• Hospital Name:
• Preparer's First Name:  
• Preparer's Last Name:  
• Email Address:    

When entering dollar amounts, please enter only numbers, and a decimal if necessary.
Please omit dollar signs and commas.

• Patient billings for inpatients and outpatients at the established rates

  Gross Charges:  

• Write-offs and estimated allowances for the difference between Gross Charges and estimated payments on Charity accounts, accounts that cannot be collected because of an inability to pay

  Charity Allowances:  

• Gross charges less contractual allowances and charity allowances. Does not include Premium revenues

  Net Patient Revenue:  

• Total unrestricted revenues, gains and other support. Includes net patient revenue, premium revenue gifts for restricted operating activities, other operating revenue

  Total Operating Revenues:  

• Salaries and Wages for employees, as defined by the IRS

  Salaries and Wages:  

• All employee benefit expenses including payroll taxes, pension expenses, tuition and/or education expenses, health, life and dental insurance, etc.

  Employee Benefits:  

• Interest expenses on all outstanding debt

  Interest:  

• Depreciation and amortization of assets calculated in accordance with GAAP should be included in this category

  Depreciation & Amortization:  

• Gross charges written off for care rendered to patients who after study will not pay. Recorded as an expense.

  Bad Debts:  

• All other expenses

  Other Expenses:  

• Total operating expenses including interest, depreciation and amortization

  Total Expenses:

• Total Operating Revenues minus Expenses, this line is computed be subtracting expenses from operating revenues

  Operating Income:

• All unrestricted items not included in Operations, including investment income and unrestricted contributions

  Non-Operating Income:  

• Operating Income plus or minus Nonoperating Revenue/Expenses

  Excess of Revenue over Expenses:

• Unrestricted cash, short term investments, investments in liquid equity investments, includes Assets limited as to use that are internally restricted (not monies held by trustee, such as Bond Reserve Funds and other debt service funds)

  Cash & Investments:  

• Gross accounts receivable less any related allowances

  Net Accounts Receivable:  

• Liquid assets as defined by GAAP

  Current Assets:  

• Short term liabilities as defined by GAAP

  Current Liabilities:  

• Long term debt as defined by GAAP

  Long Term Debt:  

• Unrestricted net assets as defined by GAAP// Also called Stockholders' Equity

  Unrestricted Net Assets (Stockholder Equity):  

• All accumulated depreciation that has been recorded to date, please do not show as a negative

  Accumulated Depreciation:  

• Adult and pediatric patient discharges computed in accordance with Medicare Guidelines

  Patient Discharges:  

• Adult and pediatric patient days computed in accordance with Medicare Guidelines

  Patient Days:  

• All emergency room, urgent care, and trauma visits

  ED Visits:  

• Include all live births, including cesarean deliveries

  Births:  

• Include all FTE's, included in the salary expense line whether employed or not. An FTE represents 2080 paid hours

  FTE's:  

• Include employed RN's who provide direct patient care. An FTE represents 2080 paid hours

  RN FTE's:  

• Unfilled FTE's at the end of the reporting period divided by unfilled FTE's plus filled FTE's

  Vacancy Rate:

• The number of FTE's leaving annualized (for quarterly data multiply by 4) divided by the average number of FTE's

  Turnover Rate: