| A | B | C | D | E | F | G | H | |||
| Estimated | Estimated | Estimated | ||||||||
| Estimated | Payable | Recoverable | Amount Eligible | Estimated | First Interim | |||||
| Submitted | Percent | Amount | Two-Thirds | Amount | for Distribution | Distribution | Distribution | |||
| Type | POC # | Provider Name | POC Amount | Allowable | (Col A x B) | of Col C | To Date | (Col D - E) | at 35% | w/ De Minimus |
| Hospital | APP0009839 | ATLANTIC CITY MEDICAL CENTER | $235,068.38 | 97.2% | $228,529.49 | $152,352.99 | $0.00 | $152,352.99 | $53,323.55 | $53,323.55 |
| Hospital | APP0009817 | ATLANTIC CITY MEDICAL CENTER | $0.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Hospital | APP0010850 | BARNERT HOSPITAL | $1,089,618.65 | 58.6% | $638,928.87 | $425,952.58 | $387,359.89 | $38,592.69 | $13,507.44 | $13,507.44 |
| Hospital | APP0009489 | BAYONNE HOSPITAL | $214,759.06 | 56.2% | $120,736.84 | $80,491.23 | $14,951.40 | $65,539.83 | $22,938.94 | $22,938.94 |
| Hospital | APP0009809 | BAYSHORE COMMUNITY HOSPITAL | $1,788.73 | 39.4% | $705.00 | $470.00 | $942.00 | ($472.00) | $0.00 | $0.00 |
| Hospital | APP0010812 | BERGEN REGIONAL MEDICAL CENTER & BERGEN PINES COUN | $21,713.60 | 35.7% | $7,745.55 | $5,163.70 | $745.00 | $4,418.70 | $1,546.54 | $1,546.54 |
| Hospital | APP0010839 | BROCKTON HOSPITAL | $279.01 | 100.0% | $279.01 | $186.01 | $0.00 | $186.01 | $65.10 | $0.00 |
| Hospital | APP0049315 | CAPITAL HEALTH SYSTEM | $15,179.61 | 92.7% | $14,075.81 | $9,383.87 | $45.00 | $9,338.87 | $3,268.60 | $3,268.60 |
| Hospital | APP0010799 | CAPITAL HEALTH SYSTEM AT FULD | $981.00 | 17.8% | $175.00 | $116.67 | $45.00 | $71.67 | $25.08 | $0.00 |
| Hospital | APP0010808 | CHILDREN'S HOSPITAL OF PHILADELPHIA | $324,381.97 | 41.3% | $134,077.40 | $89,384.93 | $0.00 | $89,384.93 | $31,284.73 | $31,284.73 |
| Hospital | APP0010860 | CHILDREN'S SPECIALIZED HOSPITAL | $113,976.16 | 60.8% | $69,315.18 | $46,210.12 | $0.00 | $46,210.12 | $16,173.54 | $16,173.54 |
| Hospital | APP0009818 | CHILTON MEMORIAL HOSPITAL | $18,379.00 | 31.7% | $5,832.60 | $3,888.40 | $590.80 | $3,297.60 | $1,154.16 | $1,154.16 |
| Hospital | APP0009486 | CHRIST HOSPITAL | $910,560.33 | 53.9% | $491,184.43 | $327,456.29 | $62,424.22 | $265,032.07 | $92,761.22 | $92,761.22 |
| Hospital | APP0010262 | CLARA MAAS MEDICAL CENTER | $110,009.23 | 59.2% | $65,161.51 | $43,441.01 | $130.00 | $43,311.01 | $15,158.85 | $15,158.85 |
| Hospital | APP0001220 | COLUMBUS HOSPITAL | $543,970.30 | 28.2% | $153,644.49 | $102,429.66 | $21,272.81 | $81,156.85 | $28,404.90 | $28,404.90 |
| Hospital | APP0049198 | CT. CHILDREN'S MEDICAL CENTER | $2,129.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Hospital | APP0010775 | EAST ORANGE GENERAL HOSPITAL | $52,655.81 | 30.7% | $16,139.59 | $10,759.73 | $3,790.00 | $6,969.73 | $2,439.41 | $2,439.41 |
