{"text_format":"1","workbook":"xlsx","n_sheets":21,"sheets":["Summary","Reporting Hierarchy","Sch 3&4 - Source Documentation","Dropdowns","Table Templates","Sch 5 Source Documentation","Allocation","Schedule 5a.1","Schedule 5a.2","Schedule 5b","Schedule 5c","Schedule 3a","Schedule 3b","Schedule 3c","Schedule 4a","Schedule 4b","Schedule 4c","CHHA Pediatric R&R-RT&R Est.","Sheet1","LHSCA WR&R Estimation Template","FI WR&R Estimation Template"],"not_rendered":{"charts":0,"images":4,"macros":1,"external_links":1,"defined_names":7,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Summary","index":0,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Reporting Hierarchy","index":1,"n_rows":24,"n_cols":11,"rows_kept":24,"cut":false,"hidden":false,"merged":[[2,8,5,14],[1,0,9,6]]}
["Reporting Hierarchy"]
["Instructions: \nThis is the first tab you should complete in this template, as the information entered in this tab will dictate which Schedule 3, 4, and 5 tabs will populate for completion (similar to the web-based Tool functionality). \n\n\t1. First, please enter your agency name. Then, answer Question #1 by entering the number of CHHA, LHCSA and/or FI entities your agency operates. Note that this should match the number of entities entered within the Reporting Hierarchy tab of the web-based Tool. Please read through the information below before answering Question #1:\n\t\ta. For the purposes of the Home Care Cost Report, LHCSA and FI entities are required to be separated by county. For example, if a LHCSA provides services in two counties, then that agency is said to have two entities for the purposes of the Home Care cost report submission. \n\t\tb. For CHHAs, the Operating Certificate will be used as the unique entity identifier and will be the driver for how the information should be reported on certain schedules. For example, if an agency holds three CHHA operating certificates, the agency is said to have three CHHA entities for the purposes of the cost report. CHHA entities are not classified based on county of operation, but rather solely based on their operating certificate.\n\n\tOnce you have entered the correct numbers of each entity type entered in question #1, hit \"submit.\" The response to Question #1 will dictate what how many entities need to be entered in Question #2.\n\nComplete Question #2 by entering the name for each entity,  selecting the corresponding entity type from the drop-down menu, and entering the entity identifier (i.e., the county for LHCSA and FI entities, and the operating Certificate for each CHHA entity). Then, please hit \"submit.\"  Note:  Based on information submitted in these 2 questions, Schedule 3, 4, and 5 tabs will populate. "]
[null,null,null,null,null,null,null,null,"Reset Button: If you determine that you entered the wrong number of entities in Question #1, you may reset the template to a blank version using the \"Reset\" button below. BY CLICKING THE RESET BUTTON, ALL DATA ENTERED IN THE REST OF THE TEMPLATE WILL BE DELETED. "]
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["Agency Name:"]
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["Question 1:","Please enter the total quantity of CHHA, LHCSA, and FI entities operated by the above agency. "]
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[null,"CHHA"]
[null,"LHCSA",null,null,null,null,null,null,null,null," "]
[null,"FI"]
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[]
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["Question 2:","For each NEW entity added above, please add a row with the requested information. "]
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[null,"Name of Entity","Entity Type (CHHA, LHCSA, FI)","Entity Identifier\n(Operating Certificate for CHHA, County for LHCSA/FI)"]

{"sheet":"Sch 3&4 - Source Documentation","index":2,"n_rows":9,"n_cols":8,"rows_kept":9,"cut":false,"hidden":false,"merged":[[1,0,2,6],[3,7,5,7],[3,4,5,4],[3,6,5,6],[3,0,5,0],[3,1,5,1],[3,2,5,2],[3,3,5,3],[3,5,5,5]]}
["Schedule 3&4 Source Documentation"]
["Instructions: This tab should include the source documentation for Schedule 3 and 4 expenses (i.e., Trial Balance, General ledger, or P&L exported from your system into Excel version). It should also include the categorization of each expense account by Financial Statement schedule (asset, liability, or revenue/expense), Schedule 3 column categorization, and Schedule 4 column and row categorization. Please follow the detailed instructions below for the information that should be populated within each column. "]
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["Export your Agency's Trial balance, General Ledger, or P&L into Excel format and insert account numbers for each account in this column. ","Export your Agency's Trial balance, General Ledger, or P&L into Excel format and insert the account name/description for each account in this column. ","Export your Agency's Trial balance, General Ledger, or P&L into Excel format and insert the account balance for each account in this column. ","In this column, use the drop-down menu in each row to select the Cost Report Financial Statement Schedule (17, 18, or 19)  that each account should be reported in. ","In this column, use the drop-down menu in each row to select the entity type each expense account should be assigned to.  If account should be allocated across multiple entity types, please select \"Allocation\" in drop down menu. ","In this column, use the drop-down menu in each row to select the  Schedule 3 column that each expense account should be reported in.  Please select \"N/A\" on the drop-down for all Balance Sheet and Revenue accounts. ","In this column, use the drop-down menu in each row to select the Schedule 3 service type row that each expense account should be directly assigned to. Note that the drop-down menu will not appear until an entity type was selected in Column E. Select the \"Allocation\" option from the drop-down for any expense accounts that should be allocated across service types. Please select \"N/A\" on the drop-down for all Balance Sheet and Revenue accounts. ","In this column, use the drop-down in each row to select the Schedule 4 cost center row that each Schedule 3 Program Administration expense account should be directly assigned to. Please select \"N/A\" from the drop-down for all Balance Sheet accounts, Revenue accounts, non-reimbursable expenses, and direct care personnel expenses.   "]
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["Account Number","Account Name/Description","Account Balance"," FS Schedule","Entity Type","Schedule 3 Column #","Schedule 3 Line #","Schedule 4 Line #"]

{"sheet":"Dropdowns","index":3,"n_rows":21,"n_cols":14,"rows_kept":21,"cut":false,"hidden":true,"merged":[]}
["Types"]
["CHHA",null,"FS Schedule","Entity Type","Schedule 3 Column #","Schedule 4 Column #",null,"CHHA","LHCSA","FI",null,"CHHA_Entity","LHCSA_Entity","FI_Entity"]
["LHCSA",null,"Schedule 17: Assets","Allocation","Non-reimbursable costs 002 ","Criminal Background check & Fingerprinting 001",null,"Allocation","Allocation","Allocation",null,"Home Health Aide 001","PC: Level I 001","CDPAS: Individual - Basic 001"]
["FI",null,"Schedule 18: Liabilities","CHHA","Program Administration 005           ","Capital Related - Building & Fixtures 002",null,"Home Health Aide 001","PC: Level I 001","CDPAS: Individual - Basic 001",null,"Home Health Physical Therapy 002","PC: Level II 002","CDPAS: Individual - Hard to Serve  002"]
[null,null,"Schedule 19: Revenue and Expenses","LHCSA","Program Aide (Direct Care) 006","Capital Related - Movable Equipment 003",null,"Home Health Physical Therapy 002","PC: Level II 002","CDPAS: Individual - Hard to Serve  002",null,"Home Health Occupational Therapy 003","PC: Level II - Hard to Serve 003","CDPAS: Individual - Live-In 003"]
[null,null,null,"FI","Program RN/Supervision Assessment (Direct Care) 007","Plant Operations & Maintenance 004",null,"Home Health Occupational Therapy 003","PC: Level II - Hard to Serve 003","CDPAS: Individual - Live-In 003",null,"Home Health Registered Nurse 004","Live-In 004","CDPAS: Multiple - Basic 004"]
[null,null,null,null,"Program Staff Training  008","Rent - Building 005",null,"Home Health Registered Nurse 004","Live-In 004","CDPAS: Multiple - Basic 004",null,"Home Health Medical Social Services 005","Nursing Supervision 005","CDPAS: Multiple - Hard to Serve  005"]
[null,null,null,null,"Transportation 009","Rent - Furnishings 006 ",null,"Home Health Medical Social Services 005","Nursing Supervision 005","CDPAS: Multiple - Hard to Serve  005",null,"Home Health Nutrition 006","Nursing Assessment 006","CDPAS: Multiple - Live-In 006"]
[null,null,null,null,"Contracted Purchased Services 010","Rent - Vehicles 007",null,"Home Health Nutrition 006","Nursing Assessment 006","CDPAS: Multiple - Live-In 006",null,"Home Health Speech Therapy 007","Shared Aide: Level I 007","Other non-reimbursable services 008"]
[null,null,null,null,"Other 011","Interest - Property 008",null,"Home Health Speech Therapy 007","Shared Aide: Level I 007","Other non-reimbursable services 008",null,"Home Health Respiratory Therapy 008","Shared Aide: Level II 008"]
[null,null,null,null,"N/A","Depreciation - Plant 009",null,"Home Health Respiratory Therapy 008","Shared Aide: Level II 008","N/A",null,"Home Social & Environmental Support 009","Other non-reimbursable services 010"]
[null,null,null,null,null,"Depreciation - Equipment & Furnishings 010",null,"Home Social & Environmental Support 009","Other non-reimbursable services 010",null,null,"Home Health Sign Language/Oral Interpreter 010","Home Health Aide 011"]
[null,null,null,null,null,"Depreciation - Vehicles 011",null,"Home Health Sign Language/Oral Interpreter 010","Home Health Aide 011",null,null,"Nursing Supervision 015","Subcontractor services 012"]
[null,null,null,null,null,"Transportation 012",null,"Nursing Supervision 015","Subcontractor services 012",null,null,"Nursing Assessment 016"]
[null,null,null,null,null,"Utilities 013",null,"Nursing Assessment 016","N/A",null,null,"Other non-reimbursable services 018"]
[null,null,null,null,null,"Supplies & Materials 014",null,"Other non-reimbursable services 018",null,null,null,"Personal care services 019"]
[null,null,null,null,null,"Insurance 015",null,"Personal care services 019"]
[null,null,null,null,null,"Administration & General 016",null,"N/A"]
[null,null,null,null,null,"Employee physicals/uniforms/immunizations 017"]
[null,null,null,null,null,"Other 018"]
[null,null,null,null,null,"N/A"]

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,8,106,9],[106,10,106,11],[106,12,106,13],[107,16,107,17],[107,18,107,19],[105,2,105,3],[105,4,105,5],[105,6,105,7],[105,8,105,9],[105,10,105,11],[105,12,105,13],[105,14,105,15],[105,16,105,17],[105,18,105,19],[104,2,104,3],[104,4,104,5],[104,6,104,7],[104,8,104,9],[104,10,104,11],[104,12,104,13],[104,14,104,15],[104,16,104,17],[104,18,104,19],[102,14,102,15],[102,16,102,17],[102,18,102,19],[103,2,103,3],[103,4,103,5],[103,6,103,7],[103,8,103,9],[103,10,103,11],[103,12,103,13],[103,14,103,15],[102,2,102,3],[102,4,102,5],[102,6,102,7],[102,8,102,9],[102,10,102,11],[102,12,102,13],[103,16,103,17],[103,18,103,19],[101,2,101,3],[101,4,101,5],[101,6,101,7],[101,8,101,9],[101,10,101,11],[101,12,101,13],[101,14,101,15],[101,16,101,17],[101,18,101,19],[100,2,100,3],[100,4,100,5],[100,6,100,7],[100,8,100,9],[100,10,100,11],[100,12,100,13],[100,14,100,15],[100,16,100,17],[100,18,100,19],[98,14,98,15],[98,16,98,17],[98,18,98,19],[99,2,99,3],[99,4,99,5],[99,6,99,7],[99,8,99,9],[99,10,99,11],[99,12,99,13],[99,14,99,15],[98,2,98,3],[98,4,98,5],[98,6,98,7],[98,8,98,9],[98,10,98,11],[98,12,98,13],[99,16,99,17],[99,18,99,19],[97,2,97,3],[97,4,97,5],[97,6,97,7],[97,8,97,9],[97,10,97,11],[97,12,97,13],[97,14,97,15],[97,16,97,17],[97,18,97,19],[96,2,96,3],[96,4,96,5],[96,6,96,7],[96,8,96,9],[96,10,96,11],[96,12,96,13],[96,14,96,15],[96,16,96,17],[96,18,96,19],[95,2,95,3],[95,4,95,5],[95,6,95,7],[95,8,95,9],[95,10,95,11],[95,12,95,13],[95,14,95,15],[95,16,95,17],[95,18,95,19],[94,2,94,3],[94,4,94,5],[94,6,94,7],[94,8,94,9],[94,10,94,11],[94,12,94,13],[94,14,94,15],[94,16,94,17],[94,18,94,19],[93,2,93,3],[93,4,93,5],[93,6,93,7],[93,8,93,9],[93,10,93,11],[93,12,93,13],[93,14,93,15],[93,16,93,17],[93,18,93,19],[90,23,90,25],[90,26,90,28],[90,29,90,31],[90,32,90,34],[91,2,91,7],[91,8,91,13],[91,14,91,19],[91,20,92,20],[91,21,92,21],[91,22,92,22],[91,29,92,29],[91,30,92,30],[91,31,92,31],[91,32,92,32],[91,33,92,33],[91,34,92,34],[91,23,92,23],[91,24,92,24],[91,25,92,25],[91,26,92,26],[91,27,92,27],[91,28,92,28],[92,10,92,11],[92,12,92,13],[88,1,88,7],[89,1,89,7],[90,0,92,0],[90,1,92,1],[90,2,90,19],[90,20,90,22],[92,2,92,3],[92,4,92,5],[92,6,92,7],[92,8,92,9],[92,14,92,15],[92,16,92,17],[92,18,92,19],[84,2,84,3],[84,4,84,5],[84,6,84,7],[84,8,84,9],[84,10,84,11],[84,12,84,13],[84,14,84,15],[84,16,84,17],[84,18,84,19],[83,2,83,3],[83,4,83,5],[83,6,83,7],[83,8,83,9],[83,10,83,11],[83,12,83,13],[83,14,83,15],[83,16,83,17],[83,18,83,19],[81,14,81,15],[81,16,81,17],[81,18,81,19],[82,2,82,3],[82,4,82,5],[82,6,82,7],[82,8,82,9],[82,10,82,11],[82,12,82,13],[82,14,82,15],[81,2,81,3],[81,4,81,5],[81,6,81,7],[81,8,81,9],[81,10,81,11],[81,12,81,13],[82,16,82,17],[82,18,82,19],[80,2,80,3],[80,4,80,5],[80,6,80,7],[80,8,80,9],[80,10,80,11],[80,12,80,13],[80,14,80,15],[80,16,80,17],[80,18,80,19],[79,2,79,3],[79,4,79,5],[79,6,79,7],[79,8,79,9],[79,10,79,11],[79,12,79,13],[79,14,79,15],[79,16,79,17],[79,18,79,19],[77,14,77,15],[77,16,77,17],[77,18,77,19],[78,2,78,3],[78,4,78,5],[78,6,78,7],[78,8,78,9],[78,10,78,11],[78,12,78,13],[78,14,78,15],[77,2,77,3],[77,4,77,5],[77,6,77,7],[77,8,77,9],[77,10,77,11],[77,12,77,13],[78,16,78,17],[78,18,78,19],[76,2,76,3],[76,4,76,5],[76,6,76,7],[76,8,76,9],[76,10,76,11],[76,12,76,13],[76,14,76,15],[76,16,76,17],[76,18,76,19],[75,2,75,3],[75,4,75,5],[75,6,75,7],[75,8,75,9],[75,10,75,11],[75,12,75,13],[75,14,75,15],[75,16,75,17],[75,18,75,19],[73,14,73,15],[73,16,73,17],[73,18,73,19],[74,2,74,3],[74,4,74,5],[74,6,74,7],[74,8,74,9],[74,10,74,11],[74,12,74,13],[74,14,74,15],[73,2,73,3],[73,4,73,5],[73,6,73,7],[73,8,73,9],[73,10,73,11],[73,12,73,13],[74,16,74,17],[74,18,74,19],[72,2,72,3],[72,4,72,5],[72,6,72,7],[72,8,72,9],[72,10,72,11],[72,12,72,13],[72,14,72,15],[72,16,72,17],[72,18,72,19],[71,2,71,3],[71,4,71,5],[71,6,71,7],[71,8,71,9],[71,10,71,11],[71,12,71,13],[71,14,71,15],[71,16,71,17],[71,18,71,19],[69,14,69,15],[69,16,69,17],[69,18,69,19],[70,2,70,3],[70,4,70,5],[70,6,70,7],[70,8,70,9],[70,10,70,11],[70,12,70,13],[70,14,70,15],[69,2,69,3],[69,4,69,5],[69,6,69,7],[69,8,69,9],[69,10,69,11],[69,12,69,13],[70,16,70,17],[70,18,70,19],[68,2,68,3],[68,4,68,5],[68,6,68,7],[68,8,68,9],[68,10,68,11],[68,12,68,13],[68,14,68,15],[68,16,68,17],[68,18,68,19],[65,26,66,26],[65,27,66,27],[65,28,66,28],[65,29,66,29],[65,30,66,30],[65,31,66,31],[66,16,66,17],[66,18,66,19],[67,2,67,3],[67,4,67,5],[67,6,67,7],[67,8,67,9],[67,10,67,11],[67,12,67,13],[67,14,67,15],[67,16,67,17],[67,18,67,19],[64,20,64,22],[64,23,64,25],[64,26,64,28],[64,29,64,31],[64,32,64,34],[65,2,65,7],[65,8,65,13],[65,14,65,19],[65,20,66,20],[65,21,66,21],[65,22,66,22],[65,23,66,23],[65,24,66,24],[65,25,66,25],[65,32,66,32],[65,33,66,33],[65,34,66,34],[66,2,66,3],[66,4,66,5],[66,6,66,7],[66,8,66,9],[66,10,66,11],[66,12,66,13],[66,14,66,15],[2,1,2,5],[3,1,3,5],[2,15,2,19],[3,15,3,19],[62,1,62,7],[63,1,63,7],[64,0,66,0],[64,1,66,1],[64,2,64,19],[26,1,26,3],[27,1,27,3],[53,0,53,1],[54,0,54,1],[4,14,5,14],[4,15,5,15],[4,17,5,17],[4,18,5,18],[53,14,53,15],[54,14,54,15],[26,15,26,17],[27,15,27,17],[2,29,2,33],[3,29,3,33],[26,29,26,31],[27,29,27,31],[53,28,53,29],[54,28,54,29],[4,20,5,20],[4,21,5,21],[4,23,5,23],[4,24,5,24],[4,25,5,25],[4,26,5,26]]}
["Schedule 3a",null,null,null,null,null,null,null,null,null,null,null,null,null,"Schedule 3b",null,null,null,null,null,null,null,null,null,null,null,null,null,"Schedule 3c"]
[]
["CHHA Name ","Example CHHA",null,null,null,null,null,null,null,null,null,null,null,null,"LHCSA Name ","Example LHCSA",null,null,null,null,null,null,null,null,null,null,null,null,"FI Name ","Example FI"]
["CHHA Operating Certificate","Operating Certificate",null,null,null,null,null,null,null,null,null,null,null,null,"LHCSA County","County #1",null,null,null,null,null,null,null,null,null,null,null,null,"FI County","County #1"]
["Schedule 3a: CHHA Costs & Expenses by Service Type",null,"Total Entity Costs\n(002 + 003+ 004)","Non-reimbursable Costs (Adjustment to Expense)","Non-reimbursable WR&R costs","Total reimbursable Costs\n(Sum of columns 005 through 011)","Program Administration","Program Aide (Direct Care)","Program RN Supervision/ Assessment \n(Direct Care)","Program Staff Training","Transportation","Contracted Purchased Services","Other",null,"Schedule 3b: LHCSA Costs & Expenses by Service Type",null,"Total Entity Costs","Non-reimbursable Costs (Adjustment to Expense)","Non-reimbursable WR&R costs","Total reimbursable Costs","Program Administration","Program Aide (Direct Care)","Program RN Supervision/ Assessment","Program Staff Training","Transportation","Contracted Purchased Services","Other",null,"Schedule 3c: FI Costs & Expenses by Service Type",null,"Total Entity Costs\n(002 + 003+ 004)","Non-reimbursable Costs (Adjustment to Expense)","Non-reimbursable WR&R Costs","Total Reimbursable Costs\n(Sum of columns 005 through 011)","Program Administration","Program Aide (Direct Care)","Program RN Supervision/ Assessment \n(Direct Care)","Program Staff Training","Transportation","Contracted Purchased Services","Other"]
[null,null,"001","002","003","004","005","006","007","008","009","010","011",null,null,null,"(002 + 003+ 004)",null,null,"(Sum of columns 005 through 011)",null,null,"(Direct Care)",null,null,null,null,null,null,null,"001","002","003","004","005","006","007","008","009","010","011"]
["Direct Care",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"001","002","003","004","005","006","007","008","009","010","011",null,"Direct Care"]
["Home Health Aide ","001",{"$f":"SUM(D8:F8)","v":0},null,null,{"$f":"SUM(G8:M8)","v":0},null,null,null,null,null,null,null,null,"Direct Care",null,null,null,null,null,null,null,null,null,null,null,null,null,"CDPAS: Individual - Basic","001",{"$f":"SUM(AF8:AH8)","v":0},null,null,{"$f":"SUM(AI8:AO8)","v":0}]
["Home Health Physical Therapy","002",{"$f":"SUM(D9:F9)","v":0},null,null,{"$f":"SUM(G9:M9)","v":0},null,null,null,null,null,null,null,null,"PC: Level I ","001",{"$f":"SUM(R9:T9)","v":0},null,null,{"$f":"SUM(U9:AA9)","v":0},null,null,null,null,null,null,null,null,"CDPAS: Individual - Hard to Serve ","002",{"$f":"SUM(AF9:AH9)","v":0},null,null,{"$f":"SUM(AI9:AO9)","v":0}]
["Home Health Occupational Therapy","003",0,null,null,0,null,null,null,null,null,null,null,null,"PC: Level II","002",{"$f":"SUM(R10:T10)","v":0},null,null,{"$f":"SUM(U10:AA10)","v":0},null,null,null,null,null,null,null,null,"CDPAS: Individual - Live-In","003",0,null,null,0]
["Home Health Registered Nurse","004",0,null,null,0,null,null,null,null,null,null,null,null,"PC: Level II - Hard to Serve","003",0,null,null,0,null,null,null,null,null,null,null,null,"CDPAS: Multiple - Basic","004",0,null,null,0]
["Home Health Medical Social Services","005",0,null,null,0,null,null,null,null,null,null,null,null,"Live-In","004",0,null,null,0,null,null,null,null,null,null,null,null,"CDPAS: Multiple - Hard to Serve ","005",0,null,null,0]
["Home Health Nutrition","006",0,null,null,0,null,null,null,null,null,null,null,null,"Nursing Supervision","005",0,null,null,0,null,null,null,null,null,null,null,null,"CDPAS: Multiple - Live-In","006",0,null,null,0]
["Home Health Speech Therapy","007",0,null,null,0,null,null,null,null,null,null,null,null,"Nursing Assessment","006",0,null,null,0,null,null,null,null,null,null,null,null,"SUBTOTAL (reimbursable services)","007",{"$f":"SUM(AE8:AE13)","v":0},{"$f":"SUM(AF8:AF13)","v":0},0,0,{"$f":"SUM(AI8:AI13)","v":0},0,0,0,0,0,0]
["Home Health Respiratory Therapy","008",0,null,null,0,null,null,null,null,null,null,null,null,"Shared Aide: Level I","007",0,null,null,0,null,null,null,null,null,null,null,null,"Other non-reimbursable services","008"]
["Home Social & Environmental Support","009",0,null,null,0,null,null,null,null,null,null,null,null,"Shared Aide: Level II","008",0,null,null,{"$f":"SUM(U16:AA16)","v":0},null,null,null,null,null,null,null,null,"GRAND TOTAL","009",{"$f":"SUM(AE14:AE15)","v":0},0,0,0,0,0,0,0,0,0,0]
["Home Health Sign Language/Oral Interpreter","010",0,null,null,0,null,null,null,null,null,null,null,null,"SUBTOTAL (reimbursable services)","009",0,{"$f":"SUM(R9:R16)","v":0},0,0,0,0,0,0,0,0,0]
["Nursing Supervision","015",0,null,null,0,null,null,null,null,null,null,null,null,"Other non-reimbursable services*","010",{"$f":"SUM(R18:T18)","v":0},null,null,0]
["Nursing Assessment","016",0,null,null,0,null,null,null,null,null,null,null,null,"Subcontractor services","012",0,null,null,0]
["SUBTOTAL (reimbursable services)","017",0,{"$f":"SUM(D8:D19)","v":0},0,0,0,0,0,0,0,0,0,null,"Home Health Aide","011",0,null,null,0]
