,"North End Waterfront Health (formerly North End CHC)"]
[null,1456,"North Shore Community Health, Inc."]
[null,111,"Outer Cape Health Services"]
[null,120,"South Cove Community Health Center"]
[null,3874,"Springfield Health Services for the Homeless"]
[null,128,"Stanley Street Treatment and Resistance (SSTAR)"]
[null,134,"Upham's Corner Health Center"]
[null,137,"Whittier Street Health Center"]

{"sheet":"System Data","index":24,"n_rows":27,"n_cols":2,"rows_kept":27,"cut":false,"hidden":true,"merged":[]}
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[{"$f":"MassHealthProviderID","v":0},"MassHealthID"]
[{"$f":"'1. Agency Information'!C18","v":"2023-12-31"},"FiscalYear"]
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[{"$f":"IF(AND(A9,A10,A11,A12,A13,A14,A15,A16,A17,A18,A19,A20,A21,A22,A23,A24,A25,A26,A27),TRUE,FALSE)","v":false},"vRequiredFields"]
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[{"$f":"IF('Tab 10. Accuracy of Report'!E26=\"No Action Required\",TRUE,FALSE)","v":false},"vRequiredFieldE26"]
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[{"$f":"IF('Tab 10. Accuracy of Report'!E34=\"No Action Required\",TRUE,FALSE)","v":true},"vRequiredFieldE34"]
[{"$f":"IF('Tab 10. Accuracy of Report'!E35=\"No Action Required\",TRUE,FALSE)","v":true},"vRequiredFieldE35"]
[{"$f":"IF('Tab 10. Accuracy of Report'!E36=\"No Action Required\",TRUE,FALSE)","v":true},"vRequiredFieldE36"]
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[{"$f":"IF('Tab 10. Accuracy of Report'!E38=\"No Action Required\",TRUE,FALSE)","v":false},"vRequiredFieldE38"]
[{"$f":"IF('Tab 10. Accuracy of Report'!E39=\"No Action Required\",TRUE,FALSE)","v":false},"vRequiredFieldE39"]
[{"$f":"IF('Tab 10. Accuracy of Report'!E40=\"No Action Required\",TRUE,FALSE)","v":false},"vRequiredFieldE40"]
[{"$f":"IF('Tab 10. Accuracy of Report'!E41=\"No Action Required\",TRUE,FALSE)","v":true},"vRequiredFieldE41"]
[{"$f":"IF('Tab 10. Accuracy of Report'!E42=\"No Action Required\",TRUE,FALSE)","v":false},"vRequiredFieldE42"]