P00135 COLLECTIONS by ztn96829

VIEWS: 15 PAGES: 9

									                                                                                                                                             Humana Military Healthcare Services
                                                                                                                                                      DRG Reimbursement
                                                                                                                                           Capital and Direct Medical Education Costs
                                                                                                                                                          South Region
                                                                                                                                                       Contract 18895631
                                                                                                                                                        Fiscal Year 2006
                                                                                                                                                           April 2006
                                                                                                                                                         P00135 Credits




                                                                                                              PERIOD                                                                                         TOTAL MEDICAL        TOTAL
                                                                                              PROVIDER       COVERED   PERIOD                                         VOUCHER           TOTAL CAPITAL          EDUCATION       TMA/CHAMPUS           TYPE    CONTROL
            HOSPITAL NAME               HOSPITAL ADDRESS                CITY/STATE/ZIP         NUMBER          FROM  COVERED TO MEDICARE NUMBER                       NUMBER              PAYMENT               PAYMENT          PAYMENT           PAYMENT   NUMBER
HUMANA SOUTH

                   ALABAMA
MARSHALL MEDICAL CENTER NORTH       8000 AL HWY 69             GUNTERSVILLE, AL 35976-7119      636004420     10/01/91     09/30/92               010010                                      ($13,269.00)             $0.00        ($13,269.00)                  57088
MARSHALL MEDICAL CENTER NORTH       8000 AL HWY 69             GUNTERSVILLE, AL 35976-7119      636004420     10/01/92     09/30/93               010010                                       ($1,860.00)             $0.00         ($1,860.00)                  57089
MARSHALL MEDICAL CENTER NORTH       8000 AL HWY 69             GUNTERSVILLE, AL 35976-7119      636004420     10/01/94     09/30/95               010010                                       ($3,364.00)             $0.00         ($3,364.00)                  57090
BOAZ - ABLERTVILLE MEDICAL CENTER   US HWY 431 N               BOAZ, AL 35957                   636004458     10/01/92     09/30/93               010005                                       ($2,621.00)             $0.00         ($2,621.00)                  57091
BOAZ - ABLERTVILLE MEDICAL CENTER   US HWY 431 N               BOAZ, AL 35957                   636004458     10/01/93     09/30/94               010005                                       ($9,584.00)             $0.00         ($9,584.00)                  57092
BOAZ - ABLERTVILLE MEDICAL CENTER   US HWY 431 N               BOAZ, AL 35957                   636004458     10/01/94     09/30/95               010005                                       ($3,219.00)             $0.00         ($3,219.00)                  57093
RIVERVIEW REGIONAL MEDICAL CENTER   600 S 3RD ST               GADSDEN, AL 35999                631047424     07/01/94     06/30/95               010046                                         ($983.00)             $0.00           ($983.00)                  56948
RIVERVIEW REGIONAL MEDICAL CENTER   600 S 3RD ST               GADSDEN, AL 35999                631047424     07/01/96     06/30/97               010046                                       ($3,602.00)             $0.00         ($3,602.00)                  56949
RIVERVIEW REGIONAL MEDICAL CENTER   600 S 3RD ST               GADSDEN, AL 35999                631047424     07/01/95     06/30/96               010046                                       ($1,507.00)             $0.00         ($1,507.00)                  56947
RIVERVIEW REGIONAL MEDICAL CENTER   600 S 3RD ST               GADSDEN, AL 35999                631047424     07/01/93     06/30/94               010046                                          ($38.70)             $0.00            ($38.70)                  56946
RIVERVIEW REGIONAL MEDICAL CENTER   600 S 3RD ST               GADSDEN, AL 35999                631047424     07/01/92     06/30/93               010046                                         ($602.00)             $0.00           ($602.00)                  56944
DCH REGIONAL MEDICAL                809 UNIVERSITY BLVD EAST   TUSCALOOSA, AL 35401             636000271     10/01/93     09/30/94               010092                                       ($1,734.27)             $0.00         ($1,734.27)                  57087
BAPTIST MEDICAL CENTER MONTCLAIR    800 MONTCLAIR RD           BIRMINGHAM, AL 35213             630312913     07/01/92     06/30/93               010104                                         ($855.44)             $0.00           ($855.44)                  56941
                                                                                                                                          TOTAL AL REFUND                                   ($43,239.41)              $0.00       ($43,239.41)

                   ARKANSAS
MEDICAL PARK HOSPITAL               2001 S MAIN ST             HOPE, AR 71801                   710556056     07/01/92     06/30/93               040091                                       $4,477.00               $0.00         $4,477.00      REFUND        56580
MEDICAL PARK HOSPITAL               2001 S MAIN ST             HOPE, AR 71801                   710556056     07/01/93     06/30/94               040091                                       $1,486.00               $0.00         $1,486.00      REFUND        56523
                                                                                                                                          TOTAL AR REFUND                                    $5,963.00                $0.00        $5,963.00

                    FLORIDA
SARASOTA MEMORIAL HOSPITAL          1700 S TAMIAMI TRAIL       SARASOTA, FL 34239-3555        596012500002    10/01/93     09/30/94               100087                                       ($8,193.00)             $0.00         ($8,193.00)                  57139
SARASOTA MEMORIAL HOSPITAL          1700 S TAMIAMI TRAIL       SARASOTA, FL 34239-3555        596012500002    10/01/92     09/30/93               100087                                       ($3,049.55)             $0.00         ($3,049.55)                  57138
BETHESDA MEMORIAL HOSPITAL          2815 S SEACREST BLVD       BOYNTON BEACH, FL 33435-7995      592447554    10/01/91     09/30/92               100002                                         ($688.00)             $0.00           ($688.00)                  56858
BETHESDA MEMORIAL HOSPITAL          2815 S SEACREST BLVD       BOYNTON BEACH, FL 33435-7995      592447554    10/01/93     09/30/94               100002                                          ($39.91)             $0.00            ($39.91)                  56863
BETHESDA MEMORIAL HOSPITAL          2815 S SEACREST BLVD       BOYNTON BEACH, FL 33435-7995      592447554    10/01/94     09/30/95               100002                                       ($2,612.00)             $0.00         ($2,612.00)                  56866
BETHESDA MEMORIAL HOSPITAL          2815 S SEACREST BLVD       BOYNTON BEACH, FL 33435-7995      592447554    10/01/95     09/30/96               100002                                         ($916.00)             $0.00           ($916.00)                  56867
BETHESDA MEMORIAL HOSPITAL          2815 S SEACREST BLVD       BOYNTON BEACH, FL 33435-7995      592447554    10/01/96     09/30/97               100002                                       ($1,189.00)             $0.00         ($1,189.00)                  56960
BON SECOURS, VENICE HOSPITAL        540 THE RIALTO             VENICE, FL 34285                  650597937    07/01/92     06/30/93               100070                                       ($9,216.00)             $0.00         ($9,216.00)                  57102
BON SECOURS, VENICE HOSPITAL        540 THE RIALTO             VENICE, FL 34285                  650597937    07/01/94     06/30/95               100070                                       ($3,055.00)             $0.00         ($3,055.00)                  57103
BON SECOURS, VENICE HOSPITAL        540 THE RIALTO             VENICE, FL 34285                  650597937    09/01/94     08/31/95               100070                                         ($315.00)             $0.00           ($315.00)                  57104
BON SECOURS, VENICE HOSPITAL        540 THE RIALTO             VENICE, FL 34285                  650597937    09/01/95     08/31/96               100070                                       ($4,948.00)             $0.00         ($4,948.00)                  57105
BON SECOURS, VENICE HOSPITAL        540 THE RIALTO             VENICE, FL 34285                  650597937    09/01/96     08/31/97               100070                                       ($9,935.00)             $0.00         ($9,935.00)                  57106
GULF COAST MEDICAL CENTER           449 W 23RD ST              PANAMA CITY, FL 32405             620976863    02/01/94     01/31/95               100242                                         ($164.01)             $0.00           ($164.01)                  56916
GULF COAST MEDICAL CENTER           449 W 23RD ST              PANAMA CITY, FL 32405             620976863    02/01/93     01/01/94               100242                                        $2,386.20              $0.00          $2,386.20     REFUND        56915
HCA LAWNWOOD REGIONAL               1860 N LAWNWOOD CIR        FORT PIERCE, FL 34950             591764486    01/01/94     12/31/94               100246                                        $2,660.19              $0.00          $2,660.19     REFUND        56849
JACKSON MEMORIAL HOSPITAL           1611 NW 12TH AVE           MIAMI, FL 33136                591713947004    10/01/95     09/30/96               100022                                       ($1,574.70)             $0.00         ($1,574.70)                  57137
INDIAN RIVER MEMORIAL HOSPITAL      787 37TH ST S E-170        VERO BEACH, FL 32960              592496294    10/01/91     09/30/92               100105                                       ($8,118.00)             $0.00         ($8,118.00)                  57197
INDIAN RIVER MEMORIAL HOSPITAL      787 37TH ST S E-170        VERO BEACH, FL 32960              592496294    10/01/93     09/30/94               100105                                       ($1,128.00)             $0.00         ($1,128.00)                  57198
                                                                                                                                          TOTAL FL REFUND                                   ($50,094.78)              $0.00       ($50,094.78)

                    GEORGIA
UNIVERSITY HOSPITAL                 1350 WALTON WAY            AUGUSTA, GA 30901                 581581103    12/28/92     12/26/93               110028                                       ($8,808.00)             $0.00         ($8,808.00)                  57231
UNIVERSITY HOSPITAL                 1350 WALTON WAY            AUGUSTA, GA 30901                 581581103    12/30/01     12/27/92               110028                                       ($6,226.00)             $0.00         ($6,226.00)                  57221
UNIVERSITY HOSPITAL                 1350 WALTON WAY            AUGUSTA, GA 30901                 581581103    01/01/96     12/29/96               110028                                       ($1,669.00)             $0.00         ($1,669.00)                  57235
UNIVERSITY HOSPITAL                 1350 WALTON WAY            AUGUSTA, GA 30901                 581581103    12/30/96     12/28/97               110028                                         ($570.00)             $0.00           ($570.00)                  57237
GEORGIA BAPTIST MEDICAL CENTER      303 PARKWAY DR NE          ATLANTA, GA 30312              582149128054    10/01/94     09/30/95               110107                                       ($9,994.50)             $0.00         ($9,994.50)                  57133
FLOYD MEDICAL CENTER                304 TURNER MCCALL BLVD     ROME, GA 30162                 581973570025    07/01/94     06/30/95               110054                                       ($2,685.00)             $0.00         ($2,685.00)                  57243
FLOYD MEDICAL CENTER                304 TURNER MCCALL BLVD     ROME, GA 30162                 581973570025    07/01/93     06/30/94               110054                                         ($994.00)             $0.00           ($994.00)                  57241
FLOYD MEDICAL CENTER                304 TURNER MCCALL BLVD     ROME, GA 30162                 581973570025    07/01/92     06/30/93               110054                                       ($3,091.00)             $0.00         ($3,091.00)                  57240
HAMILTON MEDICAL CENTER             1200 MEMORIAL DR           DALTON, GA 30722                  581519911    10/01/92     09/30/93               110001                                       ($1,050.00)             $0.00         ($1,050.00)                  57217
HAMILTON MEDICAL CENTER             1200 MEMORIAL DR           DALTON, GA 30722                  581519911    10/01/93     09/30/94               110001                                       ($9,602.00)             $0.00         ($9,602.00)                  57218
ST JOSEPHS HOSPITAL                 ANX 68                     ATLANTA, GA 30342                 580566257    01/01/94     12/31/94               110082                                       ($1,027.60)             $0.00         ($1,027.60)                  56809
ST MARYS HEALTH CARE SYSTEM         1230 BAXTER ST             ATHEN, GA 30606                   580566223    10/01/91     09/30/92               110006                                       ($3,208.52)             $0.00         ($3,208.52)                  56797
LEESBURG REGIONAL ME                600 E DIXIE AVE            ATLANTA, GA 30368                 590878982    07/01/94     06/30/95               100084                                       ($1,077.75)             $0.00         ($1,077.75)                  56835
                                                                                                                                          TOTAL GA REFUND                                   ($50,003.37)              $0.00       ($50,003.37)

