prov. num. - hosp.
electroencephalography
medial supplies charged to patients
drugs charged to patients
renal dialysis
asc (non-distinct part)
other ancillary
clinic
emergency
observation beds
other outpt. services
home program dialysis
durable medical equipment - rented
durable medical equipment - sold
other reimbursable costs
total medicare part a ancillary other
total medicare part a  ancillary other
drg payments - other than outliers
drg outlier payments
indirect medical education adjustment
disproportionate share adjustment
additional payment - high percentage e
subtotal of above lines
hosp. specific payments (sole communit
total payment for inpatient operating
payment for inpatient program capital
exceptive payment for inpatient progra
direct graduate medical education paym
net organ acquisition cost
cost of teaching physicians
medicare part a inpatient routine serv
medicare part a ancillary service othe
total payments (lines 8 -15)
primary payer payments
total amount payable for program benef
deductibles billed to program benefici
coinsurance billed to program benefici
reimbursable bad debts
'subtotal (line 18 plus line 21, minus
recovery of excess depreciation
other adjustments
amounts applicable to prior cost
amount due provider
sequestration adjustment
interim payments
balance due provider (program)
protested amounts
medical and other services
interns & residents
organ acquisition costs
total costs
total customary charges
lesser of cost or charges
deductibles and coinsurance
'sum of worksheets e, parts c, d, and
esrd direct medical education costs
composite rate esrd bad debts
all other bad debts
recovery of excess depreciation from p
amounts applicable to prior reporting
asc portion of blend
hosp. specific portion of blend
asc blended amount (line 5 plus line 1
asc reimbursement (lesser of line 16 o
blended charge proportion
cost proportion
outpt. radiology blended amount (line
outpt. radiology reimbursement (lesser
other outpt. diagnostic blended amount
other outpt. diagnostic reimbursement
inpatient hosp. services
organ acquisition
sum of lines 1-3
deductibles
coinsurance
reimbursable bad debts (bad debts for
direct graduate medical education
total amount payable to provider
inpatient services
excess of customary charges over reaso
excess of reasonable cost over customa
cost of covered services
recovery of excess depreciation result
'subtotal (line 26, plus or minus line
number of fte residents for ob/gyn and
number of fte residents for all other
updated per resident amount for ob/gyn
updated per resident amount for all ot
aggregate approved amount
cash on hand and in banks
temporary investments
notes receivable
accounts receivable
other receivables
allowance for uncollectible notes and
inventory
prepared expenses
other current assets
due from other funds
total current assets - facility
land
accumulated depreciation
land improvements
buildings
leasehold improvements
fixed equipment
automobiles and trucks
major movable equipment
minor depreciable equipment
minor nondepreciable equipment
total fixed assets - facility
investments
deposits on leases
due from owners/officers
other assets
total other assets
total assets - facility
accounts payable
'salaries, wages, and fees payable'
payroll taxes payable
notes and loans payable
deferred income
accelerated payments
due to other funds
other current liabilities
total current liabilities - facility
mortgage payable
notes payable
unsecured loans
loans from owners prior to 7/1/66
loans from owners on or after 7/1/66
other long term liabilities
total long term liabilities
total liabilities - facility
general fund balance
specific purpose fund
donor endowment fund - restricted
donor endowment fund - unrestricted
governing body created - endowment fun
plant fund balance - invested in plant
'plant fund balance - reserved for pla
total fund balances  - facility
total liabilities and fund balances -
hosp.
sub. prov. i
sub. prov. ii
swing bed snf
swing bed nf
skilled nursing facility
nursing facility
other long term care
total general inpatient care - facilit
icu
coronary care unit
burn icu
surgical icu
other special care unit
total intensive care type inpatient ho
total inpatient routine care services
inpatient ancillary services
outpt. ancillary services
outpt. services rendered in an inpatie
outpt. services
home health agency - outpt.
ambulance - inpatient
ambulance - outpt.
outpt. rehabilitation provider - corf
outpt. rehabilitation provider - cmhc
outpt. rehabilitation provider - opt
outpt. rehabilitation provider - oot
outpt. rehabilitation provider - osp
asc inpatient
asc outpt.
hospice inpatient
hospice outpt.
all other inpatient revenue
all other outpt. revenue
total patient revenue - inpatient   -
total patient revenue - outpt.  -  fac
total patient revenue
less:  contractual allowances and disc
net patient revenues
less:  total operating expenses
net income from service to patients
'contributions, donations, etc.'
income from investments
governmental appropriations
total other income
total (line 5 plus line 25)
total other expenses
net income or (loss) for period  (line
capital hosp. specific rate payments
capital drg other than outlier
capital drg outlier payments
total inpatient days divided by number
number of interns and residents
indirect medical education percentage
percentage of ssi recipient patient da
percentage of medicaid patient days to
sum of f2154 + f2155
allowable disproportionate share perce
new capital
old capital
total capital
ratio of old capital to new capital
total capital payments under 100% fede
reduction factor for hold harmless pay
reduced old capital amount
hold harmless payment for new capital
subtotal (f2166 + f2167)
payment under hold harmless
program inpatient routine capital cost
program inpatient ancillary capital co
total inpatient program capital cost
capital cost payment factor
program inpatient capital costs for ex
net program inpatient capital costs
applicable exception percentage
capital cost for comparison to payment
percentage adjustment for extraordinar
adjustment to capital minimum payment
capital minimum payment level
current year capital payments
current year comparison of capital min
carryover of accumulated capital minim
net comparison of capital minimum paym
current year exception payment