["Other non-reimbursable services","018",0,null,null,0,null,null,null,null,null,null,null,null,"GRAND TOTAL","013",{"$f":"SUM(Q18:Q20)","v":0},{"$f":"SUM(R18:R20)","v":0},0,{"$f":"SUM(T18:T20)","v":0},{"$f":"SUM(U18:U20)","v":0},0,0,0,0,0,0]
["Personal care services","019",0,null,null,0]
["GRAND TOTAL","020",{"$f":"SUM(C20:C22)","v":0},{"$f":"SUM(D20:D22)","v":0},0,{"$f":"SUM(F20:F22)","v":0},{"$f":"SUM(G20:G22)","v":0},0,0,0,0,0,0]
[]
["Schedule 4a",null,null,null,null,null,null,null,null,null,null,null,null,null,"Schedule 4b",null,null,null,null,null,null,null,null,null,null,null,null,null,"Schedule 4c"]
[]
["CHHA Name ",null,null,null,null,null,null,null,null,null,null,null,null,null,"LHCSA Name ","Total LHCSA",null,null,null,null,null,null,null,null,null,null,null,null,"FI Name","Total FI"]
["CHHA Operating Certificate"]
["Schedule 4a: CHHA General Service Cost Centers",null,"Program Administration","Direct Care non-personnel Costs",null,null,null,null,null,null,null,null,null,null,"Schedule 4b: LHCSA General Service Cost Centers",null,"Program Administration","Direct Care Non-personnel Costs",null,null,null,null,null,null,null,null,null,null,"Schedule 4b: LHCSA General Service Cost Centers",null,"Program Administration","Direct Care Non-personnel Costs"]
[null,null,"001","002",null,null,null,null,null,null,null,null,null,null,null,null,"001","002",null,null,null,null,null,null,null,null,null,null,null,null,"001","002"]
["GENERAL SERVICE COST CENTERS ",null,null,null,null,null,null,null,null,null,null,null,null,null,"GENERAL SERVICE COST CENTERS ",null,null,null,null,null,null,null,null,null,null,null,null,null,"GENERAL SERVICE COST CENTERS "]
["Criminal Background Check & Fingerprinting","001",null,null,null,null,null,null,null,null,null,null,null,null,"Criminal Background Check & Fingerprinting","001",null,null,null,null,null,null,null,null,null,null,null,null,"Criminal Background Check & Fingerprinting","001"]
["Capital Related - Building & Fixtures","002",null,null,null,null,null,null,null,null,null,null,null,null,"Capital Related - Building & Fixtures","002",null,null,null,null,null,null,null,null,null,null,null,null,"Capital Related - Building & Fixtures","002"]
["Capital Related - Movable Equipment","003",null,null,null,null,null,null,null,null,null,null,null,null,"Capital Related - Movable Equipment","003",null,null,null,null,null,null,null,null,null,null,null,null,"Capital Related - Movable Equipment","003"]
["Plant Operations & Maintenance","004",null,null,null,null,null,null,null,null,null,null,null,null,"Plant Operations & Maintenance","004",null,null,null,null,null,null,null,null,null,null,null,null,"Plant Operations & Maintenance","004"]
["Rent-Building","005",null,null,null,null,null,null,null,null,null,null,null,null,"Rent-Building","005",null,null,null,null,null,null,null,null,null,null,null,null,"Rent-Building","005"]
["Rent-Furnishings","006",null,null,null,null,null,null,null,null,null,null,null,null,"Rent-Furnishings","006",null,null,null,null,null,null,null,null,null,null,null,null,"Rent-Furnishings","006"]
["Rent-Vehicles","007",null,null,null,null,null,null,null,null,null,null,null,null,"Rent-Vehicles","007",null,null,null,null,null,null,null,null,null,null,null,null,"Rent-Vehicles","007"]
["Interest-Property","008",null,null,null,null,null,null,null,null,null,null,null,null,"Interest-Property","008",null,null,null,null,null,null,null,null,null,null,null,null,"Interest-Property","008"]
["Depreciation-Plant","009",null,null,null,null,null,null,null,null,null,null,null,null,"Depreciation-Plant","009",null,null,null,null,null,null,null,null,null,null,null,null,"Depreciation-Plant","009"]
["Depreciation-Equipment & Furnishings","010",null,null,null,null,null,null,null,null,null,null,null,null,"Depreciation-Equipment & Furnishings","010",null,null,null,null,null,null,null,null,null,null,null,null,"Depreciation-Equipment & Furnishings","010"]
["Depreciation-Vehicles","011",null,null,null,null,null,null,null,null,null,null,null,null,"Depreciation-Vehicles","011",null,null,null,null,null,null,null,null,null,null,null,null,"Depreciation-Vehicles","011"]
["Transportation","012",null,null,null,null,null,null,null,null,null,null,null,null,"Transportation","012",null,null,null,null,null,null,null,null,null,null,null,null,"Transportation","012"]
["Utilities","013",null,null,null,null,null,null,null,null,null,null,null,null,"Utilities","013",null,null,null,null,null,null,null,null,null,null,null,null,"Utilities","013"]
["Office Supplies & Materials","014",null,null,null,null,null,null,null,null,null,null,null,null,"Office Supplies & Materials","014",null,null,null,null,null,null,null,null,null,null,null,null,"Office Supplies & Materials","014"]
["Insurance","015",null,null,null,null,null,null,null,null,null,null,null,null,"Insurance","015",null,null,null,null,null,null,null,null,null,null,null,null,"Insurance","015"]
["Administration & General ","016",null,null,null,null,null,null,null,null,null,null,null,null,"Administration & General ","016",null,null,null,null,null,null,null,null,null,null,null,null,"Administration & General ","016"]
["Employee physicals/uniforms/immunizations","017",null,null,null,null,null,null,null,null,null,null,null,null,"Employee physicals/uniforms/immunizations","017",null,null,null,null,null,null,null,null,null,null,null,null,"Employee physicals/uniforms/immunizations","017"]
["Medical Supplies","018",null,null,null,null,null,null,null,null,null,null,null,null,"Medical Supplies","018",null,null,null,null,null,null,null,null,null,null,null,null,"Medical Supplies","018"]
["Other   ","019",null,null,null,null,null,null,null,null,null,null,null,null,"Other   ","019",null,null,null,null,null,null,null,null,null,null,null,null,"Other   ","019"]
["Grand Total","020",{"$f":"SUM(C32:C50)","v":0},{"$f":"SUM(D32:D50)","v":0},null,null,null,null,null,null,null,null,null,null,"Grand Total","020",{"$f":"SUM(Q32:Q50)","v":0},{"$f":"SUM(R32:R50)","v":0},null,null,null,null,null,null,null,null,null,null,"Grand Total","020",{"$f":"SUM(AE32:AE50)","v":0},{"$f":"SUM(AF32:AF50)","v":0}]
[]
[]
["Total Program Administration Expenses",null,{"$f":"C51","v":0},null,null,null,null,null,null,null,null,null,null,null,"Total Program Administration Expenses",null,{"$f":"Q51","v":0},null,null,null,null,null,null,null,null,null,null,null,"Total Program Administration Expenses",null,{"$f":"AE51","v":0}]
["Schedule 3 Total",null,null,null,null,null,null,null,null,null,null,null,null,null,"Schedule 3 Total",null,null,null,null,null,null,null,null,null,null,null,null,null,"Schedule 3 Total"]
["Difference",null,null,null,null,null,null,null,null,null,null,null,null,null,"Difference",null,null,null,null,null,null,null,null,null,null,null,null,null,"Difference"]
[]
["Agrees to Column 004 on Schedule 3a (Program Administration)",null,null,null,null,null,null,null,null,null,null,null,null,null,"Agrees to Column 004 on Schedule 3a (Program Administration)",null,null,null,null,null,null,null,null,null,null,null,null,null,"Agrees to Column 004 on Schedule 3a (Program Administration)"]
[]
[]
["Schedule 5a.1"]
[]
["CHHA Name ","Example CHHA"]
["CHHA Operating Certificate"]
["Schedule 5a.1: CHHA Pediatric Service Statistics",null,"Medicaid",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dual-eligible ",null,null,"Medicare",null,null,"Private Pay",null,null,"Other ",null,null,"Total"]
[null,null,"FFS",null,null,null,null,null,"MC",null,null,null,null,null,"Total Medicaid (FFS + MC)",null,null,null,null,null,"Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Total Unique Patients ","Total Unique Units of Service: Visits/Days","Total Unique Units of Service: Hours                   "]
[null,null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours"]
[null,null,"001",null,"002",null,"003",null,"004",null,"005",null,"006",null,"007",null,"008",null,"009",null,"010","011","012","013","014","015","016","017","018","019","020","021","022","023","024"]
["Direct Care"]
["Home Health Aide ","001",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C70,I70)","v":0},null,{"$f":"SUM(E70,K70)","v":0},null,{"$f":"SUM(G70,M70)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O70,X70,AA70,AD70)","v":0},null,{"$f":"SUM(S70,Z70,AC70,AF70)","v":0}]
["Home Health Physical Therapy","002",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C71,I71)","v":0},null,{"$f":"SUM(E71,K71)","v":0},null,{"$f":"SUM(G71,M71)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O71,X71,AA71,AD71)","v":0},{"$f":"SUM(Q71,Y71,AB71,AE71)","v":0}]
["Home Health Occupational Therapy","003",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q72,Y72,AB72,AE72)","v":0}]
["Home Health Registered Nurse","004",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Medical Social Services","005",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Nutrition","006",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Speech Therapy","007",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Respiratory Therapy","008",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S77,Z77,AC77,AF77)","v":0}]
["Home Social & Environmental Support","009",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q78,Y78,AB78,AE78)","v":0}]
["Home Health Sign Language/Oral Interpreter","010",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q79,Y79,AB79,AE79)","v":0}]
["Nursing Supervision","015",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q80,Y80,AB80,AE80)","v":0}]
["Nursing Assessment","016",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["SUBTOTAL (reimbursable services) ","017",{"$f":"SUM(C70:D81)","v":0},null,{"$f":"SUM(E70:F81)","v":0},null,{"$f":"SUM(G70:H81)","v":0},null,{"$f":"SUM(I70:J81)","v":0},null,{"$f":"SUM(K70:L81)","v":0},null,{"$f":"SUM(M70:N81)","v":0},null,0,null,0,null,0,null,{"$f":"SUM(U70:U81)","v":0},{"$f":"SUM(V70:V81)","v":0},0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(AG70:AG81)","v":0},{"$f":"SUM(AH70:AH81)","v":0},0]
["Other non-reimbursable services","018",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C83,I83)","v":0},null,{"$f":"SUM(E83,K83)","v":0},null,{"$f":"SUM(G83,M83)","v":0}]
["Personal care services","019",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0]
["GRAND TOTAL ","020",{"$f":"SUM(C82:D84)","v":0},null,{"$f":"SUM(E82:F84)","v":0},null,{"$f":"SUM(G82:H84)","v":0},null,{"$f":"SUM(I82:J84)","v":0},null,{"$f":"SUM(K82:L84)","v":0},null,{"$f":"SUM(M82:N84)","v":0},null,{"$f":"SUM(O82:P84)","v":0},null,{"$f":"SUM(Q82:R84)","v":0},null,{"$f":"SUM(S82:T84)","v":0},null,{"$f":"SUM(U82:U84)","v":0},{"$f":"SUM(V82:V84)","v":0},{"$f":"SUM(W82:W84)","v":0},0,0,0,0,0,0,0,0,{"$f":"SUM(AF82:AF84)","v":0},{"$f":"SUM(AG82:AG84)","v":0},{"$f":"SUM(AH82:AH84)","v":0},{"$f":"SUM(AI82:AI84)","v":0}]
