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num. - hosp.prov. num. - sub. prov.prov. num. - sub. prov. iiprov. num. - swing bed snfprov. num. - swing bed nfprov. num. - hosp.-based snfprov. num. - hosp.-based nfprov. num. - hosp.-based icf/mrprov. num. - hosp.-based hha iprov. num. - separately certified ascprov. num. - hosp.-based hospice iprov. num. - hosp.-based rhc iprov. num. - hosp.-based fqhc iprov. num. - outpt. corf iprov. num. - outpt. cmhc iprov. num. - opt facility iprov. num. - oot facility iprov. num. - osp facility isat. num. - renal dialysis ihosp. namemanual cost report indicator (m=manualhosp. title xviii payment systemsub. prov. i title xviii payment systesub. prov. ii title xviii payment systcost reporting period begin date (ccycost reporting period end date (ccynumber of months in reporting periodtype of control (see table i)type of hosp. (see table ii)type of sub. prov. i (see table ii)type of sub. prov. ii (see table ii)is hosp. (1) urban (2) rural?does this facility qualify and is curris hosp. classified as referral centerdoes hosp. operate transplant center?kidney transplant center (ccyymmddheart transplant center (ccyymmdliver transplant center (ccyymmlung transplant center (ccyymmdpancreas transplant center (ccyymmdd)if this is an organ procurement organiis this a teaching hosp. or affiliated'if a sole community hosp. (sch), 'sch beginning date of first period (ccsch ending date of first period (ccyymsch beginning date of second period (csch ending date of second period (ccyydoes hosp. have an agreement for swing'if f42 is yes, enter swing bed agreemdoes facility have hosp.-based snf whi'is this a rural hosp. with a certifie'if f45 is yes, enter snf prov. num. 'does hosp. qualify as a rural primary'if the hospital is a rpch, is this th'if a rpch, is the all-inclusive methois hosp. a rural hosp. qualifying foris hosp. an all-inclusive provider? (y'if hosp. is an all-inclusive provideris this a new hosp. under 42 cfr 412.3is this a new hosp. under 42 cfr 413.4has a new sub. prov. been established?do you elect fully pps methodology fordoes this facility qualify and receivedo you elect hold harmless payment'if hold harmless provider, are you ondo you have title xix inpatient servicare title xix nf patients occupying tidoes this facility operate an icf/mr fare there any related organization orare provider based physician costs incare physical therapy services providedare occupational therapy services provare speech therapy services provided bare respiratory therapy services provi'if costs for renal services are on woif participating in the nhcmq demonstrdoes this hospital claim expenditures'if this is a medicare dependent hosp.mdh beginning date of first period (cmdh ending date of first period (ccyymdh beginning date of second period (mdh ending date of second period (ccymalpractice premiumsmalpractice paid lossesmalpractice self insuranceare malpractice premiums and paid lossdoes your facility qualify for additioare you claiming ambulance costs? (y/n'if you are claiming ambulance costs,'if you are claiming ambulance costs,'if you are claiming ambulance costs ifile creation date (ccyymmdd) (see nosystem identification (see note 10 onssa state code (see table iii)msa/necma codefiscal intermediary numbercost report status (see table iv)'medicare utilization indicator (l, n,census division (see table v)hcfa region (see table vi)was this cost report filed using transhosp. adults & pediatrics beds (see noicu bedscoronary care unit bedsburn icu bedssurgical icu bedsother special care bedsnursery bedstotal hosp. bedssub. prov. i bedssub. prov. ii bedsskilled nursing facility bedsnursing facility bedsintermediate care facility/mental retaother long term care bedshospice bedstotal beds available in facilityhosp. adults & pediatrics bed days avaintensive care bed days availablecoronary care bed days availableburn intensive care bed days availablesurgical intensive care bed days availother special care bed days availablenursery bed days availabletotal hosp. bed days availablesub. prov. i bed days availablesub. prov. ii bed days availableskilled nursing facility bed days avainursing facility bed days availableintermediate care facility/mental retaother long term care bed days availablhospice bed days availablemedicare hosp. adults & pediatrics daytitle xviii inpatient days (hmo)medicare swing bed snf daystotal medicare routine daysmedicare icu daysmedicare coronary care unit daysmedicare burn icu daysmedicare surgical icu daysmedicare other special care unit daysmedicare inpatient days- total hosp.medicare rpch visitsmedicare sub. prov. i daysmedicare sub. prov. ii daysmedicare skilled nursing facility daysmedicare home health agency visitsmedicare hospice daysmedicare rhc/fqhc outpt. visitsambulance tripsmedicaid hosp. adults & pediatrics daymedicaid hmo daysmedicaid swing bed snf daysmedicaid swing bed nf daystotal medicaid routine daysmedicaid icu daysmedicaid