                   LOUISIANA
ST PATRICK HOSPITAL                 524 S RYAN ST              LAKE CHARLES, LA 70601            720411322    07/01/94     06/30/95               190027                                       ($2,215.00)             $0.00         ($2,215.00)                  56496
ST PATRICK HOSPITAL                 524 S RYAN ST              LAKE CHARLES, LA 70601            720411322    07/01/96     06/30/97               190027                                         ($637.00)             $0.00           ($637.00)                  56497
ST PATRICK HOSPITAL                 524 S RYAN ST              LAKE CHARLES, LA 70601            720411322    07/01/93     06/30/94               190027                                       ($1,728.00)             $0.00         ($1,728.00)                  56495
ST PATRICK HOSPITAL                 524 S RYAN ST              LAKE CHARLES, LA 70601            720411322    07/01/92     06/30/93               190027                                       ($2,361.13)             $0.00         ($2,361.13)                  56494
MERCY BAPTIST MEDICAL CENTER        2700 NAPOLEON AVE          NEW ORLEANS, LA 70154          720423887042    04/01/96     05/31/97               190135                                       ($2,327.00)             $0.00         ($2,327.00)                  57226
MERCY BAPTIST MEDICAL CENTER        2700 NAPOLEON AVE          NEW ORLEANS, LA 70154          720423887042    04/01/95     05/31/96               190135                                         ($864.00)             $0.00           ($864.00)                  57225
MERCY BAPTIST MEDICAL CENTER        2700 NAPOLEON AVE          NEW ORLEANS, LA 70154          720423887042    10/01/93     09/30/94               190135                                       ($7,694.00)             $0.00         ($7,694.00)                  57224
MERCY BAPTIST MEDICAL CENTER        2700 NAPOLEON AVE          NEW ORLEANS, LA 70154          720423887042    10/01/91     09/30/92               190135                                         ($496.00)             $0.00           ($496.00)                  57223
LAFAYETTE GEN MED CTR               1214 COOLIDGE BLVD         LAFAYETTE, LA 70503               720535375    10/01/95     09/30/96               190002                                       ($4,047.00)             $0.00         ($4,047.00)                  56579
LAFAYETTE GEN MED CTR               1214 COOLIDGE BLVD         LAFAYETTE, LA 70503               720535375    10/01/91     09/30/92               190002                                         ($628.00)             $0.00           ($628.00)                  56962
LAFAYETTE GEN MED CTR               1214 COOLIDGE BLVD         LAFAYETTE, LA 70503               720535375    10/01/92     09/30/93               190002                                       ($1,885.00)             $0.00         ($1,885.00)                  56576
LAFAYETTE GEN MED CTR               1214 COOLIDGE BLVD         LAFAYETTE, LA 70503               720535375    10/01/93     09/30/94               190002                                       ($1,790.00)             $0.00         ($1,790.00)                  56577
LAFAYETTE GEN MED CTR               1214 COOLIDGE BLVD         LAFAYETTE, LA 70503               720535375    10/01/94     09/30/95               190002                                       ($2,396.00)             $0.00         ($2,396.00)                  56578
LAFAYETTE GEN MED CTR               1214 COOLIDGE BLVD         LAFAYETTE, LA 70503               720535375    10/01/91     09/30/92               190002                                       ($3,004.00)             $0.00         ($3,004.00)                  56575
LSU HEALTH SCIENCES CENTER SHR      1501 KINGS HWY             SHREVEPORT, LA 71103              720702002    07/01/93     06/30/94               190098                                         ($588.00)             $0.00           ($588.00)                  56504
LSU HEALTH SCIENCES CENTER SHR      1501 KINGS HWY             SHREVEPORT, LA 71103              720702002    07/01/92     06/30/93               190098                                         ($427.00)             $0.00           ($427.00)                  56503
LSU HEALTH SCIENCES CENTER SHR      1501 KINGS HWY             SHREVEPORT, LA 71103              720702002    07/01/96     06/30/97               190098                                       ($5,865.00)             $0.00         ($5,865.00)                  56505
OCHSNER FOUNDATION HOSPITAL         1516 JEFFERSON HWY         NEW ORLEANS, LA 70121             720502505    05/01/94     04/30/95               190036                                       ($5,366.07)             $0.00         ($5,366.07)                  57108
ST ANNE GENERAL HOSPITAL            4608 HWY 1                 RACELAND, LA 70394                720602307    10/01/92     09/30/93               190109                                         ($238.74)             $0.00           ($238.74)                  57116
ST ANNE GENERAL HOSPITAL            4608 HWY 1                 RACELAND, LA 70394                720602307    10/01/91     09/30/92               190109                                         ($289.47)             $0.00           ($289.47)                  57115
                                                                                                                                          TOTAL LA REFUND                                   ($44,846.41)              $0.00       ($44,846.41)

                   MISSISSIPPI
GULF COAST MEDICAL CENTER           180 DEBUYS RD              BILOXI, MS 39531               640582292005      1/1/1996     12/31/1996           250125                                       ($3,295.00)             $0.00         ($3,295.00)                  57238
PARKVIEW REGIONAL MED               100 MCAULEY DR             VICKSBURG, MS 39180              621576702       5/1/1996      6/30/1997           250032                                       ($5,284.00)             $0.00         ($5,284.00)                  57229




                8/1/2010                                                                                                                    Proprietary to HMHS, Not to be Disclosed                                                                                      D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
                                                                                                                                   Humana Military Healthcare Services
                                                                                                                                            DRG Reimbursement
                                                                                                                                 Capital and Direct Medical Education Costs
                                                                                                                                                South Region
                                                                                                                                             Contract 18895631
                                                                                                                                              Fiscal Year 2006
                                                                                                                                                 April 2006
                                                                                                                                               P00135 Credits




PARKVIEW REGIONAL MED                100 MCAULEY DR          VICKSBURG, MS 39180      621576702     5/1/1992        6/30/1993           250032                                     ($1,292.00)    $0.00        ($1,292.00)   57227
PARKVIEW REGIONAL MED                100 MCAULEY DR          VICKSBURG, MS 39180      621576702     5/1/1993        6/30/1994           250032                                     ($3,460.00)    $0.00        ($3,460.00)   57228
BAPTIST MEMORIAL HOSPITAL - DESOTO   7601 S CREST PKWY       SOUTHAVEN, MS 38671      640682111     7/1/1993        6/30/1994           250141                                      ($143.33)     $0.00         ($143.33)    57096
                                                                                                                                TOTAL MS REFUND                                 ($13,474.33)     $0.00      ($13,474.33)

                  OKLAHOMA
ST JOHN MEDICAL CTR                  1923 S UTICA AVE        TULSA, OK 74104          730579286   10/1/1996         9/30/1997           370114                                     ($1,755.00)    $0.00        ($1,755.00)   56483
ST JOHN MEDICAL CTR                  1923 S UTICA AVE        TULSA, OK 74104          730579286   10/1/1995         9/30/1996           370114                                     ($1,794.00)    $0.00        ($1,794.00)   56482
ST JOHN MEDICAL CTR                  1923 S UTICA AVE        TULSA, OK 74104          730579286   10/1/1994         9/30/1995           370114                                     ($5,125.00)    $0.00        ($5,125.00)   56973
                                                                                                                                TOTAL OK REFUND                                  ($8,674.00)     $0.00       ($8,674.00)

                 PUERTO RICO
HOSPITAL SAN PABLO                   CALLE SANTA CRUZ #70    BAYAMON, PR 00961        660349748    10/1/1992        9/30/1993           400109                                     ($5,720.00)                 ($5,720.00)   57406
HOSPITAL SAN PABLO                   CALLE SANTA CRUZ #70    BAYAMON, PR 00961        660349748    10/1/1993        9/30/1994           400109                                     ($4,501.00)                 ($4,501.00)   57408
HOSPITAL SAN PABLO                   CALLE SANTA CRUZ #70    BAYAMON, PR 00961        660349748    10/1/1994        9/30/1995           400109                                     ($5,060.00)                 ($5,060.00)   57409
HOSPITAL SAN PABLO                   CALLE SANTA CRUZ #70    BAYAMON, PR 00961        660349748    10/1/1995        9/30/1996           400109                                     ($2,341.00)                 ($2,341.00)   57410
                                                                                                                                TOTAL PR REFUND                                 ($17,622.00)     $0.00      ($17,622.00)


               SOUTH CAROLINA
PIEDMONT MEDICAL CENTER              222 S HERLONG AVENUE    ROCK HILL,   SC 29730    953561198   05/01/92       04/30/93               420002                                     ($1,213.00)    $0.00        ($1,213.00)   57298
PIEDMONT MEDICAL CENTER              222 S HERLONG AVENUE    ROCK HILL,   SC 29730    953561198   05/01/94       04/30/95               420002                                     ($1,489.00)    $0.00        ($1,489.00)   57299
PIEDMONT MEDICAL CENTER              222 S HERLONG AVENUE    ROCK HILL,   SC 29730    953561198   05/01/95       04/30/96               420002                                     ($1,444.00)    $0.00        ($1,444.00)   57300
PIEDMONT MEDICAL CENTER              222 S HERLONG AVENUE    ROCK HILL,   SC 29730    953561198   05/01/96       04/30/97               420002                                     ($6,991.00)    $0.00        ($6,991.00)   57301
                                                                                                                                TOTAL SC REFUND                                 ($11,137.00)     $0.00      ($11,137.00)

                  TENNESSEE
ST FRANCIS HOSPITAL                  5959 PARK AVE           MEMPHIS, TN 38119        752522262   03/01/94       04/30/95               440183                                      ($468.09)     $0.00         ($468.09)    57128
REGIONAL MEDICAL CENTER              877 JEFFERSON AVE       MEMPHIS , TN 38103       621113169   07/01/95       06/30/96               440152                                      ($600.45)     $0.00         ($600.45)    56917
                                                                                                                                TOTAL TN REFUND                                  ($1,068.54)     $0.00       ($1,068.54)