[]
["Schedule 5a.2"]
[]
["CHHA Name ","Example CHHA"]
["CHHA Operating Certificate"]
["Schedule 5a.2: CHHA Episodic Service Statistics",null,"Medicaid",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dual-eligible ",null,null,"Medicare",null,null,"Private Pay",null,null,"Other ",null,null,"Total"]
[null,null,"FFS",null,null,null,null,null,"MC",null,null,null,null,null,"Total Medicaid (FFS + MC)",null,null,null,null,null,"Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Total Unique Patients ","Total Unique Units of Service: Visits/Days","Total Unique Units of Service: Hours                   "]
[null,null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours"]
[null,null,"001",null,"002",null,"003",null,"004",null,"005",null,"006",null,"007",null,"008",null,"009",null,"010","011","012","013","014","015","016","017","018","019","020","021","022","023","024"]
["Direct Care"]
["Home Health Aide ","001",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C96,I96)","v":0},null,{"$f":"SUM(E96,K96)","v":0},null,{"$f":"SUM(G96,M96)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O96,X96,AA96,AD96)","v":0},null,{"$f":"SUM(S96,Z96,AC96,AF96)","v":0}]
["Home Health Physical Therapy","002",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C97,I97)","v":0},null,{"$f":"SUM(E97,K97)","v":0},null,{"$f":"SUM(G97,M97)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O97,X97,AA97,AD97)","v":0},{"$f":"SUM(Q97,Y97,AB97,AE97)","v":0}]
["Home Health Occupational Therapy","003",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q98,Y98,AB98,AE98)","v":0}]
["Home Health Registered Nurse","004",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Medical Social Services","005",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Nutrition","006",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Speech Therapy","007",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["Home Health Respiratory Therapy","008",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S103,Z103,AC103,AF103)","v":0}]
["Home Social & Environmental Support","009",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q104,Y104,AB104,AE104)","v":0}]
["Home Health Sign Language/Oral Interpreter","010",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q105,Y105,AB105,AE105)","v":0}]
["Nursing Supervision","015",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q106,Y106,AB106,AE106)","v":0}]
["Nursing Assessment","016",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,0]
["SUBTOTAL (reimbursable services)","017",{"$f":"SUM(C96:D107)","v":0},null,{"$f":"SUM(E96:F107)","v":0},null,{"$f":"SUM(G96:H107)","v":0},null,{"$f":"SUM(I96:J107)","v":0},null,{"$f":"SUM(K96:L107)","v":0},null,{"$f":"SUM(M96:N107)","v":0},null,{"$f":"SUM(O96:P107)","v":0},null,{"$f":"SUM(Q96:R107)","v":0},null,{"$f":"SUM(S96:T107)","v":0},null,{"$f":"SUM(U96:U107)","v":0},{"$f":"SUM(V96:V107)","v":0},0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(AG96:AG107)","v":0},{"$f":"SUM(AH96:AH107)","v":0},{"$f":"SUM(AI96:AJ107)","v":0}]
["Other non-reimbursable services","018",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C109,I109)","v":0},null,{"$f":"SUM(E109,K109)","v":0},null,{"$f":"SUM(G109,M109)","v":0}]
["Personal care services","019",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0]
["GRAND TOTAL ","020",{"$f":"SUM(C108:D110)","v":0},null,{"$f":"SUM(E108:F110)","v":0},null,{"$f":"SUM(G108:H110)","v":0},null,{"$f":"SUM(I108:J110)","v":0},null,{"$f":"SUM(K108:L110)","v":0},null,{"$f":"SUM(M108:N110)","v":0},null,{"$f":"SUM(O108:P110)","v":0},null,{"$f":"SUM(Q108:R110)","v":0},null,{"$f":"SUM(S108:T110)","v":0},null,{"$f":"SUM(U108:U110)","v":0},{"$f":"SUM(V108:V110)","v":0},{"$f":"SUM(W108:W110)","v":0},0,0,0,0,0,0,0,0,{"$f":"SUM(AF108:AF110)","v":0},{"$f":"SUM(AG108:AG110)","v":0},{"$f":"SUM(AH108:AH110)","v":0},{"$f":"SUM(AI108:AI110)","v":0}]
[]
["Schedule 5b"]
[]
["LHCSA Name ","Example LHCSA"]
["LHCSA County","County #1"]
["Schedule 5b: LHCSA Service Statistics",null,"Medicaid",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dual-eligible ",null,null,"Medicare",null,null,"Private Pay",null,null,"Other ",null,null,"Total"]
[null,null,"FFS",null,null,null,null,null,"MC",null,null,null,null,null,"Total Medicaid (FFS + MC)",null,null,null,null,null,"Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Patients","Units of Service: Visits/Days","Units of Service: Hours","Total Unique Patients ","Total Unique Units of Service: Visits/Days","Total Unique Units of Service: Hours                   "]
[null,null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits/Days",null,"Units of Service: Hours"]
[null,null,"001",null,"002",null,"003",null,"004",null,"005",null,"006",null,"007",null,"008",null,"009",null,"010","011","012","013","014","015","016","017","018","019","020","021","022","023","024"]
["Direct Care"]
["PC: Level I ","001",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C122,I122)","v":0},null,{"$f":"SUM(E122,K122)","v":0},null,{"$f":"SUM(G122,M122)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O122,X122,AA122,AD122)","v":0},null,{"$f":"SUM(S122,Z122,AC122,AF122)","v":0}]
["PC: Level II ","002",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S123,Z123,AC123,AF123)","v":0}]
["PC: Level II - Hard to Serve","003",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S124,Z124,AC124,AF124)","v":0}]
["Live-In","004",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q125,Y125,AB125,AE125)","v":0}]
["Nursing Supervision","005",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q126,Y126,AB126,AE126)","v":0}]
["Nursing Assessment","006",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q127,Y127,AB127,AE127)","v":0}]
["Shared Aide: Level I","007",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S128,Z128,AC128,AF128)","v":0}]
["Shared Aide: Level II","008",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S129,Z129,AC129,AF129)","v":0}]
[" SUBTOTAL (reimbursable services) ",null,{"$f":"SUM(C122:D129)","v":0},null,{"$f":"SUM(E122:F129)","v":0},null,{"$f":"SUM(G122:H129)","v":0},null,{"$f":"SUM(I122:J129)","v":0},null,{"$f":"SUM(K122:L129)","v":0},null,{"$f":"SUM(M122:N129)","v":0},null,{"$f":"SUM(O122:P129)","v":0},null,{"$f":"SUM(Q122:R129)","v":0},null,{"$f":"SUM(S122:T129)","v":0},null,{"$f":"SUM(U122:U129)","v":0},{"$f":"SUM(V122:V129)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0]
["Other non-reimbursable services","009",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C131,I131)","v":0},null,{"$f":"SUM(E131,K131)","v":0},null,{"$f":"SUM(G131,M131)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O131,X131,AA131,AD131)","v":0},{"$f":"SUM(Q131,Y131,AB131,AE131)","v":0},{"$f":"SUM(S131,Z131,AC131,AF131)","v":0}]
["Subcontractor services","010"]
["Home Health Aide","011"]
["GRAND TOTAL ","012",{"$f":"SUM(C130:D133)","v":0},null,{"$f":"SUM(E130:F133)","v":0},null,{"$f":"SUM(G130:H133)","v":0},null,{"$f":"SUM(I130:J133)","v":0},null,{"$f":"SUM(K130:L133)","v":0},null,{"$f":"SUM(M130:N133)","v":0},null,{"$f":"SUM(O130:P133)","v":0},null,{"$f":"SUM(Q130:R133)","v":0},null,{"$f":"SUM(S130:T133)","v":0},null,{"$f":"SUM(U130:U133)","v":0},{"$f":"SUM(V130:V133)","v":0},{"$f":"SUM(W130:W133)","v":0},0,0,0,0,0,0,0,0,0,{"$f":"SUM(AG130:AG133)","v":0},{"$f":"SUM(AH130:AH133)","v":0},0]
[]
["Schedule 5c"]
[]
["FI Name ","Example FI"]
["FI County","County #1"]
["Schedule 5c: FI Service Statistics",null,"Medicaid",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dual-eligible ",null,null,"Medicare",null,null,"Private Pay",null,null,"Other",null,null,"Total"]
[null,null,"FFS",null,null,null,null,null,"MC",null,null,null,null,null,"Total Medicaid (FFS + MC)"]
[null,null,"Patients",null,"Units of Service: Visits",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits",null,"Units of Service: Hours",null,"Patients",null,"Units of Service: Visits",null,"Units of Service: Hours",null,"Patients","Units of Service: Visits","Units of Service: Hours","Patients","Units of Service: Visits","Units of Service: Hours","Patients","Units of Service: Visits","Units of Service: Hours","Patients","Units of Service: Visits","Units of Service: Hours","Total Unique Patients ","Total Unique Units of Service: Visits                   ","Total Unique Units of Service: Hours                   "]
[null,null,"001",null,"002",null,"003",null,"004",null,"005",null,"006",null,"007",null,"008",null,"009",null,"010","011","012","013","014","015","016","017","018","019","020","021","022","023","024"]
["Direct Care"]
["CDPAS: Individual - Basic","001",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C145,I145)","v":0},null,{"$f":"SUM(E145,K145)","v":0},null,{"$f":"SUM(G145,M145)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O145,X145,AA145,AD145)","v":0},null,{"$f":"SUM(S145,Z145,AC145,AF145)","v":0}]
["CDPAS: Individual - Hard to Serve ","002",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C146,I146)","v":0},null,{"$f":"SUM(E146,K146)","v":0},null,{"$f":"SUM(G146,M146)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(O146,X146,AA146,AD146)","v":0},null,{"$f":"SUM(S146,Z146,AC146,AF146)","v":0}]
["CDPAS: Individual - Live-In","003",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q147,Y147,AB147,AE147)","v":0}]
["CDPAS: Multiple - Basic","004",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S148,Z148,AC148,AF148)","v":0}]
["CDPAS: Multiple - Hard to Serve ","005",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,{"$f":"SUM(S149,Z149,AC149,AF149)","v":0}]
["CDPAS: Multiple - Live-In","006",null,null,null,null,null,null,null,null,null,null,null,null,0,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(Q150,Y150,AB150,AE150)","v":0}]
["SUBTOTAL (reimbursable services) ","007",{"$f":"SUM(C143:D148)","v":0},null,{"$f":"SUM(E143:F148)","v":0},null,{"$f":"SUM(G143:H148)","v":0},null,{"$f":"SUM(I143:J148)","v":0},null,{"$f":"SUM(K143:L148)","v":0},null,{"$f":"SUM(M143:N148)","v":0},null,{"$f":"SUM(O143:P148)","v":0},null,{"$f":"SUM(Q143:R148)","v":0},null,{"$f":"SUM(S143:T148)","v":0},null,{"$f":"SUM(U143:U148)","v":0},{"$f":"SUM(V143:V148)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0]
["Other non-reimbursable services","008"]
["GRAND TOTAL ","009",{"$f":"SUM(C151:D152)","v":0},null,{"$f":"SUM(E151:F152)","v":0},null,{"$f":"SUM(G151:H152)","v":0},null,{"$f":"SUM(I151:J152)","v":0},null,{"$f":"SUM(K151:L152)","v":0},null,{"$f":"SUM(M151:N152)","v":0},null,0,null,0,null,0,null,{"$f":"SUM(U151:U152)","v":0},{"$f":"SUM(V151:V152)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0]