coronary care unit daysmedicaid burn icu daysmedicaid surgical icu daysmedicaid other special care daysmedicaid nursery daysmedicaid inpatient days- total hosp.medicaid rpch visitsmedicaid sub. prov. i daysmedicaid sub. prov. ii daysmedicaid skilled nursing facility daysmedicaid nursing facility daysintermediate care facility/mental retamedicaid home health agency visitsmedicaid hospice daysmedicaid rhc/fqhc outpt. visitstotal adults & pediatrics daystotal swing bed snf daystotal swing bed nf daystotal routine daystotal icu daystotal coronary care unit daystotal burn icu daystotal surgical icu daystotal other special care unit daystotal nursery daystotal inpatient days - hosp.total rpch visitstotal sub. prov. i daystotal sub. prov. ii daystotal skilled nursing facility daystotal nursing facility daystotal intermediate care facility/mentatotal other long term daystotal home health agency visitstotal hospice daystotal rhc/fqhc outpt. visitstotal observation bed daystotal observation bed days (off site semployee discount daysinterns & residents - total hosp.interns & residents - total facilitynet interns & residents replacing non-net interns & residents replacing non-full time employees - total hosp.full time employees - total facilitynonpaid workers - total hosp.nonpaid workers - total facilitymedicare discharges - total hosp.medicare sub. prov. i dischargesmedicare sub. prov. ii dischargesmedicaid discharges - total hosp.medicaid sub. prov. i - dischargesmedicaid sub. prov. ii - dischargestotal discharges - all patients - hosptotal discharges - all patients - sub.total discharges - all patients - sub.total salariesnon-physician anesthetist part anon-physician anesthetist part bphysician - part ateaching physicianphysician - part binterns & residents (approved program)home office personnelskilled nursing facilityexcluded areascontract laborpharmacy services under contractlaboratory services under contractcontract labor: physician - part ateaching physician under contracthome office salaries & wage-related cohome office: physician part asalaries and wage related costs for tewage- related costs (core)wage- related costs (other)excluded areasnon-physician anesthetist - part anon-physician anesthetist - part bphysician part apart a teaching physiciansphysician part binterns & residents (approved program)employee benefitsadministrative & generalmaintenance & repairsoperation of plantlaundry & linen servicehousekeepingdietarycafeteriamaintenance of personnelnursing administrationcentral services & supplypharmacymedical records & medical records librsocial serviceother general servicetotal salariesnon-physician anesthetist part anon-physician anesthetist part bphysician - part ateaching physicianphysician - part binterns & residents (approved program)home office personnelskilled nursing facilityexcluded areascontract laborpharmacy services under contractlaboratory services under contractcontract labor: physician - part ateaching physician under contracthome office salaries & wage-related cohome office: physician part asalaries and wage related costs for tewage- related costs (core)wage- related costs (other)excluded areasnon-physician anesthetist - part anon-physician anesthetist - part bphysician part apart a teaching physiciansphysician part binterns & residents (approved program)employee benefitsadministrative & generalmaintenance & repairsoperation of plantlaundry & linen servicehousekeepingdietarycafeteriamaintenance of personnelnursing administrationcentral services & supplypharmacymedical records & medical records librsocial serviceother general servicepaid hours related to adjusted salarienon-physician anesthetist part anon-physician anesthetist part bphysician - part ateaching physicianphysician - part binterns & residents (approved program)home office personnelskilled nursing facilityexcluded areascontract laborpharmacy services under contractlaboratory services under contractcontract labor: physician - part ateaching physician under contracthome office salaries & wage-related cohome office: physician part asalaries and wage related costs for teemployee benefitsadministrative & generalmaintenance & repairsoperation of plantlaundry & linen servicehousekeepingdietarycafeteriamaintenance of personnelnursing administrationcentral services & supplypharmacymedical records & medical records librsocial serviceother general serviceaverage hourly wage related to total anon-physician anesthetist part anon-physician anesthetist part bphysician - part ateaching physicianphysician - part binterns & residents (approved program)home office personnelskilled nursing facilityexcluded areascontract laborpharmacy services under contractlaboratory services under contractcontract labor: physicians part ateaching physician under contracthome office salaries & wage related cohome office: physician part asalaries and wage related costs for teemployee benefitsadministrative & generalmaintenance & repairsoperation