08-99,,,,,,,FORM CMS 1728-94,,,,,,3290 (Cont.)
COMPENSATION ANALYSIS,,,,,,,,   PROVIDER NO.:,,     PERIOD:,,,
SALARIES AND WAGES,,,,,,,,    _______________,,From:  ___________,, WORKSHEET A-1,
,,,,,,,, ,,To: ___________,,,
,,,,ADMINIS-,,,,,,,ALL,TOTAL,
,,,,TRATORS,DIRECTORS,CONSULTANTS,SUPERVISORS,NURSES,THERAPISTS,AIDES,OTHER,(1),
,,,,1,2,3,4,5,6,7,8,9,
,   GENERAL SERVICE COST CENTER,,,,,,,,,,,,
 1, Capital Related - Bldg. and Fixtures,,,,,,,,,,,, 1
 2, Capital Related - Movable Equipment,,,,,,,,,,,, 2
 3, Plant Operation & Maintenance,,,,,,,,,,,, 3
 4, Transportation (See Instructions),,,,,,,,,,,, 4
 5, Administrative and General,,,,,,,,,,,, 5
,   HHA REIMBURSABLE SERVICES,,,,,,,,,,,,
 6, Skilled Nursing Care,,,,,,,,,,,, 6
 7, Physical Therapy,,,,,,,,,,,, 7
 8, Occupational Therapy,,,,,,,,,,,, 8
 9, Speech Pathology,,,,,,,,,,,, 9
10, Medical Social Services,,,,,,,,,,,,10
11, Home Health Aide,,,,,,,,,,,,11
12, Supplies ,,,,,,,,,,,,12
13,Drugs,,,,,,,,,,,,13
14,DME,,,,,,,,,,,,14
,   HHA NONREIMBURSABLE SERVICES,,,,,,,,,,,,
15, Home Dialysis Aide Services,,,,,,,,,,,,15
16, Respiratory Therapy,,,,,,,,,,,,16
17, Private Duty Nursing,,,,,,,,,,,,17
18, Clinic,,,,,,,,,,,,18
19, Health Promotion Activities,,,,,,,,,,,,19
20, Day Care Program,,,,,,,,,,,,20
21, Home Delivered Meals Program,,,,,,,,,,,,21
22,Homemaker Service,,,,,,,,,,,,22
23,Other,,,,,,,,,,,,23
,   SPECIAL PURPOSE COST CENTERS,,,,,,,,,,,,
24,CORF,,,,,,,,,,,,24
25,Hospice,,,,,,,,,,,,25
26,CMHC,,,,,,,,,,,,26
27,RHC,,,,,,,,,,,,27
28,FQHC,,,,,,,,,,,,28
29, Total,,,,,,,,,,,,29
,," (1) Transfer the amounts in column 9 to Wkst. A, column 1",,,,,,,,,,,
,,,,,,,,,,,,,
"FORM CMS-1728-94-A-1  (12-1994)  (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SEC. 3207)",,,,,,,,,,,,,
,,,,,,,,,,,,,
Rev. 7,,,,,,,,,,,,,32-309