{"sheet":"Sch 5 Source Documentation","index":5,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":false,"merged":[[1,0,5,20],[0,0,0,20]]}
["Schedule 5 Source Documentation"]
["Instructions: This tab should include the source documentation for the Schedule 5 service statistics. Please export your Schedule 5 system-generated statistical source data (e.g., HHAExchange report) into Excel format and paste it into this tab.   Please note that the statistical data should include the following:  Patient count, Payor type (e.g., Medicaid FFS, Medicare, Private Pay, etc.), days/visits, hours, service type, entity type, and entity\n\nBased on statistical source documentation within this tab, agencies may need to pivot or summarize the data into a table by service type and entity type. Then, that summary table can more easily be used to populate Schedule 5.   Please use formulas to link the data in this Schedule 5 source documentation tab (or the pivot table summary of the source data) to the applicable \"Schedule 5\" tabs. "]

{"sheet":"Allocation","index":6,"n_rows":48,"n_cols":6,"rows_kept":48,"cut":false,"hidden":false,"merged":[[0,0,0,9],[1,0,5,15]]}
["Allocation Percentages - Summary of Allocation by Entity and Service Line (from system generated support or source documentation)"]
["We understand that a home care agency may operate multiple entities, each of which may provide multiple service types. Therefore, agencies must allocate costs across their entities and service types on Schedule 3. \n\nInstructions:\nIn this tab, please document the allocation methodologies used to allocate costs on Schedules 3 and 4 of the cost report, as well as the calculations for each allocation percentage used. Acceptable allocation methodologies include total operating expenses, hours/visits of service, square feet occupied, time study, payroll costs, etc.   For further guidance on how to allocate, please watch the \"Allocation costs on Schedules 3 and 4\" pre-recorded module which is available in the \"Useful Links\" section of the Instructions tab in the Tool. \n\nNote:  Multiple allocation methodologies may be utilized to break out various costs on the Home Care cost report.  For example, hours of service could be used to break out costs by service type and entity, but a payroll allocation may be used to break out salary costs between Direct Care and Program Administration. Please create different tables within this tab by copying and pasting the one below, if multiple allocation methodologies are being used. \n\nIn the chart below, please calculate the allocation percentage for each entity and service type. Please note that you may add rows and columns to the chart as necessary. \n\n- The \"Allocation Metric\" column should include the metric that is being used as the basis of the allocation. Some examples of allocation metrics include total hours, total visits, total expenses, and total square feet occupied. For example, if your agency is using hours of service as an allocation methodology, the \"Allocation Metric\" column should include the total hours of service for that specific entity and service type. Note: You should link the value in this column to the source data that substantiates it. Using the same example, the hours of service entered in each row should be linked to the statistical data provided for Schedule 5. \n\n- The \"Allocation Percentage\" column includes a pre-determined formula that will auto-calculate the allocation percentage for each entity and service type, based on the information entered in Columns B - E. The formula divides the allocation metric for the individual row by the total amount in cell E8. The allocation percentage calculated in Column F should be used to allocate costs across the entities and service type rows in the Schedule 3 and Schedule 4 tabs of this template. "]
[]
[]
[]
[]
[]
[null,null,null,"Total",{"$f":"SUM(E10:E48)","v":0}]
[null,"Entity type (CHHA, LHCSA, FI)","Entity Identifier (Operating Certificate for CHHA, County for LHCSA/FI)","Service Type","Allocation Metric (e.g., total hours/visits or total expenses)","Allocation Percentage"]
[null,null,null,null,null,{"$f":"E10/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$f":"E17/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$f":"E30/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$f":"E35/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$f":"E37/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$f":"E39/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$f":"E44/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$error":"#DIV/0!"}]
[null,null,null,null,null,{"$f":"E47/$E$8","v":{"$error":"#DIV/0!"}}]
[null,null,null,null,null,{"$f":"E48/$E$8","v":{"$error":"#DIV/0!"}}]