                      TEXAS
CITIZENS MEDICAL CENTER              2701 HOSPITAL DR        VICTORIA TX 77901 5748   741698143   07/01/95       06/30/96               450023                                       ($996.00)    $0.00          ($996.00)   56435
CITIZENS MEDICAL CENTER              2701 HOSPITAL DR        VICTORIA TX 77901 5748   741698143   07/01/96       06/30/97               450023                                       ($277.00)    $0.00          ($277.00)   56436
CITIZENS MEDICAL CENTER              2701 HOSPITAL DR        VICTORIA TX 77901 5748   741698143   07/01/94       06/30/95               450023                                     ($5,972.00)    $0.00        ($5,972.00)   56434
CITIZENS MEDICAL CENTER              2701 HOSPITAL DR        VICTORIA TX 77901 5748   741698143   07/01/93       06/30/94               450023                                     ($7,163.00)    $0.00        ($7,163.00)   56433
CITIZENS MEDICAL CENTER              2701 HOSPITAL DR        VICTORIA TX 77901 5748   741698143   07/01/92       06/30/93               450023                                       ($236.15)    $0.00          ($236.15)   56432
UNIVERSITY TEXAS MEDICAL BRANCH      301 UNIVERSITY BLVD     GALVESTON , TX 77555     746000949   09/01/94       08/31/95               450018                                    ($10,106.00)    $0.00       ($10,106.00)   57125
UNIVERSITY TEXAS MEDICAL BRANCH      301 UNIVERSITY BLVD     GALVESTON , TX 77555     746000949   07/01/95       08/31/96               450018                                     ($2,137.00)    $0.00        ($2,137.00)   57126
TOMBALL REGIONAL HOSPITAL            605 HOLDERRIETH BLVD    TOMBALL, TX 77375        746245428   07/01/94       06/30/95               450670                                     ($4,279.00)    $0.00        ($4,279.00)   56501
TOMBALL REGIONAL HOSPITAL            605 HOLDERRIETH BLVD    TOMBALL, TX 77375        746245428   07/01/93       06/30/94               450670                                     ($1,943.53)    $0.00        ($1,943.53)   56500
GOOD SHEPHERD MEDICAL CENTER         700 E MARSHALL AVE      LONGVIEW, TX 75601       751041154   10/01/91       09/30/92               450037                                     ($5,004.83)    $0.00        ($5,004.83)   56492
GOOD SHEPHERD MEDICAL CENTER         700 E MARSHALL AVE      LONGVIEW, TX 75601       751041154   10/01/92       09/30/93               450037                                     ($2,170.00)    $0.00        ($2,170.00)   56493
MOTHER FRANCES HOSPITAL              800 E DAWSON ST         TYLER , TX 75701         750818167   07/01/94       06/30/95               450102                                    ($18,419.00)    $0.00       ($18,419.00)   56568
MOTHER FRANCES HOSPITAL              800 E DAWSON ST         TYLER , TX 75701         750818167   07/01/94       06/30/95               450102                                       ($394.00)    $0.00          ($394.00)   56969
PARKLAND HLTH AND HOSP SYSTEM        5201 HARRY HINES BLVD   DALLAS, TX 75235         756004221   10/01/93       09/30/94               450015                                     ($1,016.00)    $0.00        ($1,016.00)   56477
PARKLAND HLTH AND HOSP SYSTEM        5201 HARRY HINES BLVD   DALLAS, TX 75235         756004221   10/01/92       09/30/93               450015                                     ($4,265.00)    $0.00        ($4,265.00)   56476
PARKLAND HLTH AND HOSP SYSTEM        5201 HARRY HINES BLVD   DALLAS, TX 75235         756004221   10/01/95       09/30/96               450015                                     ($2,259.00)    $0.00        ($2,259.00)   56478
PARKLAND HLTH AND HOSP SYSTEM        5201 HARRY HINES BLVD   DALLAS, TX 75235         756004221   10/01/96       09/30/97               450015                                     ($1,648.00)    $0.00        ($1,648.00)   56479
SETON MEDICAL CENTER                 1201 W 38TH ST          AUSTIN , TX 78705        741109643   07/01/96       06/30/97               450056                                     ($2,633.00)    $0.00        ($2,633.00)   56441
MHHS THE WOODLANDS HOSP              1635 N LOOP W           HOUSTON, TX 77074        741152597   07/01/94       06/30/95               450184                                     ($1,965.09)    $0.00        ($1,965.09)   56444
MHBBH WEST CAMPUS                    3576 COLLEGE ST         BEAUMONT, TX 77701       741303720   09/01/92       08/31/93               450346                                     ($1,780.20)    $0.00        ($1,780.20)   56518
NORTHEAST MEDICAL CENTER HOSPI       18951 N MEMORIAL DR     HUMBLE, TX 77338         741881362   07/01/92       06/30/93               450684                                       ($470.90)    $0.00          ($470.90)   56506
                                                                                                                                TOTAL TX REFUND                                 ($75,134.70)                ($75,134.70)

                                                                                                               TOTAL REFUNDS                                                  ($309,331.54)               ($309,331.54)

                                                                                                               TOTAL TICHENOR REFUNDS




                8/1/2010                                                                                                          Proprietary to HMHS, Not to be Disclosed                                                           D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
                                   Humana Military Healthcare Services
                                            DRG Reimbursement
                                 Capital and Direct Medical Education Costs
                                                South Region
                                             Contract 18895631
                                              Fiscal Year 2006
                                                 April 2006
                                               P00135 Credits




Refunded back to provider
Refunded back to provider




Will be refunded to provider




                      8/1/2010   Proprietary to HMHS, Not to be Disclosed     D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
                                                                                                                                           Humana Military Healthcare Services
                                                                                                                                                    DRG Reimbursement
                                                                                                                                         Capital and Direct Medical Education Costs
                                                                                                                                                        South Region
                                                                                                                                                     Contract 18895631
                                                                                                                                                      Fiscal Year 2006
                                                                                                                                                         April 2006
                                                                                                                                                           Credits




                                                                                                                                                                                                                      TOTAL MEDICAL        TOTAL
                                                                                               PROVIDER           PERIOD              PERIOD                                          VOUCHER   TOTAL CAPITAL           EDUCATION       TMA/CHAMPUS                                CONTROL
        HOSPITAL NAME                    HOSPITAL ADDRESS                 CITY/STATE/ZIP        NUMB ER        COVERED FROM         COVERED TO        MEDICARE NUMB ER                NUMB ER     PAYMENT                PAYMENT          PAYMENT            TYPE PAYMENT          NUMB ER
HUMANA SOUTH

   REFUNDS/STALEDATES/VOIDS

             FLORIDA
TAMPA GENERAL HOSPITAL               2 COLUMBIA DR                TAMPA, FL 33606                  593458145      10/01/99             09/30/00                 100128                                  ($9,076.59)             $0.00          ($9,076.59)        Refund                     56149 Closed
ST PETERSBURG GENERAL HOSPITAL       6500 38TH AVE N              SAINT PETERSBURG, FL 33710    591174716023      05/01/01             04/30/02                 100180                                    ($850.41)             $0.00            ($850.41)        Refund                     56151 Closed
SOUTHWEST FLORIDA REGIONAL MED       2727 WINKLER AVE             FORT MYERS, FL 33901             592820563      01/01/01             12/31/01                 100220                                    ($659.76)             $0.00            ($659.76)        Refund                     57027 Closed
SHANDS OF JACKSONVILLE               655 W 8TH ST                 JACKSONVILLE, FL 32209           592142859      10/01/99             06/30/00                 100001                                  ($4,498.84)             $0.00          ($4,498.84)        Refund                     55838
BAPTIST MEDICAL CENTER NASSAU        1250 S 18TH ST               FERNANDINA BCH, 32034            593234721      10/01/02             10/01/03                 100140                                    ($202.61)             $0.00            ($202.61)        Refund                     55821
SHANDS HOSPITAL                      1600 SW ARCHER RD            GAINESVILLE, FL 32610            591943502      07/01/98             06/30/99                 100113                                     ($47.03)             $0.00             ($47.03)        Refund                     55659
SHANDS JACKSONVILLE MEDICAL CE       580 W 8TH ST                 JACKSONVILLE, FL 32209           591158241      01/01/96             12/31/96                 100170                                 ($19,671.99)             $0.00         ($19,671.99)       Staledate                   55655
BON SECOURS VENICE HOSPITAL          540 THE RIALTO               VENICE, FL 34285                 650597937      09/01/03             08/31/04                 100070                                 ($15,424.33)             $0.00         ($15,424.33)       Staledate                   55797
                                                                                                                                                      TOTAL FL REFUND                               ($50,431.56)               $0.00       ($50,431.56)
             GEORGIA
WELLSTAR KENNESTONE HOSPITAL         677 CHURCH ST NE             MARIETTA, GA 30060               582032904      07/01/96             06/30/97                 110035                                  ($7,157.70)             $0.00          ($7,157.70)        Refund                     55591
WELLSTAR COBB HOSPITAL               3950 AUSTELL RD              AUSTELL, GA 30106                580968382      07/01/99             06/30/00                 110143                                  ($3,217.63)             $0.00          ($3,217.63)        Refund                     55590
ST JOSEPHS HOSPITAL SAV GA           11705 MERCY BLVD             SAVANNAH, GA 31419               580568702      07/01/99             06/30/00                 110043                                  ($1,567.90)             $0.00          ($1,567.90)        Refund                     55703
FANNIN REGIONAL HOSPITAL             HIGHWAY 5 NORTH              BLUE RIDGE, GA 30513             760350464      01/01/04             12/31/04                 110189                                  ($5,096.68)             $0.00          ($5,096.68)       Staledate                   55601
GORDON HOSPITAL                      1035 RED BUD RD NE           CALHOUN, GA 30701             581425000001      01/01/04             12/31/04                 110023                                  ($6,073.08)             $0.00          ($6,073.08)       Staledate                   55764
                                                                                                                                                      TOTAL GA REFUND                               ($23,112.99)               $0.00       ($23,112.99)
            LOUISIANA
DOCTORS HOSPITAL                     1130 LOUISIANA AVE           SHREVEPORT, LA 71101             232306489      01/01/96             12/31/96                 190115                                  ($3,617.22)             $0.00          ($3,617.22)        Refund                     55363   Closed
DOCTORS HOSPITAL                     1130 LOUISIANA AVE           SHREVEPORT, LA 71101             232306489      01/01/98             12/31/98                 190115                                    ($113.74)             $0.00            ($113.74)        Refund                     55361   Closed
DOCTORS HOSPITAL                     1130 LOUISIANA AVE           SHREVEPORT, LA 71101             232306489      01/01/99             12/31/99                 190115                                  ($1,300.73)             $0.00          ($1,300.73)        Refund                     55364   Closed
DOCTORS HOSPITAL OF SHREVEPORT       1130 LOUISIANA AVE           SHREVEPORT, LA 71101          232306489003      01/01/92             12/31/92                 190115                                 ($14,842.83)             $0.00         ($14,842.83)        Refund                     55356   Closed
NORTH MONROE HOSPITAL                3421 MEDICAL PARK DR         MONROE, LA 71203              621113736008      01/01/01             12/31/01                 190197                                    ($412.39)             $0.00            ($412.39)        Refund                     55417
                                                                                                                                                      TOTAL LA REFUND                               ($20,286.91)               $0.00       ($20,286.91)
            MISSISSIPPI
GREENWOOD LEFLORE HOSPITAL           1401 RIVER ROAD              GREENWOOD, MS 38930           646000400001      10/01/03             09/30/04                 250099                                    ($353.29)             $0.00            ($353.29)        Refund                     56311 Closed
                                                                                                                                                      TOTAL MS REFUND                                   ($353.29)              $0.00           ($353.29)

            TENNESSE
BAPTIST MEMORIAL HOSP MED CTR        899 MADISON AVE              MEMPHIS, TN 38146                620123940            10/1/1998         9/30/1999                       440048                      ($105,207.12)             $0.00        ($105,207.12)        Refund                     56265 Closed
                                                                                                                                                                                                                                                                                                   Was supposed to be on FEB voucher but
BLOUNT MEMORIAL HOSPITAL             907 E LAMAR ALEXANDER PKWY   MARYVILLE TN 37804 5015          620505512             7/1/2001         6/30/2002                       440011                            ($0.45)             $0.00              ($0.45)        Refund                     54801 wasn't added in total.
CENTENNIAL MEDICAL CENTER            2300 PATTERSON ST            NASHVILLE, TN 37203           621113737001             1/1/2001        12/31/2001                       440161                        ($3,952.35)             $0.00          ($3,952.35)        Refund                     55990 Closed
MEMORIAL HOSPITAL                    2525 DESALES AVENUE          CHATTANOOGA, TN 37404            620532345             9/1/1997         8/31/1998                       440091                          ($689.05)             $0.00            ($689.05)        Refund                     56887 Closed
TAKOMA ADVENTIST HOSPITAL            401 TAKOMA AVE               GREENEVILLE, TN 37743            620552182             1/1/2004        12/31/2004                       440050                        ($4,250.06)             $0.00          ($4,250.06)       Staledate                   55759
WILLIAMSON MEDICAL CENTER            2021 N CAROTHERS RD          FRANKLIN, TN 37067               621501534             7/1/2003         6/30/2004                       440029                       ($17,396.37)             $0.00         ($17,396.37)       Staledate                   55476
                                                                                                                                                      TOTAL TN REFUND                              ($131,495.40)               $0.00      ($131,495.40)

