2003 GME SURCHARGES / ASSESSMENTS

REGION COUNTIES 2003 INDIVIDUAL COVERED LIVES ANNUAL ASSESSMENT 2003 FAMILY COVERED LIVES ANNUAL ASSESSMENT 2003 ALTERNATIVE PER UNIT OF PYMT SURCHARGE* For Inpatient Services Provided January 1, 2003 - June 30, 2003 ∗ 2003 ALTERNATIVE PER UNIT OF PYMT SURCHARGE* For Inpatient Services Provided July 1, 2003 - December 31, 2003
New York City Bronx
Kings
New York
Queens
Richmond
$100.52 $331.73 24.94% 26.98%
Long Island Nassau
Suffolk
$ 34.49 $113.82 12.69% 13.73%
Northern Metro Columbia
Delaware
Dutchess
Orange
Putnam
Rockland
Sullivan
Ulster
Westchester
$ 19.71 $ 65.03 8.51% 9.21%
Northeastern Albany
Clinton
Essex
Fulton
Greene
Montgomery
Rensselaer
Saratoga
Schenectady
Schoharie
Warren
Washington
$ 22.68 $ 74.84 7.70% 8.33%
Utica/Watertown Chenango
Franklin
Hamilton
Herkimer
Jefferson
Lewis Madison
Oneida
Oswego
Otsego
St. Lawrence
$ 5.61 $ 18.53 2.05% 2.22%
Central Broome
Cayuga
Chemung
Cortland
Onondaga
Schuyler
Steuben
Tioga
Tompkins
$ 27.19 $ 89.72 8.74% 9.46%
Rochester Livingston
Monroe
Ontario
Seneca
Wayne
Yates
$ 55.67 $183.71 17.02% 18.41%
Western Allegany
Cattaraugus
Chautauqua
Erie
Genesee
Niagara
Orleans
Wyoming
$ 19.87 $ 65.56 6.19% 6.70%

∗ This would be in addition to the surcharges reflected in Attachment 4.