{"sheet":"Schedule 5a.1","index":7,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":true,"merged":[[1,0,4,23]]}
["CHHA Schedule 5a.1"]
["Instructions: In this tab, use formulas to link the statistical data from the \"Schedule 5 source documentation\" tab (or a summary/pivot table of that data) to the Schedule 5 template below. \nPlease note that Schedule 5 should be populated using actual statistics from the calendar year, not an allocation.  "]

{"sheet":"Schedule 5a.2","index":8,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":true,"merged":[[1,0,4,23]]}
["CHHA Schedule 5a.2"]
["Instructions: In this tab, use formulas to link the statistical data from the \"Schedule 5 source documentation\" tab (or a summary/pivot table of that data) to the Schedule 5 template below. Please note that Schedule 5 should be populated using actual statistics from the calendar year, not an allocation.  "]

{"sheet":"Schedule 5b","index":9,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":true,"merged":[[1,0,4,23],[0,0,0,16383]]}
["LHCSA Schedule 5b"]
["Instructions: In this tab, use formulas to link the statistical data from the \"Schedule 5 source documentation\" tab (or a summary/pivot table of that data) to the Schedule 5 template below. \nPlease note that Schedule 5 should be populated using actual statistics from the calendar year, not an allocation.  "]

{"sheet":"Schedule 5c","index":10,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":true,"merged":[[1,0,4,23],[0,0,0,16383]]}
["FI Schedule 5c"]
["Instructions: In this tab, use formulas to link the statistical data from the \"Schedule 5 source documentation\" tab (or a summary/pivot table of that data) to the Schedule 5 template below. \nPlease note that Schedule 5 should be populated using actual statistics from the calendar year, not an allocation.  "]

{"sheet":"Schedule 3a","index":11,"n_rows":24,"n_cols":13,"rows_kept":24,"cut":false,"hidden":true,"merged":[[16,0,16,2],[22,0,22,1],[23,0,23,1],[1,0,7,11],[13,0,13,1],[14,0,14,1],[8,0,9,1],[10,0,10,1],[11,0,11,1],[12,0,12,1]]}
["CHHA Schedule 3a"]
["Instructions: This tab should be completed after the \"Sch 3 & 4 - Source Documentation\" tab cost categorization and \"Allocation\" tab allocation calculations were completed. Based on the cost categorization entered in the \"Sch 3&4 - Source Documentation\" tab, column totals will populate in row 9 of this tab (Schedule totals). Note that if the template was altered in the \"Sch 3 & 4 Source Documentation tab,\" the pre-created schedule total formulas may no longer be applicable. As such, please review the formulas for accuracy before proceeding with the completion of this tab. \n\nIn the AFS Total Expenses cell (C13), please enter the total expenses per your Agency's Audited Financial Statements or internal income statement. Please note any reconciling items in the \"reconciling items\" section below, and add additional rows if needed. The template will then reconcile Schedule 3 total entity costs to the total expenses per your agency's financial documentation (less reconciling items) in the Unreconciled Dollar value cell C23. \n\nOnce the total expenses for Schedule 3 have been identified, use the allocation percentages calculated for each entity and service type in the \"Allocation\" tab to calculate the cost for each entity, column, and row. Each cell in this schedule should be directly linked to the \"Allocation\" tab to demonstrate which allocation percentage is being used, and a cost category total from the schedule total row 9. Please do not manually key in numbers in the entity tables within this tab, as it makes it difficult to trace expenses back to the \"Sch 3 &4  - Source Documentation\" tab. "]
[]
[]
[]
[]
[]
[]
["Schedule Totals",null,"Total Entity Costs\n(002 + 003+ 004)","Non-reimbursable Costs (Adjustment to Expense)","Non-reimbursable WR&R costs","Total reimbursable Costs\n(Sum of columns 005 through 011)","Program Administration","Program Aide (Direct Care)","Program RN Supervision/ Assessment \n(Direct Care)","Program Staff Training","Transportation","Contracted Purchased Services","Other"]
[null,null,{"$f":"SUM(D10:F10)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E3)","v":0},null,{"$f":"SUM(G10:M10)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E4)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E5)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E6)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E7)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E8)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E9)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!A2, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!E10)","v":0}]
["Schedule 3b Totals",null,{"$f":"'Schedule 3b'!C10","v":0}]
["Schedule 3c totals",null,{"$f":"'[1]Schedule 3c'!C4","v":0}]
["Total expenses",null,{"$f":"SUM(C10:C12)","v":0}]
["AFS Total Expenses"]
["Variance",null,{"$f":"C13-C14","v":0}]
[]
["Reconciling Items"]
["Item","Description","$ Impact"]
[]
[]
[]
[]
["Total reconciling expenses",null,{"$f":"SUM(C19:C22)","v":0}]
["Unreconciled dollar value",null,{"$f":"C15-C23","v":0}]

{"sheet":"Schedule 3b","index":12,"n_rows":24,"n_cols":13,"rows_kept":24,"cut":false,"hidden":true,"merged":[[13,0,13,1],[14,0,14,1],[16,0,16,2],[22,0,22,1],[23,0,23,1],[1,0,7,11],[8,0,9,1],[10,0,10,1],[11,0,11,1],[12,0,12,1]]}
["LHCSA Schedule 3b"]
["Instructions: This tab should be completed after the \"Sch 3 & 4 - Source Documentation\" tab cost categorization and \"Allocation\" tab allocation calculations were completed. Based on the cost categorization entered in the \"Sch 3&4 - Source Documentation\" tab, column totals will populate in row 9 of this tab (Schedule totals). Note that if the template was altered in the \"Sch 3 & 4 Source Documentation tab,\" the pre-created schedule total formulas may no longer be applicable. As such, please review the formulas for accuracy before proceeding with the completion of this tab. \n\nIn the AFS Total Expenses cell (C13), please enter the total expenses per your Agency's Audited Financial Statements or internal income statement. Please note any reconciling items in the \"reconciling items\" section below, and add additional rows if needed. The template will then reconcile Schedule 3 total entity costs to the total expenses per your agency's financial documentation (less reconciling items) in the Unreconciled Dollar value cell C23. \n\nOnce the total expenses for Schedule 3 have been identified, use the allocation percentages calculated for each entity and service type in the \"Allocation\" tab to calculate the cost for each entity, column, and row. Each cell in this schedule should be directly linked to the \"Allocation\" tab to demonstrate which allocation percentage is being used, and a cost category total from the schedule total row 9. Please do not manually key in numbers in the entity tables within this tab, as it makes it difficult to trace expenses back to the \"Sch 3 &4  - Source Documentation\" tab. "]
[]
[]
[]
[]
[]
[]
["Schedule Totals",null,"Total Entity Costs\n(002 + 003+ 004)","Non-reimbursable Costs (Adjustment to Expense)","Non-reimbursable WR&R costs","Total reimbursable Costs\n(Sum of columns 005 through 011)","Program Administration","Program Aide (Direct Care)","Program RN Supervision/ Assessment \n(Direct Care)","Program Staff Training","Transportation","Contracted Purchased Services","Other"]
[null,null,{"$f":"SUM(D10:F10)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E3)","v":0},null,{"$f":"SUM(G10:M10)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E4)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E5)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E6)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E7)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E8)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E9)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A3, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E10)","v":0}]
["Schedule 3a Totals",null,{"$f":"'Schedule 3a'!C10","v":0}]
["Schedule 3c totals",null,{"$f":"'Schedule 3c'!C10","v":0}]
["Total expenses",null,{"$f":"SUM(C10:C12)","v":0}]
["AFS Total Expenses"]
["Variance",null,{"$f":"C13-C14","v":0}]
[]
["Reconciling Items"]
["Item","Description","$ Impact"]
[]
[]
[]
[]
["Total reconciling expenses",null,{"$f":"SUM(C19:C22)","v":0}]
["Unreconciled dollar value",null,{"$f":"C15-C23","v":0}]

{"sheet":"Schedule 3c","index":13,"n_rows":24,"n_cols":13,"rows_kept":24,"cut":false,"hidden":true,"merged":[[13,0,13,1],[14,0,14,1],[16,0,16,2],[22,0,22,1],[23,0,23,1],[1,0,7,11],[8,0,9,1],[10,0,10,1],[11,0,11,1],[12,0,12,1]]}
["FI Schedule 3c"]
["Instructions: This tab should be completed after the \"Sch 3 & 4 - Source Documentation\" tab cost categorization and \"Allocation\" tab allocation calculations were completed. Based on the cost categorization entered in the \"Sch 3&4 - Source Documentation\" tab, column totals will populate in row 9 of this tab (Schedule totals). Note that if the template was altered in the \"Sch 3 & 4 Source Documentation tab,\" the pre-created schedule total formulas may no longer be applicable. As such, please review the formulas for accuracy before proceeding with the completion of this tab. \n\nIn the AFS Total Expenses cell (C13), please enter the total expenses per your Agency's Audited Financial Statements or internal income statement. Please note any reconciling items in the \"reconciling items\" section below, and add additional rows if needed. The template will then reconcile Schedule 3 total entity costs to the total expenses per your agency's financial documentation (less reconciling items) in the Unreconciled Dollar value cell C23. \n\nOnce the total expenses for Schedule 3 have been identified, use the allocation percentages calculated for each entity and service type in the \"Allocation\" tab to calculate the cost for each entity, column, and row. Each cell in this schedule should be directly linked to the \"Allocation\" tab to demonstrate which allocation percentage is being used, and a cost category total from the schedule total row 9. Please do not manually key in numbers in the entity tables within this tab, as it makes it difficult to trace expenses back to the \"Sch 3 &4  - Source Documentation\" tab. "]
[]
[]
[]
[]
[]
[]
["Schedule Totals",null,"Total Entity Costs\n(002 + 003+ 004)","Non-reimbursable Costs (Adjustment to Expense)","Non-reimbursable WR&R costs","Total reimbursable Costs\n(Sum of columns 005 through 011)","Program Administration","Program Aide (Direct Care)","Program RN Supervision/ Assessment \n(Direct Care)","Program Staff Training","Transportation","Contracted Purchased Services","Other"]
[null,null,{"$f":"SUM(D10:F10)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E3)","v":0},null,{"$f":"SUM(G10:M10)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E4)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E5)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E6)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E7)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E8)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E9)","v":0},{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A4, 'Sch 3&4 - Source Documentation'!$F:$F,Dropdowns!$E10)","v":0}]
["Schedule 3a Totals",null,{"$f":"'Schedule 3a'!C10","v":0}]
["Schedule 3b totals",null,{"$f":"'Schedule 3b'!C10","v":0}]
["Total expenses",null,{"$f":"SUM(C10:C12)","v":0}]
["AFS Total Expenses"]
["Variance",null,{"$f":"C13-C14","v":0}]
[]
["Reconciling Items"]
["Item","Description","$ Impact"]
[]
[]
[]
[]
["Total reconciling expenses",null,{"$f":"SUM(C19:C22)","v":0}]
["Unreconciled dollar value",null,{"$f":"C15-C23","v":0}]

