| Period ending date |
12/31/2011 |
12/31/2010 |
12/31/2009 |
12/31/2008 |
12/31/2007 |
| Number of months in period |
12 |
12 |
12 |
12 |
12 |
| Cost report status |
As Submitted |
Settled With Audit |
Settled Without Audit |
Settled Without Audit |
Settled Without Audit |
| |
|
|
|
|
|
| Inpatient Revenue |
### |
### |
### |
### |
### |
| Outpatient Revenue |
### |
### |
### |
### |
### |
| Total Patient Revenue |
### |
### |
### |
### |
### |
| Contractual Allowance
(Discounts) |
### |
### |
### |
### |
### |
| Net Patient Revenues |
### |
### |
### |
### |
### |
| Total Operating Expense1 |
### |
### |
### |
### |
### |
| Operating Income |
### |
### |
### |
### |
### |
| Other Income (Contributions, Bequests, etc.) |
### |
### |
### |
### |
### |
| Income from Investments |
### |
### |
### |
### |
### |
| Governmental Appropriations |
### |
### |
### |
### |
### |
| Miscellaneous Non-Patient Revenue |
### |
### |
### |
### |
### |
| Total Non-Patient Revenue |
### |
### |
### |
### |
### |
| Total Other Expenses |
### |
### |
### |
### |
### |
| Net Income or (Loss) |
### |
### |
### |
### |
### |
| ____________ |
|
|
|
|
|
| 1 Depreciation Expense (included above) |
### |
### |
### |
### |
### |
Please note:
Hospitals receiving 100% Federal prospective payment for capital
were not required to complete Parts III - IV of Worksheet A-7 for
cost reports beginning on or after October 1, 2001 and ending before
February 29, 2004. All other hospitals must complete Parts III
and IV for all cost reporting periods ending on or after April 30,
2005. This worksheet is the source of interest,
depreciation, and amortization expense.
|