              TEXAS
PRESBYTERIAN HOSPITAL OF DALLAS      8200 WALNUT HILL LN          DALLAS TX 75231                  751047527      10/01/00             09/30/01                           450462                        ($6,956.30)             $0.00          ($6,956.30)        Refund                     55410 Closed
PRESBYTERIAN HOSPITAL OF DALLAS      8200 WALNUT HILL LN          DALLAS TX 75231                  751047527      10/01/97             09/30/98                           450462                        ($1,667.81)             $0.00          ($1,667.81)        Refund                     55411 Closed
METHODIST AMBULATORY SURG HOSP       STE 100, 9150 HUEBNER RD     SAN ANTONIO, TX 78240            742730328      01/01/04             12/31/04                           450780                      ($293,047.61)             $0.00        ($293,047.61)        Refund                     56703 Closed
WOODLAND HEIGHTS MEDICAL CENTER      505 S JOHN REDDITT DR        LUFKIN, TX 75904                 621762559      01/01/00             12/31/00                           450484                        ($1,631.80)             $0.00          ($1,631.80)        Refund                     55388 Closed
COVENANT HEALTH SYSTEM               3615 19TH ST                 LUBBOCK, TX 79410                751765566      06/01/98             03/31/99                           450457                       ($16,929.61)             $0.00         ($16,929.61)        Refund                     56956 Closed
UNITED REGIONAL HEALTH CARE SYSTEM   1600 10TH ST                 WICHITA FALLS, TX 76301          751912147      10/01/92             09/30/92                           450010                          ($728.19)             $0.00            ($728.19)        Refund                     55391 Closed
METHODIST SPECIALTY AND TRANSP       8026 FLOYD CURL DR           SAN ANTONIO, TX 78229         742730328007       06/01/01            06/30/02                           450631                       ($35,014.45)             $0.00         ($35,014.45)        Refund                     56040   Closed
MEMORIAL MOTHER FRANCES HOSP         4000 South Loop 256          PALESTINE, TX 75801              742791525       1/1/2000           12/31/2000                          450113                      ($846,128.61)             $0.00        ($846,128.61)        Refund                     57011   Closed
CHRISTUS HOSPITAL                    2830 CALDER ST               BEAUMONT, TX 77702            760591590003       7/1/1997            6/30/1998                          450034                          ($159.39)             $0.00            ($159.39)        Refund                     56044   Closed
CHRISTUS SPOHN HOSPITAL SOUTH        5950 SARATOGA BLVD           CORPUS CHRISTI, TX 78414      741109836008       1/1/1999            6/30/1999                          450046                        ($2,672.96)             $0.00          ($2,672.96)        Refund                     56185   Closed
HARRIS METHODIST HOSPITAL SOUT       6100 HARRIS PKWY             FORT WORTH, TX 76132             752678857      10/1/1997            9/30/1998                          450779                           $374.62              $0.00             $374.62         Refund                     55366
HOUSTON NORTHWEST MEDICAL CENT       710 FM 1960 RD W             HOUSTON, TX 77090                760520701       1/1/1997            5/31/1997                          450638                        ($2,443.57)             $0.00          ($2,443.57)        Refund                     56140
CORPUS CHRISTI MED CTR-BAY AREA      7101 S PADRE ISLAND DR       CORPUS CHRISTI, TX 78412         752387418       9/1/2001            5/31/2002                          450788                        ($1,497.05)             $0.00          ($1,497.05)        Refund                     55931
NACOGDOCHES MEDICAL CENTER HOS       4920 NE STALLINGS DR         NACOGDOCHES, TX 75965            746197600       1/1/2000           12/31/2000                          450656                          ($453.03)             $0.00            ($453.03)       Staledate                   56041
DENTON COMMUNITY HOSPITAL            207 N BONNIE BRAE ST         DENTON, TX 76201                 752887765       5/1/2004            3/31/2005                          450743                       ($22,993.01)             $0.00         ($22,993.01)       Staledate                   55800
GARLAND PHYS HOSP LTD-LELAND M       2696 W WALNUT ST STE 214     GARLAND, TX 75042             752947726001       9/1/1998            8/31/1999                          450135                          ($718.77)             $0.00            ($718.77)       Staledate                   56072
                                                                                                                                                      TOTAL TX REFUND                             ($1,232,667.54)              $0.00     ($1,232,667.54)


                                                                                                                                    TOTAL REFUNDS                                                 ($1,458,347.69)              $0.00     ($1,458,347.69)

                                                                                                               TOTAL HUMANA SOUTH REFUNDS                                                         $1,458,347.69                $0.00     $1,458,347.69




              8/1/2010                                                                                                                    Proprietary to HMHS, Not to be Disclosed                                                                            D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
                                                                                                                          Humana Military Healthcare Services
                                                                                                                                   DRG Reimbursement
                                                                                                                        Capital and Direct Medical Education Costs
                                                                                                                                       South Region
                                                                                                                                   Contract #18895631
                                                                                                                                     Fiscal Year 2006
                                                                                                                                        April 2006
                                                                                                                                   Active Duty Voucher
                                                                                                                                                                                                       TOTAL
                                                                                                                          PERIOD              PERIOD                                TOTAL             MEDICAL             TOTAL
                                                                                                          PROVIDER       COVERED             COVERED         MEDICARE   VOUCHER    CAPITAL           EDUCATION         TMA/CHAMPUS                TYPE             CONTROL
              HOSPITAL NAME                  HOSPITAL ADDRESS                     CITY/STATE/ZIP           NUMBER          FROM                 TO            NUMBER    NUMBER     PAYMENT            PAYMENT            PAYMENT                PAYMENT            NUMBER
                    ALABAMA
    ATHENS LIMESTONE HOSPITAL               700 WEST MARKET ST         ATHENS AL 35611                   636002175              01-Oct-04        30-Sep-05 10079         3869785          $664.17              $0.00                $664.17 Initial                            57064
                                            2010 BROOKWOOD MEDICAL CTR
    BROOKWOOD MEDICAL CENTER                DR                         BIRMINGHAM AL 35209-3520          630574010012           01-Jan-01        31-Dec-01 10139         3869786         $6,789.55             $0.00               $6,789.55 Correction                        57421

    DECATUR GENERAL HOSPITAL                1201 7TH ST SE                DECATUR AL 35601 3337          636000260              01-Jul-04         30-Jun-05 10085        3869787         $3,054.96             $0.00               $3,054.96 Initial                           56731

    SHELBY BAPTIST MEDICAL CENTER           1000 FIRST STREET NORTH       ALABASTER AL 35007             631181094              01-Oct-04        30-Sep-05 10016         3869788         $1,706.94             $0.00               $1,706.94 Initial                           57065

    SOUTHEAST ALABAMA MEDICAL CENT          1108 ROSS CLARK CIR           DOTHAN AL 36301 3022           636004476              01-Oct-04        30-Sep-05 10001         3869789        $13,017.34             $0.00             $13,017.34 Initial                            57344

    SPRINGHILL MEMORIAL HOSPITAL            3719 DAUPHIN STREET           MOBILE AL 36608                630784458003           01-Jan-04        31-Dec-04 10144         3869790          $847.29              $3.30                $850.59 Initial                            56726
                                                                                                                                            TOTAL AL AD PYMTS                       $26,080.25             $3.30           $26,083.55

                    ARKANSAS
    ARKANSAS HEART HOSPITAL                 1701 S SHACKLEFORD RD         LITTLE ROCK AR 72211 4335      561933245              01-Oct-04        30-Sep-05 40134         3869791         $1,191.98             $0.00               $1,191.98 Initial                           57074
    ST MARYS REGIONAL MEDICAL CENTER        1808 W MAIN ST                RUSSELLVILLE AR 72801 2724     621771866             01-Sep-04         31-Aug-05 40041         3869792          $594.41              $0.00                $594.41 Initial                            56768
                                                                                                                                            TOTAL AR AD PYMTS                        $1,786.39             $0.00            $1,786.39

                    FLORIDA
    BAPTIST HOSPITAL                        1000 W MORENO ST              PENSACOLA FL 32501 2316        590657322002           01-Oct-04        30-Sep-05 100093        3869793        $18,546.27          $349.49              $18,895.76 Initial                            57343
    BAPTIST HOSPITAL                        1000 W MORENO ST              PENSACOLA FL 32501 2316        590657322002           01-Oct-02        30-Sep-03 100093        3869794        $17,527.56          $244.87              $17,772.43 Amended - First                    57172
    CITRUS MEMORIAL HOSPITAL                502 WEST HIGHLAND BLVD        INVERNESS FL 34452             592890430002           01-Oct-04        30-Sep-05 100023        3869795          $196.66              $0.00                $196.66 Initial                            56936
    COLUMBIA FAWCETT MEMORIAL HOSP          21298 OLEAN BLVD              PORT CHARLOTTE FL 33952 6705   650252846              01-Jan-02        31-Dec-02 100236        3869796          $154.66              $0.00                $154.66 Amended - First                    55763
    GULF BREEZE HOSPITAL                    1110 GULF BREEZE PKY          GULF BREEZE FL 32561 4884      590657322              01-Oct-04        30-Sep-05 100266        3869797         $3,501.93             $0.00               $3,501.93 Initial                           57397
    GULF BREEZE HOSPITAL                    1110 GULF BREEZE PKY          GULF BREEZE FL 32561 4884      590657322              01-Oct-03        30-Sep-04 100266        3869798          $288.16              $0.00                $288.16 Amended - First                    57174
    LAKE CITY MEDICAL CENTER                1050 NORTH COMMERCE BLVD      LAKE CITY FL 32055             954176924             01-Nov-04          31-Oct-05 100156       3869799          $311.78              $0.00                $311.78 Initial                            57435
    MUNROE REGIONAL MEDICAL CENTER          1500 SW 1ST AVE               OCALA FL 34474                 592390209001           01-Oct-04        30-Sep-05 100062        3869800         $2,432.54             $0.00               $2,432.54 Initial                           57055
    SACRED HEART HOSPITAL                   5151 N 9TH AVE                PENSACOLA FL 32504             590634434              01-Jul-04         30-Jun-05 100025       3869801        $42,159.51        $14,887.08             $57,046.59 Initial                            57432
    SACRED HEART HOSPITAL EMERALD           7800 HIGHWAY 98 WEST          MIRAMAR BEACH FL 32550         721529708              01-Jul-04         30-Jun-05 100292       3869802         $2,011.76             $0.00               $2,011.76 Initial                           57431
    SHANDS HOSPITAL                         1600 SW ARCHER RD             GAINESVILLE FL 32610           591943502              01-Jul-99         30-Jun-00 100113       3869803           605.32            767.47                 1372.79 Amended - First                    55658
    SHANDS HOSPITAL                         1600 SW ARCHER RD             GAINESVILLE FL 32608           591943502              01-Jul-03         30-Jun-04 100113       3869804        $14,663.78        $16,319.05             $30,982.83 Initial                            57035
    SHANDS HOSPITAL                         1600 SW ARCHER RD             GAINESVILLE FL 32608           591943502              01-Jul-04         30-Jun-05 100113       3869805        $27,166.36        $28,883.80             $56,050.16 Initial                            57036
    SHANDS OF JACKSONVILLE                  655 W 8TH ST                  JACKSONVILLE FL 32209 6511     592142859              01-Jul-97         30-Jun-98 100001       3869806           $218.25           $234.36                $452.61 Amended - Second                   56190
    Tampa General                           2 Columbia Drive              Tampa FL 33606-3508            593458145              01-Oct-00        30-Sep-01 100128        3869807         ($860.04)         ($461.03)             ($1,321.07) Correction                        57334
    WINTER HAVEN HOSPITAL                   200 AVENUE F NE               WINTER HAVEN FL 33881 4131     590724462              01-Oct-01        30-Sep-02 100052        3869808          $237.62              $0.00                $237.62 Amended - First                    57169
    WINTER HAVEN HOSPITAL                   200 AVENUE F NE               WINTER HAVEN FL 33881 4131     590724462              01-Oct-02        30-Sep-03 100052        3869809         $1,225.18             $0.00               $1,225.18 Amended - First                   57170
    WINTER HAVEN HOSPITAL                   200 AVENUE F NE               WINTER HAVEN FL 33881 4131     590724462              01-Oct-03        30-Sep-04 100052        3869810           ($4.17)             $0.00                 ($4.17) Amended - First                   57176
                                                                                                                                            TOTAL FL AD PYMTS                      $130,383.13        $61,225.09          $191,608.22

