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IN LIEU OF FORM CMS-2552-96(042005) PREPARED 8142009 1351 FORM APPROVED OMB NO - hfs illinois

IN LIEU OF FORM CMS-2552-96(042005) PREPARED 8142009 1351 FORM APPROVED OMB NO - hfs illinois-2025

IN LIEU OF FORM CMS-2552-96(042005) PREPARED 8142009 1351 FORM APPROVED OMB NO - hfs illinois Preview on Page 1

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The document is a comprehensive financial report for Pinckneyville Community Hospital, detailing health financial systems and cost reporting for the period from May 1, 2008, to April 30, 2009. It includes various worksheets related to cost reports, reimbursement settlements, balance sheets, and patient revenues. The report outlines costs associated with inpatient and outpatient services, including detailed calculations of salaries, expenses, and adjustments necessary for compliance with Medicare regulations. Additionally, it covers allocations for hospice services and rural health clinic operations.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the provider number (14-1307) and the reporting period (from 5/1/2008 to 4/30/2009) in the designated fields.
Fill out Part I, which includes certification details. Ensure that all required signatures are provided.
Proceed to Part II for settlement summary. Input relevant financial data accurately, including costs and revenues.
Review each section carefully, ensuring compliance with applicable regulations and guidelines.
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