| Hospital | APP0002662 | ELIZABETH GENERAL MEDICAL CENTER | $585,932.85 | 64.7% | $379,025.61 | $252,683.74 | $754.90 | $251,928.84 | $88,175.09 | $88,175.09 |
| Hospital | APP0011052 | ENGLEWOOD HOSPITAL AND MEDICAL CENTER | $651,279.10 | 44.2% | $287,554.12 | $191,702.75 | $15,031.13 | $176,671.62 | $61,835.07 | $61,835.07 |
| Hospital | APP0010832 | EPISCOPAL HOSPITAL | $4,049.00 | 81.1% | $3,282.00 | $2,188.00 | $0.00 | $2,188.00 | $765.80 | $0.00 |
| Hospital | APP0010848 | GENERAL HOSPITAL CENTER AT PASSAIC | $531,388.94 | 78.3% | $416,147.39 | $277,431.59 | $18,420.70 | $259,010.89 | $90,653.81 | $90,653.81 |
| Hospital | APP0009484 | GREENVILLE HOSPITAL | $450,928.00 | 12.0% | $53,905.60 | $35,937.07 | $3,249.60 | $32,687.47 | $11,440.61 | $11,440.61 |
| Hospital | APP0009816 | HACKENSACK MEDICAL CENTER | $980,148.29 | 52.9% | $518,533.64 | $345,689.09 | $28,220.88 | $317,468.21 | $111,113.87 | $111,113.87 |
| Hospital | APP0010815 | HOLY NAME HOSPITAL | $663,568.16 | 32.5% | $215,951.64 | $143,967.76 | $13,416.31 | $130,551.45 | $45,693.01 | $45,693.01 |
| Hospital | APP0010261 | HOSPITAL CENTER AT ORANGE | $238,946.04 | 37.8% | $90,297.05 | $60,198.03 | $10,946.85 | $49,251.18 | $17,237.91 | $17,237.91 |
| Hospital | APP0010263 | IRVINGTON GENERAL HOSPITAL | $21,859.80 | 32.3% | $7,055.52 | $4,703.68 | $135.68 | $4,568.00 | $1,598.80 | $1,598.80 |
| Hospital | APP0010790 | JACOBI MEDICAL CENTER NYC | $38,220.00 | 41.3% | $15,797.60 | $10,531.73 | $0.00 | $10,531.73 | $3,686.11 | $3,686.11 |
| Hospital | APP0009483 | JERSEY CITY MEDICAL CENTER | $6,628,275.68 | 30.9% | $2,045,642.37 | $1,363,761.58 | $992,419.29 | $371,342.29 | $129,969.80 | $129,969.80 |
| Hospital | APP0009831 | JERSEY SHORE MEDICAL CENTER | $7,292.00 | 45.3% | $3,300.00 | $2,200.00 | $0.00 | $2,200.00 | $770.00 | $0.00 |
| Hospital | APP0010868 | JOHN F. KENNEDY MEDICAL CENTER | $224,607.79 | 71.6% | $160,850.66 | $107,233.77 | $13,581.74 | $93,652.03 | $32,778.21 | $32,778.21 |
| Hospital | APP0049505 | JOHNS HOPKINS BAYVIEW MED CTR | $285.15 | 179.1% | $510.77 | $340.51 | $0.00 | $340.51 | $119.18 | $0.00 |
| Hospital | APP0049504 | JOHNS HOPKINS HOSPITAL | $4,406.87 | 2.7% | $117.86 | $78.57 | $0.00 | $78.57 | $27.50 | $0.00 |
| Hospital | APP0009814 | KIMBALL MEDICAL CENTER | $2,844.25 | 77.3% | $2,200.00 | $1,466.67 | $0.00 | $1,466.67 | $513.33 | $0.00 |
| Hospital | APP0049450 | LINCOLN HOSPITAL | $5,532.31 | 33.5% | $1,851.73 | $1,234.49 | $0.00 | $1,234.49 | $432.07 | $0.00 |
| Hospital | APP0009485 | MEADOWLANDS HOSPITAL | $102,950.65 | 41.7% | $42,897.68 | $28,598.45 | $101.00 | $28,497.45 | $9,974.11 | $9,974.11 |
| Hospital | APP0010870 | MEMORIAL MEDICAL CENTER | $21,932.40 | 55.2% | $12,101.28 | $8,067.52 | $90.00 | $7,977.52 | $2,792.13 | $2,792.13 |