                     GEORGIA
    CARTERSVILLE MEDICAL CENTER             960 JOE FRANK HARRIS PKY SE   CARTERSVILLE GA 30120 2129     582433438              01-Oct-04        30-Sep-05 110030        3869811         $3,701.86             $0.00               $3,701.86 Initial                           56938
    COLISEUM MEDICAL CENTERS                350 HOSPITAL DRIVE            MACON GA 31217                 621736983              01-Jul-02         30-Jun-03 110164       3869812         $2,655.90             $0.00               $2,655.90 Amended - First                   57056
    DOCTORS HOSPITAL OF AUGUSTA DB          3651 WHEELER RD               AUGUSTA GA 30909 6246          581162801              01-Apr-01         31-Mar-02 110177       3869813         $1,828.24             $0.00               $1,828.24 Correction                        57417
    HUGHSTON ORTHOPEDIC HOSPITAL            100 FRIST CT                  COLUMBUS GA 31909 3578         621130833005           01-Oct-04        30-Sep-05 110200        3869814         $6,192.78             $0.00               $6,192.78 Initial                           56939
    ROCKDALE MEDICAL CENTER INC             1412 MILSTEAD AVE             CONYERS GA 30012 3877          582117722              01-Oct-04        30-Sep-05 110091        3869815         $1,840.44             $0.00               $1,840.44 Initial                           57395
                                                                                                                                            TOTAL GA AD PYMTS                       $16,219.22             $0.00           $16,219.22

                    LOUISIANA
    LOUISIANA HEART HOSPITAL                64030 HIGHWAY 434             LACOMBE LA 70445 3456          562227298              01-Oct-04        30-Sep-05 190250        3869816         $1,029.32             $0.00               $1,029.32 Initial                           57076
    LSU HEALTH SCIENCES CENTER SHR          1501 KINGS HWY
                                            2810 AMBASSADOR CAFFERY       SHREVEPORT LA 71103 4228       720702002              01-Jul-04         30-Jun-05 190098       3869817        $21,312.90         $4,417.88             $25,730.78 Initial                            56677
    SOUTHWEST MEDICAL CENTER-LAFAY          PKWY                          LAFAYETTE LA 70506 5906        581741727             01-Sep-04         31-Aug-05 190205        3869818         $2,783.04             $0.00               $2,783.04 Initial                           56675
                                                                                                                                            TOTAL LA AD PYMTS                       $25,125.26         $4,417.88           $29,543.14

                    MISSISSIPPI
    BAPTIST MEMORIAL HOSP OF NORTH MS       2301 S LAMAR BLVD             OXFORD MS 38655 5338           640772726              01-Oct-03        30-Sep-04 250034        3869819          $284.95              $0.00                $284.95 Amended - First                    57080
    BAPTIST MEMORIAL-GOLDEN TRIANGLE        2520 5TH STREET NORTH         COLUMBUS MS 39705 2008         621519754005           01-Oct-03        30-Sep-04 250100        3869820         $2,995.06             $0.00               $2,995.06 Amended - First                   57079
    BILOXI REGIONAL MEDICAL CENTER          150 REYNOIR ST                BILOXI MS 39530 4130           592754033002           01-Oct-04        30-Sep-05 250007        3869821         $5,537.06             $0.00               $5,537.06 Initial                           57163
                                                                                                                                            TOTAL MISSISSIPPI AD PYMTS               $8,817.07             $0.00            $8,817.07

                    OKLAHOMA
    BROKEN ARROW MED CTR                    3000 S ELM PL                 BROKEN ARROW OK 74012 7917     730803027              01-Jul-04         30-Jun-05 370176       3869822          $583.41              $0.00                $583.41 Initial                            56927
    INTEGRIS BAPTIST REG HEALTH CENTER      200 2ND AVE SW                MIAMI OK 74354 6830            730584411              01-Jul-04         30-Jun-05 370004       3869823          $488.38              $0.00                $488.38 Initial                            56718
    INTEGRIS BASS BAPTIST HEALTH CENTER     600 S MONROE ST               ENID OK 73701 7211             730612674001           01-Jul-04         30-Jun-05 370016       3869824        $11,463.43             $0.00             $11,463.43 Initial                            56716
    INTEGRIS CANADIAN VALLEY REG HOSPITAL   1201 HEALTH CENTER PKWY       YUKON OK 73099 6381            731605613              01-Jul-04         30-Jun-05 370211       3869825         $2,799.22             $0.00               $2,799.22 Initial                           56715
    ST FRANCIS HOSPITAL                     6161 S YALE AVE               TULSA OK 74136 1902            730700090              01-Jul-04         30-Jun-05 370091       3869826         $4,733.96          $927.63                $5,661.59 Initial                           56928
    ST FRANCIS HOSPITAL                     6161 S YALE AVE               TULSA OK 74136 1902            730700090              01-Jul-01         30-Jun-02 370091       3869827            $3.78           $236.21                 $239.99 Amended - First                    56696
    ST FRANCIS HOSPITAL                     6161 S YALE AVE               TULSA OK 74136 1902            730700090              01-Jul-03         30-Jun-04 370091       3869828           $12.16           ($10.50)                   $1.66 Amended - First                  56698
                                                                                                                                                                                                                           D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
8/1/2010                                                                                                                                TOTAL OK Disclosed
                                                                                                                        Proprietary to HMHS, Not to beAD PYMTS                      $20,084.34         $1,153.34           $21,237.68
                                                                                                                  Humana Military Healthcare Services
                                                                                                                           DRG Reimbursement
                                                                                                                Capital and Direct Medical Education Costs
                                                                                                                               South Region
                                                                                                                           Contract #18895631
                                                                                                                             Fiscal Year 2006
                                                                                                                                April 2006
                                                                                                                           Active Duty Voucher


            SOUTH CAROLINA
    CAROLINAS HOSPITAL SYSTEM              805 PAMPLICO HWY           FLORENCE SC 29501 0550     621587267002           01-Jul-04        30-Jun-05 420091    3869829          $197.35             $0.00             $197.35 Initial                            56678
    MCLEOD REGIONAL HOSPITAL               555 E CHEVES ST            FLORENCE SC 29506 2617     570370242001           01-Oct-98        30-Sep-99 420051    3869830       ($7,059.15)       ($1,467.13)         ($8,526.28) Correction                        57364
    REGIONAL MED CTR                       3000 ST MATTHEWS RD        ORANGEBURG SC 29118 1442   576008010              01-Oct-04        30-Sep-05 420068    3869831        $1,747.18             $0.00            $1,747.18 Initial                           57160
                                                                                                                                    TOTAL SOUTH CAROLINA AD PYMTS      ($5,114.62)       ($1,467.13)       ($6,581.75)

                TENNESSEE
    BAPTIST MEM HOSP COLLIERVILLE          1500 W POPLAR AVENUE       COLLIERVILLE TN 38017      620123940030           01-Oct-04        30-Sep-05 440217    3869832        $6,537.79            $16.23            $6,554.02 Initial                           57404

    BAPTIST MEMORIAL HOSP MED CTR          899 MADISON AVE            MEMPHIS TN 38146           620123940              01-Oct-96        30-Sep-97 440048    3869833          $114.78            $65.97             $180.75 Amended - Second                   56839
    BAPTIST MEMORIAL HOSPITAL-UNION CITY   RUSSELL & BISHOP STREETS   UNION CITY TN 38261        621138045004           01-Oct-99        30-Sep-00 440130    3869834        $6,800.71             $0.00            $6,800.71 Amended - First                   56802
    LIVINGSTON REGIONAL HOSP               315 OAK ST                 LIVINGSTON TN 38570 1728   621762419             01-Mar-04         28-Feb-05 440187    3869835          $693.38             $0.00             $693.38 Initial                            57053
    SKYLINE MEDICAL CENTER                 3441 DICKERSON PIKE        NASHVILLE TN 37207 2539    621560757             01-Dec-02         30-Nov-03 440006    3869836        $7,969.28             $0.00            $7,969.28 Amended - First                   57171
                                                                                                                                    TOTAL TN AD PYMTS                  $22,115.94           $82.20         $22,198.14
                   TEXAS
    CHARLTON METHODIST HOSPITAL            3500 W WHEATLAND RD        DALLAS TX 75237 3460       750800661002           01-Jul-04        30-Jun-05 450723    3869837        $1,833.94           $576.43            $2,410.37 Initial                           56751
    EAST HOUSTON MEDICAL CENTER            13111 EAST FWY             HOUSTON TX 77015 5820      760223803             01-Mar-02         28-Feb-03 450126    3869838           $27.29             $0.00               $27.29 Amended - First                   57428
    HARLINGEN MEDICAL CENTER               5501 S EXPRESSWAY 77       HARLINGEN TX 78550 3213    562143518              01-Oct-04        30-Sep-05 450855    3869839        $3,866.06             $0.00            $3,866.06 Initial                           57071
    HEART HOSPITAL OF AUSTIN               3801 N LAMAR BLVD          AUSTIN TX 78756 4080       561962571              01-Oct-04        30-Sep-05 450824    3869840        $1,953.87             $0.00            $1,953.87 Initial                           57072
    MEDICAL CENTER HOSPITAL                500 W 4TH ST               ODESSA TX 79761 5001       752302928              01-Oct-04        30-Sep-05 450132    3869841        $7,306.05         $2,242.05            $9,548.10 Initial                           57437
    MEDICAL CITY DALLAS HOSPITAL           7777 FOREST LN             DALLAS TX 75230 2505       621682198              01-Jun-04        31-May-05 450647    3869842        $3,459.50             $0.00            $3,459.50 Initial                           57058
    METHODIST MEDICAL CENTER               1441 N BECKLEY AVE         DALLAS TX 75203 1201       750800661              01-Jul-04        30-Jun-05 450051    3869843          $168.71            $84.45             $253.16 Initial                            56753
    PARKLAND HLTH AND HOSP SYSTEM          5201 HARRY HINES BLVD      DALLAS TX 75235 7708       756004221              01-Oct-00        30-Sep-01 450015    3869844          $231.26         $1,992.27            $2,223.53 Amended - First                   57069
    PARKLAND HLTH AND HOSP SYSTEM          5201 HARRY HINES BLVD      DALLAS TX 75235 7708       756004221              01-Oct-99        30-Sep-00 450015    3869845           $45.26           $184.67             $229.93 Amended - First                    57068
    PARKLAND HLTH AND HOSP SYSTEM          5201 HARRY HINES BLVD      DALLAS TX 75235 7708       756004221              01-Oct-98        30-Sep-99 450015    3869846         ($95.90)           $518.77             $422.87 Amended - First                    57067
    SHANNON MEDICAL CENTER                 120 E HARRIS AVE           SAN ANGELO TX 76903 5904   752559845001           01-Oct-04        30-Sep-05 450571    3869847        $4,561.33            $77.08            $4,638.41 Initial                           57398
    SHANNON MEDICAL CENTER                 120 E HARRIS AVE           SAN ANGELO TX 76903 5904   752559845003           01-Oct-99        30-Sep-00 450571    3869848          $206.92             $1.33             $208.25 Amended - First                    57427
    SHANNON MEDICAL CENTER                 120 E HARRIS AVE           SAN ANGELO TX 76903 5904   752559845003           01-Oct-00        30-Sep-01 450571    3869849            $8.75             $0.22                $8.97 Amended - First                   57426
    SHANNON MEDICAL CENTER                 120 E HARRIS AVE           SAN ANGELO TX 76903 5904   752559845003           01-Oct-01        30-Sep-02 450571    3869850            $1.43             $0.21                $1.64 Amended - First                   57425
    SHANNON MEDICAL CENTER                 120 E HARRIS AVE           SAN ANGELO TX 76903 5904   752559845003           01-Oct-02        30-Sep-03 450571    3869851       ($1,460.37)         ($71.38)          ($1,531.75) Amended - First                   57424
    TEXOMA MEDICAL CENTER                  1000 MEMORIAL DR           DENISON TX 75020 2035      752128961              01-Jul-04        30-Jun-05 450324    3869852          $433.15             $0.00             $433.15 Initial                            57041
    UNIVERSITY TX MED BRANCH-GALVESTON     301 UNIVERSITY BLVD        GALVESTON TX 77555 5302    746000949004          01-Sep-04         31-Aug-05 450018    3869853        $6,504.44        $17,874.52          $24,378.96 Initial                            57052
                                                                                                                                    TOTAL TX AD PYMTS                  $29,051.69        $23,480.62        $52,532.31

