The Hospital Reporting System (HRS) contains the following standard reports, (except as otherwise noted by an *), from data submitted by the hospitals. Reports are generated from each hospital’s HRS inputs.  Hard copies or electronic versions of these reports are available through OHCA’s Freedom of Information office.
 

Annual Reporting Filing

Report

Description

Report 1 *

Audited Financial Statements that are general purpose financial statements with all related schedules and notes, which express the unqualified opinion of an independent certified public accounting firm for the most recently completed fiscal year for the hospital, each of its affiliates or related corporations except for those affiliates that were inactive or that had an immaterial amount of total assets, and the hospital’s parent corporation.

Report 2 *

Medicare Cost Report for the most recently completed fiscal year, as filed, and any final audited Medicare Cost Reports for prior years that were not previously submitted.

Report 3 *

The most recent legal chart of corporate structure including the hospital, each of its affiliates and subsidiaries and its parent corporation.

Report 4 *

Separate current lists of officers and directors for the hospital, its affiliates and related corporations and its parent corporation.

Report 5

A report that identifies by purpose the net assets of the hospital and each affiliate or related corporation at the end of the most recently completed fiscal year.

Report 6

A report that identifies all transactions between the hospital and each of its affiliates or related corporations during the most recently completed fiscal year.

Report 6A

A report that identifies all transactions between hospital affiliates or related corporations during the most recently completed fiscal year.

Report 7

A report that identifies all expenditures incurred by each affiliate or related corporation for the benefit of the hospital.

Report 8 A report that identifies all commitments or endorsements entered into by the hospital for the benefit of each affiliate or related corporation.

Report 9 *

The total number of discharges and related number of patient days by town of origin, based on zip code and diagnostic category (submitted electronically by CHIME).

Report 10 *

The average length of stay and length of stay range by diagnostic category, age grouping and expected payor source (submitted electronically by CHIME).

Report 11 *

The total number of discharges to residence, home health agency, another hospital, a skilled nursing facility, an intermediate care facility and all other locations (submitted electronically by CHIME).

Report 12 *

The total number of inpatient surgical procedures by diagnosis, principal surgical procedure and age grouping with the related number of cases and patient days; (submitted electronically by CHIME).

Report 13 *

Outpatient surgical procedures including ambulatory surgery by principal surgical procedure and age grouping with the related number of cases (submitted electronically by CHIME).

Report 14 *

Case mix and revenue support schedules shall be reported. Case mix means the average of inpatient cases as differentiated by DRG, treated by a hospital during a fiscal year.  (submitted electronically by CHIME).

Report 15

The uncompensated care policies and procedures of the hospital for the most recently completed fiscal year.

Report 16

A report identifying all donations and funds, which are or have been restricted for the care of indigent patients for the most recently completed fiscal year.

Report 17

A report from each hospital that holds or administers one or more hospital bed funds that is maintained and annually compiled by the hospital for the most recently completed fiscal year, and that includes both patient activity and bed fund activity information.

Report 18

A report that provides hospital debt collection information including debt collection placement policies and procedures and individual collection agent information for the most recently completed fiscal year.

Report 19

A report listing the salaries and fringe benefits for the ten highest paid positions in the hospital.

Report 20

A report containing the name of each joint venture, partnership and corporation affiliated with the hospital and specific information about each entity for the most recently completed fiscal year. 

Report 21

A report containing the salaries and the fair market value of any fringe benefits as described in Section 19a-643-206(b)(19) of OHCA’s Regulations, paid to hospital employees by each joint venture, partnership and related corporation either directly or indirectly, and by the hospital to the employees of each hospital affiliate or related corporation. 

Report 22

A report of all transfers of assets, transfers of operations or changes of control involving the hospital’s clinical or nonclinical services or functions from the hospital to a person or entity organized or operated on a for profit basis.

Report 23

A report that identifies the Hospital Charity Care and Reduced Cost Services provided by the hospital that reports (1) the number of applicants for charity care and reduced cost services, (2) the number of approved applicants, and (3) the total and average charges and costs of the amount of charity care and reduced cost services provided.

 
 
 

Twelve Month Actual Filing

Report

Description

Report 100

A report that provides detailed balance sheet information from the hospital’s audited financial statements for the most recently completed fiscal year.

Report 150

A report that provides detailed statement of operations information from the hospital’s audited financial statements for the most recently completed fiscal year.

Report 165

A report that provides detailed hospital gross revenue, net revenue, utilization statistics and outpatient Emergency Department outpatient data by payer for the most recently completed fiscal year.

Report 175

A report that provides detailed hospital operating expenses by expense category and by department for the most recently completed fiscal year.

Report 185 

A report that provides various forms of hospital financial and statistical information including a statement of operations summary, profitability summary, net assets summary, cost data summary, liquidity measures summary, solvency measures summary, utilization measures summary, gross revenue payer mix percentages, and net revenue payer mix percentages.

Report 200 

A report that provides Medicare managed care activity by payer.

Report 250

A report that provides Medicaid managed care activity by payer.

Report 300

report that provides detailed balance sheet information from the hospital parent corporation’s consolidated audited financial statements for the most recently completed fiscal year.

Report 350

A report that provides detailed statement of operations information from the hospital parent corporation’s consolidated audited financial statements for the most recently completed fiscal year.

Report 385 

A report that provides various forms of hospital parent corporation consolidated financial information including a statement of operations summary, profitability summary, net assets summary, liquidity measures summary, and solvency measures summary.

Report 400

A report that provides hospital inpatient utilization statistics by service or department including patient days, staffed beds and licensed beds.

Report 450

A report that provides various types of hospital inpatient and outpatient services utilization statistics by service or department and hospital full time equivalent employees.

Report 485

A report that provides outpatient surgical procedures, outpatient endoscopy procedures and hospital emergency room visits by location.

Report 500

A report that provides a calculation of the hospital’s Disproportionate Share Hospital (DSH) program upper payment limit and baseline underpayment data and a comparative analysis of hospital data between the most recently completed fiscal year and the prior fiscal year.  

Report 550 

A report that provides a calculation of the hospital’s DSH program upper payment limit and baseline underpayment data.

Report 600

A report that provides a summary of the hospital’s DSH program upper payment limit and baseline underpayment data that is used as the basis for the hospital’s Report of Agreed Upon Procedures.

Report 625 *

A report of independent certified public accountants on applying agreed-upon procedures that provides the results of an independent audit of the level of hospital charges, payments and discharges by primary payer related to Medicare, Medicaid, medical assistance, CHAMPUS, TriCare and non-governmental payers and the amount of hospital charity care and bad debts.

Report 650 

A report that provides a summary of the hospital’s charity care, bad debts and uncompensated care activity.

Report 685

A report that provides a summary of the hospital’s non-government payer activity including the hospital’s total non-government gross revenue, contractual allowances, accrued payments and discount percentage.

Report 700

A report that provides a statistical analysis of the hospital’s revenue and expense using various statistics.
Report 750 * A copy of the hospital’s and the hospital parent corporation’s latest IRS Form 990, Return of Organization Exempt from Income Tax.
 

 

Hospital Budget Filing

Report

Description

Report 950 BUD

A report that provides the hospital’s operating budget for the current fiscal year in a statement of operations format that includes budgeted hospital revenues, deductions from revenue, expenses and operating statistics.