of plantlaundry & linen servicehousekeepingdietarycafeteriamaintenance of personnelnursing administrationcentral services & supplypharmacymedical records & librarysocial servicesother general servicenet salariesexcluded area salariessubtotal salariessubtotal other wages & related costssubtotal wage-related coststotal (sum of lines 3-5)net salariesexcluded area salariessubtotal salaries (line 7 minus line 8subtotal - other wages & related costssubtotal wage related coststotal (sum of lines 9-11)total overhead costsnet salariesexcluded area salariessubtotal salariessubtotal other wages & related costssubtotal wage-related coststotal (sum of lines 3-5)net salariesexcluded area salariessubtotal salaries (line 7 minus linesubtotal - other wages & related costssubtotal wage related coststotal (sum of lines 9-11)total overhead costsnet salariesexcluded area salariessubtotal salariessubtotal other wages & related costssubtotal wage-related coststotal (sum of lines 3-5)net salariesexcluded area salariessubtotal salaries (line 7 minus line 8subtotal - other wages & related costssubtotal wage related coststotal (sum of lines 9-11)total overhead costsnet salariesexcluded area salariessubtotal salariessubtotal other wages & related costssubtotal wage-related coststotal (sum of lines 3-5)net salariesexcluded area salariessubtotal salaries (line 7 minus line 8subtotal - other wages & related costssubtotal wage related coststotal (sum of lines 9-11)total overhead costsemployee benefitsadministrative & generalmaintenance & repairsoperation of plantlaundry & linen servicehousekeepingdietarycafeteriamaintenance of personnelnursing administrationcentral services & supplypharmacymedical records & medical records librsocial serviceother general servicenonphysician anesthetistsnursing schoolinterns & residents in approved prograinterns & residents in approved prog -paramedical education programadults & pediatrics - (general routineicucoronary care unitburn icusurgical icuother special caresub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facility/mental retaother long term careoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorywhole blood & packed red blood cells'blood storing, processing, & trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectrocephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencydistinct observation bed unitother outpt. servicesrural health clinicfederally qualified health centerhome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursableoutpt. rehabilitation provider - corfoutpt. rehabilitation provider -cmhcoutpt. rehabilitation provider - optoutpt. rehabilitation provider - ootoutpt. rehabilitation provider - ospinterns & residents (non approved proghome health agencylung acquisitionkidney acquisitionliver acquisitionheart acquisitionpancreas acquisitionother organ acquisitionutilization review - snfasc (distinct part)hospiceother special purposenon-reimbursable cost centerstotal salaries - facilityold capital-related costs - buildingsold capital-related costs - movable eqnew capital-related costs - buildingsnew capital-related costs - movable eqemployee benefitsadministrative & generalmaintenance & repairsoperation of plantlaundry & linen servicehousekeepingdietarycafeteriamaintenance of personnelnursing administrationcentral services & supplypharmacymedical records & medical records librsocial serviceother general servicenonphysician anesthetistsnursing schoolinterns & residents - salaries & fringinterns & residents - other program coparamedical education programadults & pediatrics - (general routineicucoronary care unitburn icusurgical icuother special caresub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facility/mental retaother long term careoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical laboratory service (progrwhole blood & packed red blood cells'blood storing, processing, & trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectrocephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencydistinct observation bed unitother outpt. servicesrural health clinicfederally qualified health centerhome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursableoutpt. rehabilitation provider - corfoutpt. rehabilitation provider -cmhcoutpt. rehabilitation provider - optoutpt. rehabilitation provider - ootoutpt. rehabilitation provider - ospinterns & residents (non approved proghome health agencylung acquisitionkidney acquisitionliver acquisitionheart acquisitionpancreas acquisitionother organ acquisitioninterest expenseutilization review - snfother capital-related costsasc (distinct part)hospiceother special purposenonreimbursable cost centerstotal other costs - facilityold capital-related costs - buildingsold capital-related costs - movable eqnew capital-related costs- buildingsnew capital-related costs - movable eqemployee benefitsadministrative & generalmaintenance & repairsoperation of plantlaundry & linen