                                                                                                                                    TOTAL SOUTH AD PYMTS               $274,548.67       $88,895.30        $363,443.97




                                                                                                                                                                                                           D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
8/1/2010                                                                                                        Proprietary to HMHS, Not to be Disclosed
                                                                                                                        Humana Military Healthcare Services
                                                                                                                                 DRG Reimbursement
                                                                                                                      Capital and Direct Medical Education Costs
                                                                                                                                     South Region
                                                                                                                                 Contract #18895631
                                                                                                                                   Fiscal Year 2006
                                                                                                                                      April 2006
                                                                                                                               Non-Active Duty Voucher

                                                                                                                                                                                                        TOTAL
                                                                                                                      PERIOD             PERIOD                                                        MEDICAL                TOTAL
                                                                                                       PROVIDER      COVERED            COVERED         MEDICARE   VOUCHER    TOTAL CAPITAL           EDUCATION            TMA/CHAMPUS                  TYPE             CONTROL
           HOSPITAL NAME              HOSPITAL ADDRESS                     CITY/STATE/ZIP               NUMBER         FROM                TO            NUMBER    NUMBER       PAYMENT                PAYMENT               PAYMENT                  PAYMENT            NUMBER
                 ALABAMA
ATHENS LIMESTONE HOSPITAL            700 WEST MARKET ST         ATHENS AL 35611                       636002175           01-Oct-04         30-Sep-05 10079         3869854             $21,474.70                $0.00                 $21,474.70 Initial                           57064
                                     2010 BROOKWOOD MEDICAL CTR
BROOKWOOD MEDICAL CENTER             DR                         BIRMINGHAM AL 35209-3520              630574010012        01-Jan-01         31-Dec-01 10139         3869855              $4,427.97           ($6,641.95)               ($2,213.98) Correction                        57421
DECATUR GENERAL HOSPITAL             1201 7TH ST SE                DECATUR AL 35601 3337              636000260            01-Jul-04        30-Jun-05 10085         3869856             $29,895.00                $0.00                 $29,895.00 Initial                           56731
NORTHPORT HOSP DCH                   2700 HOSPITAL DR              NORTHPORT AL 35476                 631073301           01-Oct-97         30-Sep-98 10145         3869857                $303.66                $0.00                    $303.66 Correction                        57342
SHELBY BAPTIST MEDICAL CENTER        1000 FIRST STREET NORTH       ALABASTER AL 35007                 631181094           01-Oct-04         30-Sep-05 10016         3869858             $60,596.53                $0.00                 $60,596.53 Initial                           57065
SOUTHEAST ALABAMA MEDICAL CENT       1108 ROSS CLARK CIR           DOTHAN AL 36301 3022               636004476           01-Oct-04         30-Sep-05 10001         3869859            $278,000.45                $0.00                $278,000.45 Initial                           57344
SPRINGHILL MEMORIAL HOSPITAL         3719 DAUPHIN STREET           MOBILE AL 36608                    630784458003        01-Jan-04         31-Dec-04 10144         3869860             $69,816.30              $272.27                 $70,088.57 Initial                           56726
                                                                                                                                       TOTAL AL NAD PYMTS                         $464,514.61            ($6,369.68)           $458,144.93

                ARKANSAS
ARKANSAS HEART HOSPITAL              1701 S SHACKLEFORD RD         LITTLE ROCK AR 72211 4335          561933245           01-Oct-04         30-Sep-05 40134         3869861             $46,189.37                $0.00                 $46,189.37 Initial                           57074
DARDANELLE HOSPITAL                  200 N 3RD ST                  DARDANELLE AR 72834 3802           710383863           01-Nov-04         31-Oct-05 41302         3869862                $848.65                $0.00                    $848.65 Initial                           57402
ST MARYS REGIONAL MEDICAL CENTER     1808 W MAIN ST                RUSSELLVILLE AR 72801 2724         621771866           01-Sep-04         31-Aug-05 40041         3869863             $12,839.30                $0.00                 $12,839.30 Initial                           56768
                                                                                                                                       TOTAL AR NAD PYMTS                          $59,877.32                 $0.00              $59,877.32

                 FLORIDA
BAPTIST HOSPITAL                     1000 W MORENO ST              PENSACOLA FL 32501 2316            590657322002        01-Oct-04         30-Sep-05 100093        3869864            $132,342.53            $2,493.86                $134,836.39 Initial                           57343
BAPTIST HOSPITAL                     1000 W MORENO ST              PENSACOLA FL 32501 2316            590657322002        01-Oct-02         30-Sep-03 100093        3869865            ($17,208.57)           ($251.69)               ($17,460.26) Amended - First                   57172
CITRUS MEMORIAL HOSPITAL             502 WEST HIGHLAND BLVD        INVERNESS FL 34452                 592890430002        01-Oct-04         30-Sep-05 100023        3869866             $63,128.89                $0.00                 $63,128.89 Initial                           56936
COLUMBIA FAWCETT MEMORIAL HOSP       21298 OLEAN BLVD              PORT CHARLOTTE FL 33952 6705       650252846           01-Jan-02         31-Dec-02 100236        3869867             ($3,092.40)               $0.00                ($3,092.40) Amended - First                   55763
COLUMBIA FAWCETT MEMORIAL HOSPITAL   21298 OLEAN BLVD              PORT CHARLOTTE FL 33952-6705       650252846           01-Jan-01         31-Dec-01 100236        3869868              $5,625.89                $0.00                  $5,625.89 Amended - Second                  55081
COLUMBIA HOSPITAL                    2201 45TH STREET              WEST PALM BEACH FL 33407 2047      621694177            01-Jul-01        30-Jun-02 100234        3869869              $1,022.56              $312.19                  $1,334.75 Correction                        57413
CORAL SPRINGS MEDICAL CENTER         3000 CORAL HILLS DR           CORAL SPRINGS FL 33065 4108        596012065019         01-Jul-01        30-Jun-02 100276        3869870                $152.33                $0.00                    $152.33 Correction                        57400
GULF BREEZE HOSPITAL                 1110 GULF BREEZE PKY          GULF BREEZE FL 32561 4884          590657322           01-Oct-04         30-Sep-05 100266        3869871             $59,532.82                $0.00                 $59,532.82 Initial                           57397
GULF BREEZE HOSPITAL                 1110 GULF BREEZE PKY          GULF BREEZE FL 32561 4884          590657322           01-Oct-03         30-Sep-04 100266        3869872                $301.16                $0.00                    $301.16 Amended - First                   57174
LAKE CITY MEDICAL CENTER             1050 NORTH COMMERCE BLVD      LAKE CITY FL 32055                 954176924           01-Nov-04         31-Oct-05 100156        3869873             $36,478.08                $0.00                 $36,478.08 Initial                           57435
MUNROE REGIONAL MEDICAL CENTER       1500 SW 1ST AVE               OCALA FL 34474                     592390209001        01-Oct-04         30-Sep-05 100062        3869874             $88,990.41                $0.00                 $88,990.41 Initial                           57055
NORTH BROWARD MED CENTER             201 E SAMPLE RD               POMPANO BEACH FL 33064 3502        596012065            01-Jul-99        30-Jun-00 100086        3869875              $1,151.53                $0.00                  $1,151.53 Correction                        57383
NORTH BROWARD MED CENTER             201 E SAMPLE RD               POMPANO BEACH FL 33064 3502        596012065            01-Jul-01        30-Jun-02 100086        3869876              $1,535.52                $0.00                  $1,535.52 Correction                        57412
PALM BEACH GARDENS MED CTR           3360 BURNS RD                 PALM BEACH GARDENS FL 33410-4323   591223933001        01-Oct-00         30-Sep-01 100176        3869877              $1,421.05                $0.00                  $1,421.05 Correction                        57348
PALMS WEST HOSPITAL                  13001 SOUTHERN BLVD           LOXAHATCHEE FL 33470               621694178           01-Jun-01         31-May-02 100269        3869878              $1,168.75                $0.00                  $1,168.75 Correction                        57351
SACRED HEART HOSPITAL                5151 N 9TH AVE                PENSACOLA FL 32504                 590634434            01-Jul-04        30-Jun-05 100025        3869879           $1,227,541.26         $433,461.06              $1,661,002.32 Initial                           57432
SACRED HEART HOSPITAL EMERALD        7800 HIGHWAY 98 WEST          MIRAMAR BEACH FL 32550             721529708            01-Jul-04        30-Jun-05 100292        3869880             $72,423.29                $0.00                 $72,423.29 Initial                           57431
SHANDS HOSPITAL                      1600 SW ARCHER RD             GAINESVILLE FL 32610               591943502            01-Jul-99        30-Jun-00 100113        3869881               -2929.55             13077.06                   10147.51 Amended - First                   55658
SHANDS HOSPITAL                      1600 SW ARCHER RD             GAINESVILLE FL 32608               591943502            01-Jul-03        30-Jun-04 100113        3869882            $446,452.92          $496,848.94                $943,301.86 Initial                           57035
SHANDS HOSPITAL                      655 W 8TH ST                  GAINESVILLE FL 32608               591943502            01-Jul-97        30-Jun-98 100113        3869883              $8,745.03            $3,458.86                 $12,203.89 Amended - First                   56361
SHANDS HOSPITAL                      1600 SW ARCHER RD             GAINESVILLE FL 32608               591943502            01-Jul-04        30-Jun-05 100113        3869884            $407,897.82          $433,684.97                $841,582.79 Initial                           57036
South Bay Hospital                   4016 State Road 674           Sun City FL 33573-5256             592822337           01-Sep-01         31-Aug-02 100259        3869885              $1,764.17                $0.00                  $1,764.17 Correction                        57352
ST PETERSBURG GENERAL HOSPITAL       6500 38TH AVE N               SAINT PETERSBURG FL 33710 1629     591174716023        01-May-01         30-Apr-02 100180        3869886                $622.47                $0.00                    $622.47 Correction                        57350
Tampa General                        2 Columbia Drive              Tampa FL 33606-3508                593458145           01-Oct-00         30-Sep-01 100128        3869887             $15,767.59            $8,452.30                 $24,219.89 Correction                        57334
TAMPA GENERAL HOSPITAL               2 COLUMBIA DR                 TAMPA FL 33606 3508                593458145           01-Oct-96         30-Sep-97 100128        3869888             $12,743.08            $9,939.19                 $22,682.27 Amended - Second                  56146
WINTER HAVEN HOSPITAL                200 AVENUE F NE               WINTER HAVEN FL 33881 4131         590724462           01-Oct-01         30-Sep-02 100052        3869889             ($1,646.83)               $0.00                ($1,646.83) Amended - First                   57169
WINTER HAVEN HOSPITAL                200 AVENUE F NE               WINTER HAVEN FL 33881 4131         590724462           01-Oct-02         30-Sep-03 100052        3869890                $349.06                $0.00                    $349.06 Amended - First                   57170
WINTER HAVEN HOSPITAL                200 AVENUE F NE               WINTER HAVEN FL 33881 4131         590724462           01-Oct-03         30-Sep-05 100052        3869891               ($160.86)               $0.00                  ($160.86) Amended - First                   57176
                                                                                                                                       TOTAL FL NAD PYMTS                        $2,562,120.00        $1,401,476.74         $3,963,596.74