| Hospital | APP0009811 | MEMORIAL SLOAN-KETTERING HOSP. | $214,822.00 | 1.5% | $3,302.30 | $2,201.53 | $0.00 | $2,201.53 | $770.54 | $0.00 |
| Hospital | APP0009813 | MONMOUTH HOSPITAL/MEDICAL CNTR | $9,487.70 | 86.5% | $8,202.95 | $5,468.63 | $0.00 | $5,468.63 | $1,914.02 | $1,914.02 |
| Hospital | APP0009819 | MORRISTOWN MEMORIAL HOSPITAL | $423,096.25 | 87.8% | $371,276.06 | $247,517.37 | $3,859.05 | $243,658.32 | $85,280.41 | $85,280.41 |
| Hospital | APP0010777 | MOUNTAINSIDE HOSPITAL | $14,236.21 | 85.5% | $12,167.33 | $8,111.55 | $38.40 | $8,073.15 | $2,825.60 | $2,825.60 |
| Hospital | APP0010856 | MUHLENBERG HOSPITAL | $767,808.61 | 42.0% | $322,480.60 | $214,987.07 | $87,644.73 | $127,342.34 | $44,569.82 | $44,569.82 |
| Hospital | APP0010260 | NEWARK BETH ISRAEL MEDICAL CENTER | $144,689.16 | 78.6% | $113,781.20 | $75,854.13 | $41,134.45 | $34,719.68 | $12,151.89 | $12,151.89 |
| Hospital | APP0010820 | NEWTON MEMORIAL HOSPITAL | $12,926.00 | 88.6% | $11,452.90 | $7,635.27 | $0.00 | $7,635.27 | $2,672.34 | $2,672.34 |
| Hospital | APP0010859 | OVERLOOK HOSPITAL | $369,367.65 | 80.4% | $297,094.80 | $198,063.20 | $22,382.01 | $175,681.19 | $61,488.42 | $61,488.42 |
| Hospital | APP0009487 | PALISADES MEDICAL CENTER | $367,354.65 | 75.4% | $277,117.06 | $184,744.71 | $36,727.97 | $148,016.74 | $51,805.86 | $51,805.86 |
| Hospital | APP0010813 | PASCACK VALLEY HOSPITAL | $100,114.48 | 50.4% | $50,489.98 | $33,659.99 | $268.20 | $33,391.79 | $11,687.13 | $11,687.13 |
| Hospital | APP0010849 | PASSAIC BETH ISRAEL HOSPITAL | $506,608.06 | 32.4% | $164,104.09 | $109,402.73 | $11,261.71 | $98,141.02 | $34,349.36 | $34,349.36 |
| Hospital | APP0009894 | POCONO HOSPITAL | $130.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Hospital | APP0010835 | PRESBYTERIAN ALLEN PAVILI | $5,512.00 | 70.6% | $3,892.90 | $2,595.27 | $0.00 | $2,595.27 | $908.34 | $0.00 |
| Hospital | APP0009490 | PRESBYTERIAN HOSPITAL | $125,918.82 | 9.9% | $12,491.10 | $8,327.40 | $0.00 | $8,327.40 | $2,914.59 | $2,914.59 |
| Hospital | APP0010857 | RAHWAY HOSPITAL | $121,774.46 | 58.0% | $70,683.60 | $47,122.40 | $4,408.46 | $42,713.94 | $14,949.88 | $14,949.88 |
| Hospital | APP0010867 | RARITAN BAY MEDICAL CENTER | $3,266,412.74 | 48.7% | $1,591,245.23 | $1,060,830.15 | $192,524.40 | $868,305.75 | $303,907.01 | $303,907.01 |
| Hospital | APP0010866 | ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | $1,901,207.79 | 37.9% | $721,168.15 | $480,778.77 | $69,573.44 | $411,205.33 | $143,921.87 | $143,921.87 |
| Hospital | APP0007683 | RWJUH AT HAMILTON | $50,347.44 | 22.6% | $11,353.93 | $7,569.29 | $0.00 | $7,569.29 | $2,649.25 | $2,649.25 |
| Hospital | APP0010792 | SHORE MEMORIAL HOSPITAL | $21,172.34 | 40.4% | $8,553.80 | $5,702.53 | $0.00 | $5,702.53 | $1,995.89 | $1,995.89 |