servicehousekeepingdietarycafeteriamaintenance of personnelnursing administrationcentral services & supplypharmacymedical records & medical records librsocial serviceother general servicenonphysician anesthetistsnursing schoolinterns & residents - salaries & fringinterns & residents - other program coparamedical education programadults & pediatrics - (general routineicucoronary care unitburn icusurgical icuother special caresub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facility/mental retaother long term careoperating roomrecovery roomdelivery room and labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, & trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencydistinct observation bed unitother outpt. servicesrural health clinicfederally qualified health centerhome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursableoutpt. rehabilitation provider - corfoutpt. rehabilitation provider - cmhcoutpt. rehabilitation provider - optoutpt. rehabilitation provider - ootoutpt. rehabilitation provider - ospintern & resident service (non-approvehome health agencylung acquisitionkidney acquisitionliver acquisitionheart acquisitionpancreas acquisitionother organ acquisitionasc (distinct part)hospiceother special purposenonreimbursable cost centerstotal cost before allocation - facilitnonphysician anesthetistsnursing schoolinterns & residents - salary & fringesinterns & residents - program costs (aparamedical educationadults & pediatrics - (general routineicucoronary care unitburn icusurgical icuother special caresub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facility/mental retaother long term careoperating roomrecovery roomdelivery room and labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, & trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencydistinct observation bed unitother outpt. servicesrural health clinicfederally qualified health centerhome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursableoutpt. rehabilitation provider - corfoutpt. rehabilitation provider - cmhcoutpt. rehabilitation provider - optoutpt. rehabilitation provider - ootoutpt. rehabilitation provider - ospinterns & residents service (non-approhome health agencylung acquisitionkidney acquisitionliver acquisitionheart acquisitionpancreas acquisitionother organ acquisitionasc (distinct part)hospiceother special purposenonreimbursable cost centerscross foot adjustmentsnegative cost centerstotal costs - facilityrespiratory therapy limit adjustmentphysical therapy limit adjustmentoccupational therapy limit adjustmentspeech pathology therapy limit adjustmadults & pediatrics - (general routineicucoronary care unitburn icusurgical icuother special caresub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facility/mental retaother long term careoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bed unitdistinct observation bedsother outpt. servicesrural health centerfederally qualified health centerhome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursable costssubtotalless: observation bedstotal costs - facility (line 101 minustotal capital reduction - facilityinpatient capital reduction factoroutpt. capital reduction factortotal operating cost reduction - faciloutpt. operating cost reduction factoradults & pediatrics - (general routineicucoronary care unitburn icusurgical icuother special caresub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facility/mental retaother long term careoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursable costsoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursable costsoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab serviceswhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicerhcfqhchome program dialysisdurable medical equipment - renteddurable medical equipment - soldother reimbursable costsoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulance servicesdurable medical equipment - renteddurable medical equipment - soldother reimbursable costsadults & pediatrics - (general routineicucoronary care unitburn icusurgical icuother special care unitoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicerhcfqhchome program dialysisdurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal medicare part a ancillary chargenet medicare part a ancillary chargesoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicerhcfqhchome program dialysisdurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal medicare part a costs - hosp.total swing-bed costgeneral inpatient routine servicegeneral inpatient routine service costgeneral inpatient routine serviceicu - medicare costcoronary care unit - medicare costburn icu - medicare costsurgical icu - medicare costother special care unit - medicare cosmedicare inpatient ancillary'total medicare inpatient operating copass through costs - program inpatientpass through costs - program inpatienttotal program excludable coststotal program inpatient operating costtefra target amount per dischargetarget amountdifference between target amount andincentive / bonus paymentrelief paymentinpatient cost plus incentive paymentoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisdurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal medicare part a ancillary costsgeneral inpatient routine service costgeneral inpatient routine service costtotal program general inpatient routinmedicare inpatient ancillary costtotal medicare inpatient operating cospass through costs - program inpatientpass through costs - program inpatienttotal program excludable coststotal program inpatient operating costtefra target amount per dischargetarget amountdifference between target amount andincentive / bonus paymentrelief paymentinpatient cost plus incentive paymentoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisdurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal medicare part a ancillary costsgeneral inpatient routine service costgeneral inpatient routine service costtotal program general inpatient routinmedicare inpatient ancillary costtotal medicare inpatient operating cospass through costs - program inpatientpass through costs - program inpatienttotal program excludable coststotal program inpatient operating costtefra target amount per dischargetarget amountdifference between target amount andincentive / bonus paymentrelief paymentinpatient cost plus incentive paymentoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna chargestotal asc medicare part b charges - hooperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal asc medicare part b charges - hooperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcrhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal asc medicare part b charges - hooperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna chargespbp other part b chargestotal other medicare part b charges -operating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna chargespbp clinical lab chargestotal other medicare part b charges -operating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna chargespbp clinical lab chargestotal other medicare part b chargesoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna coststotal asc medicare part b charges - hooperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal asc medicare part b charges - hooperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal asc medicare part b charges - hooperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna coststotal other medicare part b costs - hooperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna coststotal other medicare part b costs - suoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorypbp clinical lab services (program onlwhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costscrna coststotal other medicare part b costs - sulandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal assets - facilitylandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal purchases - facilitylandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal donations - facilitylandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal disposals & retirements - facililandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal fully depreciated assets - facillandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal assets - facilitylandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal purchases - facilitylandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal donations - facilitylandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal disposals & retirements facilitylandland improvementsbuildings and fixturesbuilding improvementsfixed equipmentmovable equipmentsubtotaltotal fully depreciated assets - facilold capital-related cost - building &old capital-related cost - movable equnew capital-related cost - building &new capital-related cost - movable equtotal insurance costs - facilityold capital-related cost - building &old capital-related cost - movable equnew capital-related cost - building &new capital-related cost - movable equtotal taxes - facilityold capital-related cost - building &old capital-related cost - movable equnew capital-related cost - building &new capital-related cost - movable equtotal other capital-related costs - faold capital-related cost - building &old capital-related cost - movable equnew capital-related cost - building &new capital-related cost - movable equtotal depreciation - facilityold capital-related cost - building &old capital-related cost - movable equnew capital-related cost - building &new capital-related cost - movable equtotal lease costs - facilityold capital-related cost - building &old capital-related cost - movable equnew capital-related cost - building &new capital-related cost - movable equtotal interest costs - facilityold capital-related cost - building &old capital-related cost - movable equnew capital-related cost - building &new capital-related cost - movable equtotal capital-related costs - facilitytotal directly assigned old capital readults and pediatrics (general routineicucoronary care unitburn icusurgical icuother special care unitsub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facilityother long term careoperating roomrecovery roomdelivery room and labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorywhole blood and packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencydistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costsoutpt. rehabilitation providers (totalintern - resident service (not in apprhome health agencylung acquisitionkidney acquisitionliver acquisitionheart acquisitionpancreas acquisitionother organ acquisitionambulatory surgical center (distinct phospiceother special purposenonreimbursable costscross foot adjustmentsnegative cost centerstotal old capital related costs - facitotal directly assigned new capital readults & pediatrics (general routine cicucoronary care unitburn icusurgical icuother special care unitsub. prov. isub. prov. iinurseryskilled nursing facilitynursing facilityintermediate care facilityother long term careoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorywhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedical supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencydistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisambulancedurable medical equipment - renteddurable medical equipment - soldother reimbursable costsoutpt. rehab providers (total)intern - resident service (not in apprhome health agencylung acquisitionkidney acquisitionliver acquisitionheart acquisitionpancreas acquisitionother organ acquisitionambulatory surgical centerhospiceother special purposenonreimbursable costscross foot adjustmentsnegative cost centerstotal new capital related costs - faciadults & pediatrics (general routine cicucoronary care unitburn icusurgical icuother special care unitsub. prov. isub. prov. iinurserytotal medicare part a inpatient routinadults & pediatrics (general routine cicucoronary care unitburn icusurgical icuother special care unitsub. prov. isub. prov. iinurserytotal medicare a inpatient routine newoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorywhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedial supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisdurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal medicare part a ancillary old caoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorywhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiologyelectroencephalographymedial supplies charged to patientsdrugs charged to patientsrenal dialysisasc (non-distinct part)other ancillaryclinicemergencynon distinct observation bedsdistinct observation bed unitother outpt. servicesrhcfqhchome program dialysisdurable medical equipment - renteddurable medical equipment - soldother reimbursable coststotal medicare part a ancillary new catotal medicare part a ancillary old ctotal medicare part a ancillary new ctotal medicare part a ancillary old ctotal medicare part a ancillary new cadults & pediatrics (general routine cicucoronary care unitburn icusurgical icuother special care unitsub. prov. isub. prov. iinurserysnfnficf/mrtotal medicare part a inpatient routinoperating roomrecovery roomdelivery room & labor roomanesthesiologyradiology - diagnosticradiology - therapeuticradioisotopelaboratorywhole blood & packed red blood cells'blood storing, processing, trans.'intravenous therapyrespiratory therapyphysical therapyoccupational therapyspeech pathologyelectrocardiology010001 017016 103979 014506 SOUTHEAST ALABAMA MEDICAL CENTER P199710011998093012 91001YNN 0 0 0 0 0 N0 0 0 0 0N 0NNNNNNNNNNYYNNYNNNYNNNNY0N0 0 0 0 0NNNN200106272 T52 1218000010JF504Yt d#] y e e`{3&s  R 2c Au$i4~p jYD]u".8( 2\u$lƳ~p jTMu".8( 2\A(BG4>Fns~4rN$KXl<nJth(Da > .RrP~i4窊~pftP~lƳ~pb;aAFAG|AG|Rfa jYD]u".8( 2\RLB"KF ' S,HD!7!g f$ Tq?WF`ʬS]7I>u7* iOOjxm:%C 6!,v ; v#kD(t$xo(P ~8Nq t 6#X 7#|FV?p#'R J_R;º4 zUo)3gտA*Ӯj wS~E7 \ 71 Q9D ѿ+Qʬ fFDVNqi,6h$ %Є[^A*c.dSlˏsw'wGa1uK3H@J9s pcS4@; -yg=J^A*c.dSlˏsw'wGa1uK3H@J9s pcS4@;  #8\,C66!5&ǑU^h2:; `qhO8h A>A?]P7p~ tqr9^0p5-A .8A\$A$HAo4*҇#A AA(BA AXAw$AH|A">A3AgA\AIDA$pH1\v0A<AcA&ЄA AHAm A2((A!A2&RiT}XQ[ 8=q FM) v(MpRem}.p ,cCK 3vB-37'_j:7|06 {ar^A^AŒ4ZarT`i5^j/.Z޷=\vVHK1 63')!g]ٍ1?a1N^ ; 0/l(| #%= f _GNY~P#o#.4 k?`!I T #x0,zX~L\  OLN֥c !O?s:=@*W+qnYTT02}02}02}jc5QZ#}  KN V(& HRbRbK0#7P[FV$ cX?  $ 'R J_Rt2p?Z^8Q)r^^ bQr# I#CE"@2|YHӕ˘s<]o%7srM >5Vv,_[^w:pP  QJGQ&Sx >$%7[HUF>6FRZ3"+  OWE $31AaW}"R010004 015420 NORTH JACKSON HOSPITAL P199710011998093012 91001NNN 0 0 0 0 0 N0 0 0 0 0N 0NNNNNYYBNNNYNNNYNNNYYNNYN0Y0 0 0 0 0NNY@PN199909282 T52 1 00010NF504Y-9P@) hQEr yX_XX|`p'J:$uGF@ N7j&kGFa@ N7j&kA8G't$H hX0` #'GF*q&3X{GFv+Z4BA8?TAqAqn@i6 N7j&k 8@=H7[S GF [ {2U7>rh1af $nA_5|_`T1ɠNSAKT\!K޻h 0 U7KuR6," (QV´և*Z/ބ9N\Z(m;$:UeF ZF?]G#32;$:UeF ZL?]G#32\\#$0G-]v  mEIX Z ]CW?b7+ > n2Zաb{ AA<Aϐ8JA@A"&A*A6A`A:AsKgA @A! 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