RPT CR Analysis - Microsofthalmanac.blob.core.windows.net/...V2_Analysis_2016... · 100258 DELRAY MEDICAL CENTER 00100 Amounts 0.048364 Ratio 100269 PALMS WEST HOSPITAL 00100 Amounts

E00 Wkst E Calculation of Reimbursement Settlement

A Part A - Inpatient Hospital Services under PPS

A18 Hospital Medicare

00101 DRG Amounts other than outlier payments for discharges occuring prior to October 1, 2013.

100080 JFK MEDICAL CENTER 00100 Amounts 18,427,257.

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 16,695,594.

100176 PALM BEACH GARDENS 00100 Amounts 31,273,000.

100234 WEST PALM HOSPITAL 00100 Amounts 1,939,545.

100258 DELRAY MEDICAL CENTER 00100 Amounts 56,580,228.

100268 WEST BOCA MEDICAL CENTER 00100 Amounts 10,856,355.

100269 PALMS WEST HOSPITAL 00100 Amounts 5,485,146.

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 13,536,181.

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 8,500,571.

100288 ST MARYS MEDICAL CENTER 00100 Amounts 4,862,814.

00200 Outlier Payments for Discharges

100002 BETHESDA HOSPITAL INC 00100 Amounts 998,345.


100130 LAKESIDE MEDICAL CENTER 00100 Amounts 226,863.



100234 WEST PALM HOSPITAL 00100 Amounts 105,542.

100253 JUPITER MEDICAL CENTER 00100 Amounts 595,708.


100268 WEST BOCA MEDICAL CENTER 00100 Amounts 288,378.

100269 PALMS WEST HOSPITAL 00100 Amounts 503,862.

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 493,496.

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 839,812.

100288 ST MARYS MEDICAL CENTER 00100 Amounts 305,088.

00300 Managed Care Similated Payments.

100002 BETHESDA HOSPITAL INC 00100 Amounts 25,141,018.



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CR Hospital Analysis Report 2016Hospital Analysis Report for Palm Beach County Florida for Worksheet E and G1, G2 and G3......

Provider Provider Name Col Column Desc Amount Type

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00400 Bed days available divided by number of days in the cost reporting period. Beds

100002 BETHESDA HOSPITAL INC 00100 Amounts 381.22 Beds

100080 JFK MEDICAL CENTER 00100 Amounts 441.05 Beds

100130 LAKESIDE MEDICAL CENTER 00100 Amounts 66.22 Beds

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 345.47 Beds

100176 PALM BEACH GARDENS 00100 Amounts 182.64 Beds

100234 WEST PALM HOSPITAL 00100 Amounts 158.37 Beds

100253 JUPITER MEDICAL CENTER 00100 Amounts 193.83 Beds

100258 DELRAY MEDICAL CENTER 00100 Amounts 314.18 Beds

100268 WEST BOCA MEDICAL CENTER 00100 Amounts 186.95 Beds

100269 PALMS WEST HOSPITAL 00100 Amounts 193.61 Beds

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 210.75 Beds

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 316.23 Beds

100288 ST MARYS MEDICAL CENTER 00100 Amounts 383.71 Beds

00500 IME Adj - FTE count for allopathic and osteopathic programs for periods before 12/31/1996.

FTEs

100080 JFK MEDICAL CENTER 00100 Amounts 1.58 FTEs

100130 LAKESIDE MEDICAL CENTER 00100 Amounts 15. FTEs

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 10.50 FTEs

00600 IME Adj - FTE count for allopathic and osteopathic programs which meet the criteria for new programs

FTEs


100234 WEST PALM HOSPITAL 00100 Amounts 6.3200 FTEs

100269 PALMS WEST HOSPITAL 00100 Amounts 20.6700 FTEs

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00700 IME Adj - MMA Section 422 reduction amount to the IME cap as specified under 42 CRR 412.105(f)(1)(iv

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 0.11

00701 IME Adj - ACA Section 5503 reduction amount to the IME cap as specified under MMA Section 42 CRR 412

100269 PALMS WEST HOSPITAL 00100 Amounts 6.86

00800 IME Adj - Adjustment to FTE count for allopathic and osteopathic programs for affiliated programs in

FTEs

100002 BETHESDA HOSPITAL INC 00100 Amounts 45. FTEs

00801 IME Adj - The amount of increase if the hospital was awarded FTE cap slots under section 5503 of the

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 9.