| Hospital | APP0009822 | SOMERSET MEDICAL CENTER | $41,884.45 | 63.9% | $26,765.04 | $17,843.36 | $59.04 | $17,784.32 | $6,224.51 | $6,224.51 |
| Hospital | APP0049472 | SOUTH FULTON MEDICAL CENTER | $3,770.45 | 100.0% | $3,770.45 | $2,513.63 | $0.00 | $2,513.63 | $879.77 | $0.00 |
| Hospital | APP0009837 | ST. CLARES HOSPITAL | $42,670.35 | 52.3% | $22,300.00 | $14,866.67 | $0.00 | $14,866.67 | $5,203.33 | $5,203.33 |
| Hospital | APP0010858 | ST. ELIZABETH HOSPITAL | $1,347,797.06 | 33.0% | $444,128.29 | $296,085.53 | $32,371.00 | $263,714.53 | $92,300.09 | $92,300.09 |
| Hospital | APP0009482 | ST. FRANCIS HOSPITAL | $265,644.99 | 65.3% | $173,574.48 | $115,716.32 | $92,337.63 | $23,378.69 | $8,182.54 | $8,182.54 |
| Hospital | APP0010258 | ST. JAMES HOSPITAL | $123,366.85 | 49.0% | $60,443.88 | $40,295.92 | $9,591.30 | $30,704.62 | $10,746.62 | $10,746.62 |
| Hospital | APP0010851 | ST. JOSEPH'S HOSPITAL | $15,091,000.01 | 30.5% | $4,608,393.04 | $3,072,262.03 | $1,133,555.40 | $1,938,706.63 | $678,547.32 | $678,547.32 |
| Hospital | APP0010788 | ST. MARY'S HOSPITAL | $325,253.88 | 86.1% | $279,992.24 | $186,661.49 | $175.00 | $186,486.49 | $65,270.27 | $65,270.27 |
| Hospital | APP0010853 | ST. MARY'S HOSPITAL (HOSP/CLIN) | $810,620.63 | 71.5% | $579,239.59 | $386,159.73 | $19,713.22 | $366,446.51 | $128,256.28 | $128,256.28 |
| Hospital | APP0010774 | ST. MICHAEL'S HOSPITAL | $528,424.51 | 27.5% | $145,356.41 | $96,904.27 | $13,212.20 | $83,692.07 | $29,292.22 | $29,292.22 |
| Hospital | APP0010869 | ST. PETER'S MEDICAL CENTER | $1,485,743.66 | 47.0% | $697,656.21 | $465,104.14 | $89,545.90 | $375,558.24 | $131,445.38 | $131,445.38 |
| Hospital | APP0010823 | ST. VINCENT MEDICAL CENTER | $563.00 | 11.0% | $62.00 | $41.33 | $0.00 | $41.33 | $14.47 | $0.00 |
| Hospital | APP0010784 | TAMPA GENERAL HOSPITAL | $554.00 | 22.6% | $125.00 | $83.33 | $0.00 | $83.33 | $29.17 | $0.00 |
| Hospital | APP0010816 | THE VALLEY HOSPITAL | $118,214.88 | 78.4% | $92,665.72 | $61,777.15 | $0.00 | $61,777.15 | $21,622.00 | $21,622.00 |
| Hospital | APP0010257 | UMDNJ/UNIVERSITY HOSPITAL | $1,033,019.08 | 88.9% | $918,625.04 | $612,416.69 | $90,172.35 | $522,244.34 | $182,785.52 | $182,785.52 |
| Hospital | APP0010264 | UNION HOSPITAL | $21,052.71 | 77.1% | $16,225.46 | $10,816.97 | $0.00 | $10,816.97 | $3,785.94 | $3,785.94 |
| Hospital | APP0049364 | WAYNE GENERAL HOSPITAL | $34,304.24 | 10.8% | $3,698.14 | $2,465.43 | $0.00 | $2,465.43 | $862.90 | $0.00 |
| Hospital | APP0010852 | WAYNE GENERAL HOSPITAL | $2,554,638.25 | 41.7% | $1,064,304.08 | $709,536.05 | $81,021.37 | $628,514.68 | $219,980.14 | $219,980.14 |
| Hospital | APP0009840 | WEST HUDSON HOSPITAL | $9,553.20 | 10.5% | $1,004.66 | $669.77 | $0.00 | $669.77 | $234.42 | $0.00 |
| TOTALS | $47,080,959.68 | $19,392,741.00 | $12,928,493.99 | $3,620,241.43 | $9,308,252.56 | $3,258,053.58 | $3,251,635.91 |