{"sheet":"Schedule 4a","index":14,"n_rows":31,"n_cols":5,"rows_kept":31,"cut":false,"hidden":true,"merged":[[1,0,5,14],[7,0,7,3]]}
["CHHA Schedule 4a"]
["Instructions: This tab should be completed after the \"Sch 3 & 4 - Source Documentation\" tab cost categorization and allocation calculations were completed. Based on the cost categorization entered in  \"Sch 3&4 - Source Documentation\" tab, column and row totals will populate in the Schedule total table at the top of this tab. Note that if the template was altered in the \"Sch 3 & 4 Source Documentation tab,\" the pre-created schedule total formulas may no longer be applicable. As such, please review the formulas for accuracy before proceeding with the completion of this tab. \n\nOnce the total expenses for Schedule 4 have been identified, use the allocation percentages calculated for each entity and service type in the \"Allocation\" tab to calculate the cost for each entity, column, and row. Each cell in this schedule should be directly linked to the \"Allocation\" tab to show which allocation percentage is being used and a cost category total from the schedule total table. Please do not manually key in numbers in the entity tables within this tab, as it makes it difficult to trace expenses back to the \"Sch 3 &4  - Source Documentation\" tab. "]
[]
[]
[]
[]
[]
["Schedule 4 Totals"]
["Schedule 4a: CHHA General Service Cost Centers",null,"Program Administration","Direct Care non-personnel Costs"]
[null,null,"001","002"]
["GENERAL SERVICE COST CENTERS "]
["Criminal Background Check & Fingerprinting","001",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A2, 'Sch 3&4 - Source Documentation'!$H:$H,A12)","v":0}]
["Capital Related - Building & Fixtures","002",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A2, 'Sch 3&4 - Source Documentation'!$H:$H,A13)","v":0}]
["Capital Related - Movable Equipment","003",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A2, 'Sch 3&4 - Source Documentation'!$H:$H,A14)","v":0}]
["Plant Operations & Maintenance","004",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A2, 'Sch 3&4 - Source Documentation'!$H:$H,A15)","v":0}]
["Rent-Building","005",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A16)","v":0}]
["Rent-Furnishings","006",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A17)","v":0}]
["Rent-Vehicles","007",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A18)","v":0}]
["Interest-Property","008",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A19)","v":0}]
["Depreciation-Plant","009",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A20)","v":0}]
["Depreciation-Equipment & Furnishings","010",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A21)","v":0}]
["Depreciation-Vehicles","011",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A22)","v":0}]
["Transportation","012",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A23)","v":0}]
["Utilities","013",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A24)","v":0}]
["Office Supplies & Materials","014",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A25)","v":0},null," "]
["Insurance","015",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A26)","v":0}]
["Administration & General ","016",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A27)","v":0}]
["Employee physicals/uniforms/immunizations","017",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A28)","v":0}]
["Medical Supplies","018",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A29)","v":0}]
["Other   ","019",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$2, 'Sch 3&4 - Source Documentation'!$H:$H,A30)","v":0}]
["Grand Total","020",{"$f":"SUM(C12:C30)","v":0},{"$f":"SUM(D12:D30)","v":0}]

{"sheet":"Schedule 4b","index":15,"n_rows":31,"n_cols":5,"rows_kept":31,"cut":false,"hidden":true,"merged":[[1,0,5,14],[7,0,7,3]]}
["LHCSA Schedule 4b"]
["Instructions: This tab should be completed after the \"Sch 3 & 4 - Source Documentation\" tab cost categorization and allocation calculations were completed. Based on the cost categorization entered in  \"Sch 3&4 - Source Documentation\" tab, column and row totals will populate in the Schedule total table at the top of this tab. Note that if the template was altered in the \"Sch 3 & 4 Source Documentation tab,\" the pre-created schedule total formulas may no longer be applicable. As such, please review the formulas for accuracy before proceeding with the completion of this tab. \n\nOnce the total expenses for Schedule 4 have been identified, use the allocation percentages calculated for each entity and service type in the \"Allocation\" tab to calculate the cost for each entity, column, and row. Each cell in this schedule should be directly linked to the \"Allocation\" tab to show which allocation percentage is being used and a cost category total from the schedule total table. Please do not manually key in numbers in the entity tables within this tab, as it makes it difficult to trace expenses back to the \"Sch 3 &4  - Source Documentation\" tab. "]
[]
[]
[]
[]
[]
["Schedule 4 Totals"]
["Schedule 4a: CHHA General Service Cost Centers",null,"Program Administration","Direct Care non-personnel Costs"]
[null,null,"001","002"]
["GENERAL SERVICE COST CENTERS "]
["Criminal Background Check & Fingerprinting","001",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A12)","v":0}]
["Capital Related - Building & Fixtures","002",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A13)","v":0}]
["Capital Related - Movable Equipment","003",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A14)","v":0}]
["Plant Operations & Maintenance","004",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A15)","v":0}]
["Rent-Building","005",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A16)","v":0}]
["Rent-Furnishings","006",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A17)","v":0}]
["Rent-Vehicles","007",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A18)","v":0}]
["Interest-Property","008",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A19)","v":0}]
["Depreciation-Plant","009",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A20)","v":0}]
["Depreciation-Equipment & Furnishings","010",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A21)","v":0}]
["Depreciation-Vehicles","011",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A22)","v":0}]
["Transportation","012",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A23)","v":0}]
["Utilities","013",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A24)","v":0}]
["Office Supplies & Materials","014",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A25)","v":0},null," "]
["Insurance","015",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A26)","v":0}]
["Administration & General ","016",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A27)","v":0}]
["Employee physicals/uniforms/immunizations","017",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A28)","v":0}]
["Medical Supplies","018",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A29)","v":0}]
["Other   ","019",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$3, 'Sch 3&4 - Source Documentation'!$H:$H,A30)","v":0}]
["Grand Total","020",{"$f":"SUM(C12:C30)","v":0},{"$f":"SUM(D12:D30)","v":0}]

{"sheet":"Schedule 4c","index":16,"n_rows":31,"n_cols":5,"rows_kept":31,"cut":false,"hidden":true,"merged":[[1,0,5,14],[7,0,7,3]]}
["FI Schedule 4c"]
["Instructions: This tab should be completed after the \"Sch 3 & 4 - Source Documentation\" tab cost categorization and allocation calculations were completed. Based on the cost categorization entered in  \"Sch 3&4 - Source Documentation\" tab, column and row totals will populate in the Schedule total table at the top of this tab. Note that if the template was altered in the \"Sch 3 & 4 Source Documentation tab,\" the pre-created schedule total formulas may no longer be applicable. As such, please review the formulas for accuracy before proceeding with the completion of this tab. \n\nOnce the total expenses for Schedule 4 have been identified, use the allocation percentages calculated for each entity and service type in the \"Allocation\" tab to calculate the cost for each entity, column, and row. Each cell in this schedule should be directly linked to the \"Allocation\" tab to show which allocation percentage is being used and a cost category total from the schedule total table. Please do not manually key in numbers in the entity tables within this tab, as it makes it difficult to trace expenses back to the \"Sch 3 &4  - Source Documentation\" tab. "]
[]
[]
[]
[]
[]
["Schedule 4 Totals"]
["Schedule 4a: CHHA General Service Cost Centers",null,"Program Administration","Direct Care non-personnel Costs"]
[null,null,"001","002"]
["GENERAL SERVICE COST CENTERS "]
["Criminal Background Check & Fingerprinting","001",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A12)","v":0}]
["Capital Related - Building & Fixtures","002",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A13)","v":0}]
["Capital Related - Movable Equipment","003",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A14)","v":0}]
["Plant Operations & Maintenance","004",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A15)","v":0}]
["Rent-Building","005",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A16)","v":0}]
["Rent-Furnishings","006",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A17)","v":0}]
["Rent-Vehicles","007",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A18)","v":0}]
["Interest-Property","008",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A19)","v":0}]
["Depreciation-Plant","009",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A20)","v":0}]
["Depreciation-Equipment & Furnishings","010",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A21)","v":0}]
["Depreciation-Vehicles","011",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A22)","v":0}]
["Transportation","012",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A23)","v":0}]
["Utilities","013",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A24)","v":0}]
["Office Supplies & Materials","014",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A25)","v":0},null," "]
["Insurance","015",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A26)","v":0}]
["Administration & General ","016",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A27)","v":0}]
["Employee physicals/uniforms/immunizations","017",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A28)","v":0}]
["Medical Supplies","018",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A29)","v":0}]
["Other   ","019",{"$f":"SUMIFS('Sch 3&4 - Source Documentation'!$C:$C,'Sch 3&4 - Source Documentation'!$E:$E,Dropdowns!$A$4, 'Sch 3&4 - Source Documentation'!$H:$H,A30)","v":0}]
["Grand Total","020",{"$f":"SUM(C12:C30)","v":0},{"$f":"SUM(D12:D30)","v":0}]

{"sheet":"CHHA Pediatric R&R-RT&R Est.","index":17,"n_rows":25,"n_cols":11,"rows_kept":25,"cut":false,"hidden":true,"merged":[[20,0,20,5],[0,0,0,7],[3,0,3,10],[4,0,6,0],[4,1,6,1],[4,2,6,2],[4,3,6,3],[4,4,6,4],[4,5,6,5],[4,7,6,7],[4,8,6,8],[4,9,6,9],[4,10,6,10],[8,0,8,5],[12,0,12,5],[16,0,16,5]]}
["DOH-approved Recruitment & Retention (R&R) and Recruitment, Training & Retention (RT&R) Revenue Estimation Template - CHHA Pediatric services only"]
["For additional guidance, including WR&R instructions for agencies contracted with the City of New York, refer to pages 16-19 of the 2022 Home Care Cost Report Instructions or the \"Workers' Recruitment & Retention Reporting Guidance\" pre-recorded module available in the \"Useful Links\" section of the Tool."]
[null,"  "]
["Comments/Instructions for template"]
["In calendar year 2022, CHHAs received a 2.25% R&R rate add-on and a 4.70%  RT&R add-on (6.95% total) for pediatric services. R&R and RT&R rate add-ons were not provided for CHHA episodic services. Use this rate add-on percentage if rate sheet doesn’t clearly identify R&R/RT&R add-on dollar value.","Enter Medicaid Reimbursement rate from rate sheet (FFS and/or MC)","Formula = Medicaid reimbursement rate/(Medicaid reimbursement rate/(1+R&R and RT&R rate add-ons)","Select a reimbursable service type* from the drop-down menu options. ","Enter total units of service from Schedule 5a.1 for the specific entity and service type listed in Column D.","Amount must be offset from total R&R + RT&R costs ",null,"Sum of all R&R + RT&R revenue (Column F)","Should be supported by trial expense accounts or general ledger detail with certain expenses containing R&R and RT&R expenses.","Report R&R and RT&R costs that were covered by the R&R and RT&R revenue as non-allowable in column 003 of Schedule 3.","If this value is positive (i.e., there are R&R and RT&R costs in excess of R&R and RT&R revenue received), report the excess costs in column 005 (Program Administration), Column 006 (Program Aide), Column 007 (Program RN Supervision/Assessment, or Column 008 (Program Staff Training) on Schedule 3. If value is negative (i.e., R&R and RT&R revenue is greater than R&R and RT&R costs), do not enter the value on Schedule 3, as it is not a cost. "]
[]
[]
[]
["Entity #1, Service Type #1",null,null,null,null,null,null,"Total estimated R&R + RT&R revenue","Total R&R + RT&R costs","Non-reimbursable R&R +RT&R costs to be reported in Column 003","Reimbursable R&R + RT&R costs to be reported in Column 005-008 (report amount in Schedule 3 if positive, do not report if negative)"]
["R&R + RT&R Rate Add-On %","2022 Medicaid Reimbursement rate","R&R + RT&R Rate Add-On ($)","Reimbursable Service Type* (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated R&R + RT&R revenue",null,{"$f":"SUM(F11,F15,F19,F23)","v":0},null,{"$f":"H10","v":0},{"$f":"I10-J10","v":0}]
[6.9500000000000006E-2,null,{"$f":"B11-(B11/(1+A11))","v":0},null,null,{"$f":"E11*C11","v":0}]
[]
["Entity #1, Service Type #2"]
["R&R + RT&R Rate Add-On %","2022 Medicaid Reimbursement rate","R&R + RT&R Rate Add-On ($)","Reimbursable Service Type* (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated R&R + RT&R revenue"]
[6.9500000000000006E-2,null,{"$f":"B15-(B15/(1+A15))","v":0},null,null,{"$f":"E15*C15","v":0}]
[]
["Entity #2, Service Type #1"]
["R&R + RT&R Rate Add-On %","2022 Medicaid Reimbursement rate","R&R + RT&R Rate Add-On ($)","Reimbursable Service Type* (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated R&R + RT&R revenue"]
[6.9500000000000006E-2,null,{"$f":"B19-(B19/(1+A19))","v":0},null,null,{"$f":"E19*C19","v":0}]
[]
["Entity #2, Service Type #2"]
["R&R + RT&R Rate Add-On %","2022 Medicaid Reimbursement rate","R&R + RT&R Rate Add-On ($)","Reimbursable Service Type* (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated R&R + RT&R revenue"]
[6.9500000000000006E-2,null,{"$f":"B23-(B23/(1+A23))","v":0},null,null,{"$f":"E23*C23","v":0}]
[]
["*\"Reimbursable\" refers to a service type that is reimbursed through the Medicaid Fee-for-service CHHA program."]