                 GEORGIA
CARTERSVILLE MEDICAL CENTER          960 JOE FRANK HARRIS PKY SE   CARTERSVILLE GA 30120 2129         582433438           01-Oct-04         30-Sep-05 110030        3869892             $23,136.62                $0.00                 $23,136.62 Initial                           56938
COLISEUM MEDICAL CENTERS             350 HOSPITAL DRIVE            MACON GA 31217                     621736983            01-Jul-02        30-Jun-03 110164        3869893             ($2,655.90)               $0.00                ($2,655.90) Amended - First                   57056
DOCTORS HOSPITAL OF AUGUSTA DB       3651 WHEELER RD               AUGUSTA GA 30909 6246              581162801           01-Apr-01         31-Mar-02 110177        3869894               ($592.43)               $0.00                  ($592.43) Correction                        57417
EMORY EASTSIDE MEDICAL CENTER        1700 MEDICAL WAY              SNELLVILLE GA 30078                582433432           01-Sep-00         31-Aug-01 110192        3869895              $1,960.66                $0.00                  $1,960.66 Correction                        57418
HUGHSTON ORTHOPEDIC HOSPITAL         100 FRIST CT                  COLUMBUS GA 31909 3578             621130833005        01-Oct-04         30-Sep-05 110200        3869896             $51,606.46                $0.00                 $51,606.46 Initial                           56939
JEFF DAVIS HOSPITAL                  163 S TALLAHASSEE ST          HAZLEHURST GA 31539                580903829           01-Oct-04         30-Sep-05 111333        3869897              $2,736.01                $0.00                  $2,736.01 Initial                           57060
POLK MEDICAL CENTER                  424 N MAIN ST                 CEDARTOWN GA 30125 2644            621619423           01-Oct-04         30-Sep-05 111330        3869898              $4,696.67                $0.00                  $4,696.67 Initial                           56921
REDMOND REGIONAL MEDICAL CENTE       501 REDMOND ROAD              Rome GA 30164                      581123037001         01-Jul-01        30-Jun-02 110168        3869899             $14,139.74                $0.00                 $14,139.74 Correction                        57416
ROCKDALE MEDICAL CENTER INC          1412 MILSTEAD AVE             CONYERS GA 30012 3877              582117722           01-Oct-04         30-Sep-05 110091        3869900             $18,739.03                $0.00                 $18,739.03 Initial                           57395
SOUTH FULTON MEDICAL CENTER          1170 CLEVELAND AVE            EAST POINT GA 30344-3615           752919505           25-Apr-01         31-May-02 110066        3869901              $2,727.42              $149.68                  $2,877.10 Correction                        57357
UNIVERSITY HOSPITAL                  1350 WALTON WAY               AUGUSTA GA 30901                   581581103           01-Jan-01         31-Dec-01 110028        3869902              $1,768.70              $330.70                  $2,099.40 Correction                        57339
UNIVERSITY HOSPITAL                  1350 WALTON WAY               AUGUSTA GA 30901                   581581103           28-Dec-98         26-Dec-99 110028        3869903              $2,286.72              $299.80                  $2,586.52 Correction                        57338
UNIVERSITY HOSPITAL                  1350 WALTON WAY               AUGUSTA GA 30901                   581581103           29-Dec-97         27-Dec-98 110028        3869904             ($4,685.92)               $0.00                ($4,685.92) Correction                        57376
                                                                                                                                       TOTAL GA NAD PYMTS                         $115,863.78              $780.18             $116,643.96




8/1/2010                                                                                                              Proprietary to HMHS, Not to be Disclosed                                                              D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
                                                                                                                      Humana Military Healthcare Services
                                                                                                                               DRG Reimbursement
                                                                                                                    Capital and Direct Medical Education Costs
                                                                                                                                   South Region
                                                                                                                               Contract #18895631
                                                                                                                                 Fiscal Year 2006
                                                                                                                                    April 2006
                                                                                                                             Non-Active Duty Voucher

                LOUISIANA
DOCTORS HOSPITAL OF JEFFERSON             4320 HOUMA BLVD             METAIRIE LA 70006              953720659019       01-Jun-00         31-May-01 190203       3869905         $4,887.58             $0.00                 $4,887.58 Correction                        57373
LAFAYETTE HEART HOSPITAL LLC              1105 KALISTE SALOOM RD      LAFAYETTE LA 70508 5705        562258410001       01-Oct-04         30-Sep-05 190263       3869906         $1,900.60             $0.00                 $1,900.60 Initial                           57073
LOUISIANA HEART HOSPITAL                  64030 HIGHWAY 434           LACOMBE LA 70445 3456          562227298          01-Oct-04         30-Sep-05 190250       3869907        $31,908.87             $0.00                $31,908.87 Initial                           57076
LSU HEALTH SCIENCES CENTER SHR            1501 KINGS HWY              SHREVEPORT LA 71103 4228       720702002           01-Jul-04        30-Jun-05 190098       3869908       $102,447.24        $21,235.95               $123,683.19 Initial                           56677
                                          2810 AMBASSADOR CAFFERY
SOUTHWEST MEDICAL CENTER-LAFAY            PKWY                        LAFAYETTE LA 70506 5906        581741727          01-Sep-04         31-Aug-05 190205       3869909        $29,778.49             $0.00                $29,778.49 Initial                           56675
VILLE PLATTE MEDICAL CENTER               800 E MAIN ST               VILLE PLATTE LA 70586 4618     621868757          01-Oct-04         30-Sep-05 190167       3869910         $6,249.38             $0.00                 $6,249.38 Initial                           57164
                                                                                                                                     TOTAL LA NAD PYMTS                    $177,172.16        $21,235.95           $198,408.11

               MISSISSIPPI
BAPTIST MEMORIAL HOSP OF NORTH MS         2301 S LAMAR BLVD           OXFORD MS 38655 5338           640772726          01-Oct-03         30-Sep-04 250034       3869911           ($10.55)            $0.00                   ($10.55) Amended - First                  57080
BAPTIST MEMORIAL-GOLDEN TRIANGLE          2520 5TH STREET NORTH       COLUMBUS MS 39705 2008         621519754005       01-Oct-03         30-Sep-04 250100       3869912            $12.64             $0.00                    $12.64 Amended - First                   57079
BILOXI REGIONAL MEDICAL CENTER            150 REYNOIR ST              BILOXI MS 39530 4130           592754033002       01-Oct-04         30-Sep-05 250007       3869913        $49,833.58             $0.00                $49,833.58 Initial                           57163
MAGNOLIA REGIONAL HEALTH CENTE            611 ALCORN DR               CORINTH MS 38834 9368          640428003          01-Oct-04         30-Sep-05 250009       3869914        $10,125.16             $0.00                $10,125.16 Initial                           57165
                                                                                                                                     TOTAL MS NAD PYMTS                     $59,960.83             $0.00             $59,960.83

               OKLAHOMA
BROKEN ARROW MED CTR                      3000 S ELM PL               BROKEN ARROW OK 74012 7917     730803027           01-Jul-04        30-Jun-05 370176       3869915         $7,000.97             $0.00                 $7,000.97 Initial                           56927
INTEGRIS BAPTIST REG HEALTH CENTER        200 2ND AVE SW              MIAMI OK 74354 6830            730584411           01-Jul-04        30-Jun-05 370004       3869916         $3,540.77             $0.00                 $3,540.77 Initial                           56718
INTEGRIS BASS BAPTIST HEALTH CENTER       600 S MONROE ST             ENID OK 73701 7211             730612674001        01-Jul-04        30-Jun-05 370016       3869917        $86,630.80             $0.00                $86,630.80 Initial                           56716
INTEGRIS CANADIAN VALLEY REG HOSPITAL     1201 HEALTH CENTER PKWY     YUKON OK 73099 6381            731605613           01-Jul-04        30-Jun-05 370211       3869918        $32,890.88             $0.00                $32,890.88 Initial                           56715
INTEGRIS CLINTON REGIONAL HOSPITAL        100 N 30TH ST               CLINTON OK 73601 3117          731531028001        01-Jul-04        30-Jun-05 370029       3869919         $7,755.56             $0.00                 $7,755.56 Initial                           56719
INTEGRIS GROVE GENERAL HOSPITAL           1310 S MAIN ST              GROVE OK 74344 5304            730731338           01-Jul-04        30-Jun-05 370113       3869920        $16,386.23             $0.00                $16,386.23 Initial                           56720
MAYES COUNTY MEDICAL CENTER               111 N BAILEY ST             PRYOR OK 74361 4211            730981133           01-Jul-04        30-Jun-05 370015       3869921         $9,085.12             $0.00                 $9,085.12 Initial                           56786
MEDICAL CENTER OF SOUTHEAST OK            1800 W UNIVERSITY BLVD      DURANT OK 74701 3006           581725656          01-Oct-04         30-Sep-05 370014       3869922        $19,598.33         $4,891.61                $24,489.94 Initial                           57434
ST FRANCIS HOSPITAL                       6161 S YALE AVE             TULSA OK 74136 1902            730700090           01-Jul-04        30-Jun-05 370091       3869923        $61,239.25        $11,999.95                $73,239.20 Initial                           56928
ST FRANCIS HOSPITAL                       6161 S YALE AVE             TULSA OK 74136 1902            730700090           01-Jul-01        30-Jun-02 370091       3869924        $11,485.50        $18,341.48                $29,826.98 Amended - First                   56696
ST FRANCIS HOSPITAL                       6161 S YALE AVE             TULSA OK 74136 1902            730700090           01-Jul-03        30-Jun-04 370091       3869925       ($10,218.77)       ($2,030.37)             ($12,249.14) Amended - First                   56698
                                                                                                                                     TOTAL OK NAD PYMTS                    $245,394.64        $33,202.67           $278,597.31

