Identification, Utilization, Statistical Data
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. S | Hospice Cost Report Information Required Certification | 3806.1 |
| Wkst. S-1 | Hospice Identification Data | 3807 |
| Wkst. S-1, Parts I | Hospice Identification Data | 3807.1 |
| Wkst. S-1, Parts II | Hospice Enrollment Data | 3807.2 |
| Wkst. S-1, Parts III | Hospice Census Data | 3807.3 |
Reclassification And Adjustment Of Trial Balance Of Expenses
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. A-1 | Compensation Analysis – Salaries and Wages | 3811 |
| Wkst. A-2 | Compensation Analysis – Employee benefits (Payroll Related) | 3812 |
| Wkst. A-3 | Compensation Analysis – Contracted Services/Purchased Services | 3813 |
| Wkst. A-6 | Reclassifications | 3816 |
| Wkst. A-7 | Analysis of Changes in Capital Asset Balances | 3817 |
| Wkst. A-8 | Adjustments to Expenses | 3818 |
| Wkst. A-8-1 | Statement of Costs of Services From Related Organizations and Home Office Costs | 3818.1 |
Cost and Cost Allocation
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. B | Cost Allocation – General Service Costs and | 3820 |
| Wkst. B-1 | Cost Allocation Statistical Basis | 3820 |
Computation of Per Diem Cost
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. D-1 | Calculation of Per Diem Cost | 3830 |
Financial Statements
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. G | Balance Sheet | 3850 |
| Wkst. G-1 | Statement of Changes in Fund Balances | 3850.1 |
| Wkst. G-2 | Statement of Patient Revenues and Net Income | 3850.2 |