{"sheet":"Sheet1","index":18,"n_rows":12,"n_cols":8,"rows_kept":12,"cut":false,"hidden":true,"merged":[]}
["Home Health Aide"]
["Home Health Physical Therapy",null,"PC: Level I",null,null,null,null,"Individual - Basic"]
["Home Health Occupational Therapy",null,"PC: Level II",null,null,null,null,"Individual - Hard to Serve/Enhanced"]
["Home Health Registered Nurse",null,"PC: Level II - Hard to Serve",null,null,null,null,"Individual - Live-In"]
["Home Health Medical Social Services",null,"Live-in",null,null,null,null,"Multiple - Basic"]
["Home Health Nutrition",null,"Nursing Supervision",null,null,null,null,"Multiple - Hard to Serve"]
["Home Health Speech Therapy",null,"Nursing Assessment",null,null,null,null,"Multiple - Live-In"]
["Home Health Respiratory Therapy",null,"Shared Aide: Level I"]
["Home Social & Environmental Support",null,"Shared Aide: Level II"]
["Home Health Sign Language/Oral Interpreter"]
["Nursing Supervision"]
["Nursing Assessment"]

{"sheet":"LHSCA WR&R Estimation Template","index":19,"n_rows":25,"n_cols":11,"rows_kept":25,"cut":false,"hidden":true,"merged":[[8,0,8,5],[12,0,12,5],[16,0,16,5],[20,0,20,5],[3,0,3,10],[4,0,6,0],[4,1,6,1],[4,2,6,2],[4,3,6,3],[4,4,6,4],[4,5,6,5],[4,7,6,7],[4,8,6,8],[4,9,6,9],[4,10,6,10]]}
["DOH-approved Workers' Recruitment & Retention (WR&R) Revenue Estimation Template - LHCSA services"]
["For additional guidance, including WR&R instructions for agencies contracted with the City of New York, refer to pages 16-19 of the 2022 Home Care Cost Report Instructions or the \"Workers' Recruitment & Retention Reporting Guidance\" pre-recorded module available in the \"Useful Links\" section of the Tool."]
[null,"  "]
["Comments/Instructions for template"]
["In calendar year 2022, LHCSAs received a 4.56% WR&R rate add-on. Use this rate assumption if rate sheet doesn’t clearly identify WR&R add-on.","Enter Medicaid Reimbursement rate from rate sheet (FFS and/or MC)","Formula = Medicaid reimbursement rate -(Medicaid reimbursement rate/(1+WR&R add-on %)","Select a reimbursable service type* from the drop-down menu options. ","Enter total units of service from Schedule 5b, for the specific entity and service type listed in Column D.","Amount must be offset from total WR&R costs ",null,"Sum of all WR&R revenue (Column F)","Should be supported by trial expense accounts or general ledger detail with certain expenses containing WR&R expenses.","Report WR&R costs that were covered by the WR&R revenue as non-reimbursable in column 003 of Schedule 3.","If this value is positive (i.e., there are WR&R costs in excess of WR&R revenue received), report the excess costs in column 005 (Program Administration), Column 006 (Program Aide), Column 007 (Program RN Supervision/Assessment, or Column 008 (Program Staff Training) on Schedule 3. If value is negative (i.e., WR&R revenue is greater than WR&R costs), do not enter the value on Schedule 3, as it is not a cost. "]
[]
[]
[]
["Entity #1, Service Type #1",null,null,null,null,null,null,"Total estimated WR&R revenue","Total WR&R costs","Non-reimbursable WR&R costs to be reported in Column 003","Reimbursable WR&R costs to be reported in Columns 005-008 (report amount In Schedule 3 if positive, do not report if negative)"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable Service Type* (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue",null,{"$f":"SUM(F11,F15,F19,F23)","v":0},null,{"$f":"H10","v":0},{"$f":"I10-J10","v":0}]
[4.5600000000000002E-2,null,{"$f":"B11-(B11/(1+A11))","v":0},null,null,{"$f":"E11*C11","v":0}]
[]
["Entity #1, Service Type #2"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable* Service Type (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue"]
[4.5600000000000002E-2,null,{"$f":"B15-(B15/(1+A15))","v":0},null,null,{"$f":"E15*C15","v":0}]
[]
["Entity #2, Service Type #1"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable* Service Type (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue"]
[4.5600000000000002E-2,null,{"$f":"B19-(B19/(1+A19))","v":0},null,null,{"$f":"E19*C19","v":0}]
[]
["Entity #2, Service Type #2"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable* Service Type (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue"]
[4.5600000000000002E-2,null,{"$f":"B23-(B23/(1+A23))","v":0},null,null,{"$f":"E23*C23","v":0}]
[]
["*\"Reimbursable\" refers to a service type that is reimbursed through the Medicaid Fee-for-service Personal Care Program."]

{"sheet":"FI WR&R Estimation Template","index":20,"n_rows":24,"n_cols":11,"rows_kept":24,"cut":false,"hidden":true,"merged":[[8,0,8,5],[12,0,12,5],[16,0,16,5],[20,0,20,5],[3,0,3,10],[4,0,6,0],[4,1,6,1],[4,2,6,2],[4,3,6,3],[4,4,6,4],[4,5,6,5],[4,7,6,7],[4,8,6,8],[4,9,6,9],[4,10,6,10]]}
["DOH-approved Workers' Recruitment & Retention (WR&R) Revenue Estimation Template - FI Services"]
["For additional guidance, including WR&R instructions for agencies contracted with the City of New York, refer to pages 16-19 of the 2022 Home Care Cost Report Instructions or the \"Workers' Recruitment & Retention Reporting Guidance\" pre-recorded module available in the \"Useful Links\" section of the Tool."]
[null,"  "]
["Comments/Instructions for template"]
["In calendar year 2022, FIs received a 4.56% WR&R rate add-on.  Use this rate assumption if rate sheet doesn’t clearly identify WR&R add-on.","Enter Medicaid Reimbursement rate from rate sheet (FFS and/or MC)","Formula = Medicaid reimbursement rate -(Medicaid reimbursement rate/(1+WR&R add-on %)","Select a reimbursable service type* from the drop-down menu options. ","Enter total units of service from Schedule 5c, for the specific entity and service type listed in Column D.","Amount must be offset from total WR&R costs ",null,"Sum of all WR&R revenue (Column F)","Should be supported by trial expense accounts or general ledger detail with certain expenses containing WR&R expenses.","Report WR&R costs that were covered by the WR&R revenue as non-reimbursable in column 003 of Schedule 3.","If this value is positive (i.e., there are WR&R costs in excess of WR&R revenue received), report the excess costs in column 005 (Program Administration), Column 006 (Program Aide), Column 007 (Program RN Supervision/Assessment, or Column 008 (Program Staff Training) on Schedule 3. If value is negative (i.e., WR&R revenue is greater than WR&R costs), do not enter the value on Schedule 3, as it is not a cost. "]
[]
[]
[]
["Entity #1, Service Type #1",null,null,null,null,null,null,"Total estimated WR&R revenue","Total WR&R costs","Non-reimbursable WR&R costs to be reported in Column 003","Reimbursable WR&R costs to be reported in Columns 005-008 (report amount in Schedule 3 if positive, do not report if negative)"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable Service Type* (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue",null,{"$f":"SUM(F11,F15,F19,F23)","v":0},null,{"$f":"H10","v":0},{"$f":"I10-J10","v":0}]
[4.5600000000000002E-2,null,{"$f":"B11-(B11/(1+A11))","v":0},null,null,{"$f":"E11*C11","v":0}]
[]
["Entity #1, Service Type #2"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable* Service Type (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue"]
[4.5600000000000002E-2,null,{"$f":"B15-(B15/(1+A15))","v":0},null,null,{"$f":"E15*C15","v":0}]
[]
["Entity #2, Service Type #1"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable* Service Type (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue"]
[4.5600000000000002E-2,null,{"$f":"B19-(B19/(1+A19))","v":0},null,null,{"$f":"E19*C19","v":0}]
[]
["Entity #2, Service Type #2"]
["WR&R Rate Add-On %","2022 Medicaid Reimbursement rate","WR&R Rate Add-On ($)","Reimbursable* Service Type (select one from drop-down)","Units of service (FFS and/or MC)","Total estimated WR&R revenue"]
[4.5600000000000002E-2,null,{"$f":"B23-(B23/(1+A23))","v":0},null,null,{"$f":"E23*C23","v":0}]
["*\"Reimbursable\" refers to a service type that is reimbursed through the Medicaid Fee-for-service Consumer Directed Program."]