User Guide for the Cost Data Collection Instrument

Lease/Mortgage Costs 

Annual depreciation  (if owned & no  mortgage) 

Facility  ID/Function Lease or rental costs 

Mortgage & interest  costs 

Facility 1  Facility 2  Facility 3  Etc. 

*For agencies that have a parent organization, you will need to track and allocate to your NPI the portion of  other facilities costs incurred at the level of the parent organization, e.g. regional buildings or service facilities  serving multiple NPIs, based on your organizational approach for allocating costs to specific NPIs.     Total costs in this context includes costs paid by another organization or entity on your behalf and  includes costs for facilities that were partially related to your ground ambulance operations.     Do not include facilities that were donated or exceptions for which there was no cost.   Be mindful not to include these interest costs elsewhere. 

Insurance, Maintenance, Utilities & Taxes 

Expenditure 

Amount 

Total facilities‐related insurance costs  Total facilities maintenance/improvement  Total facilities utilities costs  Total facilities taxes 

*For agencies that have a parent organization, you will need to track and allocate to your NPI the portion of  other facilities costs incurred at the level of the parent organization, e.g. regional buildings or service facilities  serving multiple NPIs, based on your organizational approach for allocating costs to specific NPIs.     Total costs includes costs paid by another organization or entity on your behalf.   Total costs includes costs for facilities that were partially related to your ground ambulance operations.  

 Total costs does not include donations or exceptions for which there was no cost.   Do not include labor costs if said labor costs were already included in labor section.    Do not include any taxes if included in the mortgage section.

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