AzHHA - Financial Reporting Tool

Financial Reporting Tool

Please report this information by first selecting the reporting period and then filling out the following form in its entirety. I realize the numbers may change after they have been audited or based on additional reviews. However we need the best available information and need it on a timely basis. We will not disclose any individual hospital information.

Hospital Name: *

Preparer's First Name: *

Preparer's Last Name: *

Email Address: *

When entering dollar amounts, please enter only numbers, and a decimal if necessary. Please omit dollar signs and commas.

Gross Charges: *

Patient billings for inpatients and outpatients at the established rates

Charity Allowances: *

Write-offs and estimated allowances for the difference between Gross Charges and estimated payments on Charity accounts, accounts that cannot be collected because of an inability to pay

Net Patient Revenue: *

Gross charges less contractual allowances and charity allowances. Does not include Premium revenues

Total Operating Revenue: *

Total unrestricted revenues, gains and other support. Includes net patient revenue, premium revenue gifts for restricted operating activities, other operating revenue

Salaries and Wages: *

Salaries and Wages for employees, as defined by the IRS

Employee Benefits: *

All employee benefit expenses including payroll taxes, pension expenses, tuition and/or education expenses, health, life and dental insurance, etc.

Interest: *

Interest expenses on all outstanding debt

Depreciation and Amortization: *

Depreciation and amortization of assets calculated in accordance with GAAP should be included in this category

Bad Debts: *

Gross charges written off for care rendered to patients who after study will not pay. Recorded as an expense.

Post Acute Care Costs: *

The cost hospitals incure to pay outside vendors for post acute care in order to reduce the cost of a hospital stay.

Other Expenses: *

All other expenses

Total Expenses: *

Total operating expenses including interest, depreciation and amortization

Operating Income: *

Total Operating Revenues minus Expenses, this line is computed be subtracting expenses from operating revenues

Non-operating Income: *

All unrestricted items not included in Operations, including investment income and unrestricted contributions

Excesses of Revenue Over Expenses: *

Operating Income plus or minus Nonoperating Revenue/Expenses

Cash and Investments: *

Unrestricted cash, short term investments, investments in liquid equity investments, includes Assets limited as to use that are internally restricted (not monies held by trustee, such as Bond Reserve Funds and other debt service funds)

Net Accounts Receivable: *

Gross accounts receivable less any related allowances

Current Assets: *

Liquid assets as defined by GAAP

Current Liabilities: *

Short term liabilities as defined by GAAP

Long Term Debt: *

Long term debt as defined by GAAP

Unrestricted Net Assets (Stockholder Equity): *

Unrestricted net assets as defined by GAAP. Also called Stockholders' Equity

Accumulated Depreciation: *

All accumulated depreciation that has been recorded to date, please do not show as a negative

Patient Discharges: *

Adult and pediatric patient discharges computed in accordance with Medicare Guidelines

Patient Days: *

Adult and pediatric patient days computed in accordance with Medicare Guidelines

ED Visits: *

All emergency room, urgent care, and trauma visits

Births: *

Include all live births, including cesarean deliveries

FTE's: *

Include all FTE's, included in the salary expense line whether employed or not. An FTE represents 2080 paid hours

Privileged Physicians: *

Report the total number of physicians on the medical staff with privileges, except those with courtesy, honorary, and provisional privileges. Do not include residents or interns.

Employed and Contracted Physicians: *

Physicians that are either direct hospital employees or employees of a hospital subsidiary corporation, or are under a formal contract. Exclude employed or contracted physicians for non-clinical services (administrative, medical director services, etc.)

RN FTE's: *

Include employed RN's who provide direct patient care. An FTE represents 2080 paid hours

Vacancy Rate: *

Unfilled FTE's at the end of the reporting period divided by unfilled FTE's plus filled FTE's

Turnover Rate: *

The number of FTE's leaving annualized (for quarterly data multiply by 4) divided by the average number of FTE's