Annual and 12 Month Filing Reports


Section 19a-643-206 of the Regulations of Connecticut State Agencies requires hospitals to report annually on their actual operating results for the previous fiscal year, (October 1st to September 30th), to the Office of Health Strategy (“OHS”). The two filings for which OHS collects data are the Annual Reporting Filing due on February 28th of each year and the Twelve Months Actual Filing due on March 31st of each year. These filings mainly consist of system generated reports completed in the HRS portal.  Some of the data that can be found in the reports are affiliate information, salary data, bed fund and charity care data, hospital and hospital parent corporation audited financial statement information, charges and payments information and utilization data.

A complete listing and description of each of the Annual Reporting requirements is shown below:

Annual Reporting Listing of Non - HRS Reports
Report 1 - Audited Financial Statements of the Hospital, the Hospital's parent corporation and the Hospital's affiliates
Report 2 - Medicare Cost Report
Report 3 - Most recent Legal Chart of Corporate Structure
Report 4 - Current Lists of Officers and Directors
Report 9 through Report 14 - CHIME Hospital Utilization Reports – currently not required.
Report 15 - The Hospital's Uncompensated Care Policies and Procedures

Annual Reporting Listing of HRS Reports
Report 5 - Hospital, Affiliate and Related Corporation Net Assets
Report 6 - Transactions between the Hospital and Affiliates or Related Corporations
Report 6A - Transactions between Hospital Affiliates or Related Corporations
Report 7 - Expenditures by Affiliates/Related Corps. for the Benefit of the Hospital
Report 8 - Hospital Commitments/Endorsements for the Benefit of Affs./Rel. Corps.
Report 16 - Donations and Funds Restricted for Indigent Care and Free Beds
Report 17A - Hospital Bed Funds Held or Administered by the Hospital - Patient Activity
Report 17B - Hospital Bed Funds Held or Administered by the Hospital - Fund Activity
Report 18 - Hospital Collection Placement Policies and Collection Agent Information
Report 19 - Salaries and Fringe Benefits of the Ten Highest Paid Hospital Positions
Report 20 - Report of Each Joint Venture, Partnership and Corporation Related to the Hospital
Report 21 - Hospital Salaries & Fringe Benefits paid by Joint Ventures, Affiliates & Related Corp.
Report 22 - Transfer of Assets, Operations, Change of Control from the Hospital to a For Profit Entity
Report 23 - Charity Care and Reduced Cost Services Provided by the Hospital

Twelve Months Actual Filing Listing of HRS Reports
Report 100 - Hospital Balance Sheet Information
Report 125 – Hospital Statement of Cash Flows
Report 150 - Hospital Statement of Operations Information
Report 175 - Hospital Operating Expenses by Expense Category and by Department
Report 185 - Hospital Financial and Statistical Data Analysis
Report 300 - Parent Corporation Consolidated Balance Sheet Information
Report 325 – Parent Corporation Consolidated Statement of Cash Flows
Report 350 - Parent Corporation Consolidated Statement of Operations Information
Report 385 - Parent Corporation Consolidated Financial Data Analysis
Report 400 - Hospital Inpatient Bed Utilization by Department
Report 450 - Hospital Inpatient & Outpatient Other Services Utilization & FTE Employees
Report 485 - Hospital Outpatient (OP) Surgical, OP Endoscopy & OP Emergency Room Services by Location
Report 550 – Summary of Charges Payments, Statistics and Uncompensated Care
Report 565 – Hospital Emergency Department Outpatient Charges and Payments
Report 600 – Report Summary for the Verification of Net Patient Revenue
Report 700 - Statistical Analysis of Hospital Revenue and Expense

Twelve Months Actual Filing Listing of Non-HRS Reports
Report 625 - Report of Independent Accountants on Applying Agreed-Upon Procedures
Report 750 - Hospital's and Hospital Parent Corporation's IRS Form 990, Return of Organization Exempt From Income Tax