           SOUTH CAROLINA
                                          2095 HENRY TECKLENBURG
BON SECOURS ST FRANCIS XAVIER             DRIVE                       CHARLESTON SC 29411-0001       571067254          01-Jan-00         31-Dec-00 420065       3869926           $829.03             $0.00                   $829.03 Correction                        57365
CAROLINAS HOSPITAL SYSTEM                 805 PAMPLICO HWY            FLORENCE SC 29501 0550         621587267002        01-Jul-04        30-Jun-05 420091       3869927        $18,057.80             $0.00                $18,057.80 Initial                           56678
MCLEOD REGIONAL HOSPITAL                  555 E CHEVES ST             FLORENCE SC 29506 2617         570370242001       01-Oct-98         30-Sep-99 420051       3869928         $7,537.74         $1,566.60                 $9,104.34 Correction                        57364
REGIONAL MED CTR                          3000 ST MATTHEWS RD         ORANGEBURG SC 29118 1442       576008010          01-Oct-04         30-Sep-05 420068       3869929        $26,073.24             $0.00                $26,073.24 Initial                           57160
ROPER HOSPITAL NORTH                      2750 SPEISSEGGER RD         NORTH CHARLESTON SC 29405      570360499001       01-Oct-96         30-Sep-97 420088       3869930         $2,490.22             $0.00                 $2,490.22 Correction                        57367
                                                                                                                                     TOTAL SC NAD PYMTS                     $54,988.03         $1,566.60             $56,554.63

               TENNESSEE
BAPTIST MEM HOSP COLLIERVILLE             1500 W POPLAR AVENUE        COLLIERVILLE TN 38017          620123940030       01-Oct-04         30-Sep-05 440217       3869931        $51,958.21           $128.98                $52,087.19 Initial                           57404
BAPTIST MEMORIAL HOSP MED CTR             899 MADISON AVE             MEMPHIS TN 38146               620123940          01-Oct-96         30-Sep-97 440048       3869932         ($114.78)          ($65.97)                 ($180.75) Amended - Second                  56839
BAPTIST MEMORIAL HOSPITAL-UNION CITY      RUSSELL & BISHOP STREETS    UNION CITY TN 38261            621138045004       01-Oct-99         30-Sep-00 440130       3869933        ($6,800.71)            $0.00               ($6,800.71) Amended - First                   56802
Columbia Parkridge Medical Center         2333 Mc Callie Avene        Chattanooga TN 37404-3258      620840204          01-Apr-01         31-Mar-02 440156       3869934           $831.93             $0.00                   $831.93 Correction                        57448
HENDERSONVILLE HOSPITAL                   355 NEW SHACKLE ISLAND RD   HENDERSONVILLE TN 37075-2300   621321255          01-Sep-01         31-Aug-02 440194       3869935         $2,173.32             $0.00                 $2,173.32 Correction                        57447
Jackson-Madison County General Hospital   708 West Forest Ave.        Jackson TN 38301-3901          626010402           01-Jul-01        30-Jun-02 440002       3869936        $15,502.59           $921.06                $16,423.65 Correction                        57368
LIVINGSTON REGIONAL HOSP                  315 OAK ST                  LIVINGSTON TN 38570 1728       621762419          01-Mar-04         28-Feb-05 440187       3869937        $11,232.69             $0.00                $11,232.69 Initial                           57053
METHODIST HOSP NORTH                      3960 NEW COVINGTON PIKE     MEMPHIS TN 38128 2504          620479367          01-Jan-00         31-Dec-00 440049       3869938         $3,301.84         $1,739.07                 $5,040.91 Correction                        57369
SKYLINE MEDICAL CENTER                    3441 DICKERSON PIKE         NASHVILLE TN 37207 2539        621560757          01-Dec-02         30-Nov-03 440006       3869939        ($7,969.28)            $0.00               ($7,969.28) Amended - First                   57171
ST MARYS HEALTH SYSTEM INC                900 E OAK HILL AVE          KNOXVILLE TN 37917 4505        620480068          01-Jan-01         31-Dec-01 440120       3869940           $131.59             $0.00                   $131.59 Correction                        57371
ST MARY'S JEFFERSON MEMORIAL H            110 HOSPITAL DR             JEFFERSON CITY TN 37760 5281   621660663          01-Jan-01         31-Dec-01 440056       3869941           $247.15             $0.00                   $247.15 Correction                        57370
                                                                                                                                     TOTAL TN NAD PYMTS                     $70,494.55         $2,723.14             $73,217.69
                   TEXAS
CHARLTON METHODIST HOSPITAL               3500 W WHEATLAND RD         DALLAS TX 75237 3460           750800661002        01-Jul-04        30-Jun-05 450723       3869942        $35,456.21        $11,144.24                $46,600.45 Initial                           56751
CLEVELAND REGIONAL MEDICAL CENTER         300 E CROCKETT              CLEVELAND TX 77327 4029        593215798          01-Sep-04         31-Aug-05 450296       3869943         $3,632.24             $0.00                 $3,632.24 Initial                           56723
EAST HOUSTON MEDICAL CENTER               13111 EAST FWY              HOUSTON TX 77015 5820          760223803          01-Mar-02         28-Feb-03 450126       3869944           $225.18             $0.00                   $225.18 Amended - First                   57428
HARLINGEN MEDICAL CENTER                  5501 S EXPRESSWAY 77        HARLINGEN TX 78550 3213        562143518          01-Oct-04         30-Sep-05 450855       3869945        $85,053.22             $0.00                $85,053.22 Initial                           57071
HEART HOSPITAL OF AUSTIN                  3801 N LAMAR BLVD           AUSTIN TX 78756 4080           561962571          01-Oct-04         30-Sep-05 450824       3869946       $113,324.41             $0.00               $113,324.41 Initial                           57072
MEDICAL CENTER HOSPITAL                   500 W 4TH ST                ODESSA TX 79761 5001           752302928          01-Oct-04         30-Sep-05 450132       3869947        $26,064.84         $7,998.67                $34,063.51 Initial                           57437
MEDICAL CITY DALLAS HOSPITAL              7777 FOREST LN              DALLAS TX 75230 2505           621682198          01-Jun-04         31-May-05 450647       3869948       $436,934.45             $0.00               $436,934.45 Initial                           57058
METHODIST MEDICAL CENTER                  1441 N BECKLEY AVE          DALLAS TX 75203 1201           750800661           01-Jul-04        30-Jun-05 450051       3869949        $38,971.68        $19,507.02                $58,478.70 Initial                           56753
PARKLAND HLTH AND HOSP SYSTEM             5201 HARRY HINES BLVD       DALLAS TX 75235 7708           756004221          01-Oct-00         30-Sep-01 450015       3869950           $307.08         $2,645.50                 $2,952.58 Amended - First                   57069
PARKLAND HLTH AND HOSP SYSTEM             5201 HARRY HINES BLVD       DALLAS TX 75235 7708           756004221          01-Oct-99         30-Sep-00 450015       3869951           $529.95         $2,162.41                 $2,692.36 Amended - First                   57068
PARKLAND HLTH AND HOSP SYSTEM             5201 HARRY HINES BLVD       DALLAS TX 75235 7708           756004221          01-Oct-98         30-Sep-99 450015       3869952         ($353.62)         $1,912.84                 $1,559.22 Amended - First                   57067
PARKLAND HLTH AND HOSP SYSTEM             5201 HARRY HINES BLVD       DALLAS TX 75235 7708           756004221          01-Oct-96         30-Sep-97 450015       3869953         ($151.67)         ($556.96)                 ($708.63) Amended - First                   57070
SHANNON MEDICAL CENTER                    120 E HARRIS AVE            SAN ANGELO TX 76903 5904       752559845001       01-Oct-04         30-Sep-05 450571       3869954        $90,249.17         $1,524.98                $91,774.15 Initial                           57398
SHANNON MEDICAL CENTER                    120 E HARRIS AVE            SAN ANGELO TX 76903 5904       752559845003       01-Oct-99         30-Sep-00 450571       3869955         $1,517.39             $9.73                 $1,527.12 Amended - First                   57427




8/1/2010                                                                                                            Proprietary to HMHS, Not to be Disclosed                                                    D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls
                                                                                                         Humana Military Healthcare Services
                                                                                                                  DRG Reimbursement
                                                                                                       Capital and Direct Medical Education Costs
                                                                                                                      South Region
                                                                                                                  Contract #18895631
                                                                                                                    Fiscal Year 2006
                                                                                                                       April 2006
                                                                                                                Non-Active Duty Voucher

SHANNON MEDICAL CENTER               120 E HARRIS AVE      SAN ANGELO TX 76903 5904    752559845003        01-Oct-00         30-Sep-01 450571       3869956              $302.00                $7.65                   $309.65 Amended - First                   57426
SHANNON MEDICAL CENTER               120 E HARRIS AVE      SAN ANGELO TX 76903 5904    752559845003        01-Oct-01         30-Sep-02 450571       3869957               $27.34                $3.90                    $31.24 Amended - First                   57425
SHANNON MEDICAL CENTER               120 E HARRIS AVE      SAN ANGELO TX 76903 5904    752559845003        01-Oct-02         30-Sep-03 450571       3869958          ($24,146.74)          ($1,199.21)             ($25,345.95) Amended - First                   57424
SOUTHWEST GENERAL HOSPITAL LP        7400 BARLITE BLVD     SAN ANTONIO TX 78224 1308   621795572           01-Oct-04         30-Sep-05 450697       3869959           $15,932.13                $0.00                $15,932.13 Initial                           57066
TEXOMA MEDICAL CENTER                1000 MEMORIAL DR      DENISON TX 75020 2035       752128961            01-Jul-04        30-Jun-05 450324       3869960           $31,403.72                $0.00                $31,403.72 Initial                           57041
TEXSAN HEART HOSPITAL                6700 IH 10 W          SAN ANTONIO TX 78201 2009   562270591           01-Oct-04         30-Sep-05 450878       3869961           $54,511.37                $0.00                $54,511.37 Initial                           57075
UNIVERSITY TX MED BRANCH-GALVESTON   301 UNIVERSITY BLVD   GALVESTON TX 77555 5302     746000949004        01-Sep-04         31-Aug-05 450018       3869962           $35,360.51           $97,172.37               $132,532.88 Initial                           57052
                                                                                                                        TOTAL TX NAD PYMTS                      $945,150.86          $142,333.14         $1,087,484.00


                                                                                                                        TOTAL SOUTH NAD PYMTS                 $4,755,536.78         $1,596,948.74        $6,352,485.52

                                                                                                                        TOTAL SOUTH AD PYMTS                     $274,548.67           $88,895.30            $363,443.97

                                                                                                      TOTAL HUMANA SOUTH NAD & AD PYMTS                       $5,030,085.45         $1,685,844.04        $6,715,929.49

                                                                                                      TOTAL HUMANA SOUTH CREDITS                              ($1,458,347.69)               $0.00        ($1,458,347.69)

                                                                                                      TOTAL P00135 CREDITS                                     ($309,331.54)                $0.00          ($309,331.54)

                                                                                                      TOTAL HUMANA SOUTH PAYMENT                              $3,262,406.22         $1,685,844.04        $4,948,250.26




8/1/2010                                                                                                Proprietary to HMHS, Not to be Disclosed                                                         D:\Docstoc\Working\pdf\175a00c0-d974-4527-9e8e-efcc4f7d063f.xls

								
To top