Facility Name __________________________ VPN or Provider ID_______________ Balance Sheet Date (MO-DA-YR) ______________________ 2014 HCF-4 SCHEDULE 29: DETAIL OF EMPLOYEE WAGES AND BENEFITS PART 2 (1) (2) (3) (4) (5) (6) (7) (8) Number of FTE’s* (Round to one decimal Number Total Group Life/ Positions place) of Staff Hours Total Salaries Health Benefits Pensions Other Benefits Administrator (7124.2) (7224.2) (7324.2) (4110.1) (7424.2) (7524.2) (7624.2) Officer (7125.2) (7225.2) (7325.2) (4125.1) (4426.2) (7525.2) (7625.2) Clerical Staff (7126.2) (7226.2) (7326.2) (4140.1) (7426.2) (7526.2) (7626.2) RNs (7129.2) (7229.2) (7329.2) (6030.1) (7429.2) (7529.2) (7629.2) LPNs (7130.2) (7230.2) (7330.2) (6041.1) (7430.2) (7530.2) (7630.2) Nurses Aides (7131.2) (7231.2) (7331.2) (6051.1) (7431.2) (7531.2) (7631.2) *See Instructions 2014 HCF-4 Page 31
Facility Name __________________________ VPN or Provider ID_______________ Balance Sheet Date (MO-DA-YR) ______________________ 2014 HCF-4 SCHEDULE 29: DETAIL OF EMPLOYEE WAGES AND BENEFITS PART 2 (1) Positions (2) Number of FTE’s* (Round to one decimal place) (3) Number of Staff (4) Total Hours (5) Total Salaries (6) Group Life/ Health Benefits (7) Pensions (8) Other Benefits Administrator (7124.2) (7224.2) (7324.2) (4110.1) (7424.2) (7524.2) (7624.2) Officer (7125.2) (7225.2) (7325.2) (4125.1) (4426.2) (7525.2) (7625.2) Clerical Staff (7126.2) (7226.2) (7326.2) (4140.1) (7426.2) (7526.2) (7626.2) RNs (7129.2) (7229.2) (7329.2) (6030.1) (7429.2) (7529.2) (7629.2) LPNs (7130.2) (7230.2) (7330.2) (6041.1) (7430.2) (7530.2) (7630.2) Nurses Aides (7131.2) (7231.2) (7331.2) (6051.1) (7431.2) (7531.2) (7631.2) *See Instructions 2014 HCF-4 Page 31
2014-HCF-4.docx