00900 IME Adj - (Sum of Lines 05 Plus 06 Minus Lines 07 and 7.01 Plus/Minus Line 08 plus lines 8.02 and 8.

100002 BETHESDA HOSPITAL INC 00100 Amounts 45.

100080 JFK MEDICAL CENTER 00100 Amounts 41.48

100130 LAKESIDE MEDICAL CENTER 00100 Amounts 15.

100234 WEST PALM HOSPITAL 00100 Amounts 6.32


100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 19.39

01000 IME Adj - FTE count for allopathic and ostepathic programs in the current year from your records.

FTEs

100002 BETHESDA HOSPITAL INC 00100 Amounts 14.07 FTEs


100130 LAKESIDE MEDICAL CENTER 00100 Amounts 12.67 FTEs

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 37.97 FTEs



100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 18. FTEs

01100 IME Adj - FTE counts for residents in dental and podiatric programs. FTEs



01200 IME Adj - Current Year Allowable FTEs (See Instructions) FTEs




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100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 18. FTEs

01300 IME Adj - Total Allowable FTE Count For Prior Year FTEs







01400 IME Adj - Total allowable FTE count for the penultimate year if year ended before 9-1-1997.

FTEs







01500 IME Adj - Total (Lines 12 to 14 Divided by Line 03) (See Instructions) FTEs







01600 IME Adj - Adjustment for residents in initial years of the program. FTEs



100258 DELRAY MEDICAL CENTER 00100 Amounts 15.83 FTEs

01800 IME Adj - Adjusted Rolling Average FTE Count FTEs




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100258 DELRAY MEDICAL CENTER 00100 Amounts 15.83 FTEs



01900 IME Adj - Current Year Resident to Bed Ratio (Line 18 Divided by Line 04) Ratio

100002 BETHESDA HOSPITAL INC 00100 Amounts 0.051624 Ratio

100080 JFK MEDICAL CENTER 00100 Amounts 0.105249 Ratio

100130 LAKESIDE MEDICAL CENTER 00100 Amounts 0.184083 Ratio

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 0.109908 Ratio

100234 WEST PALM HOSPITAL 00100 Amounts 0.039907 Ratio

100258 DELRAY MEDICAL CENTER 00100 Amounts 0.050385 Ratio

100269 PALMS WEST HOSPITAL 00100 Amounts 0.071329 Ratio

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 0.087023 Ratio

02000 IME Adj - Prior Year Resident to Bed Ratio (See Instructions) Ratio









02100 IME Adj - Enter the Lesser of Line 19 or Line 20 (See Instructions) Ratio









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02200 IME Adj -IME Payment Adjustment (See Instructions)









02400 IME Adj For Add-on - IME FTE Resident Count Over Cap (See Instructions)

100002 BETHESDA HOSPITAL INC 00100 Amounts -30.93

100080 JFK MEDICAL CENTER 00100 Amounts 16.24

100130 LAKESIDE MEDICAL CENTER 00100 Amounts -2.33

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 37.97

100234 WEST PALM HOSPITAL 00100 Amounts 9.99


100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts -1.39

02900 IME Adj For Add-on - Total IME Payment (Sum Lines 22 and 28)









03000 DHS Adj - Percentage of SSI recipient patient days to Medicare part A patient days (see instructions

Percent

100002 BETHESDA HOSPITAL INC 00100 Amounts 0.04 Percent

100080 JFK MEDICAL CENTER 00100 Amounts 0.08 Percent

100130 LAKESIDE MEDICAL CENTER 00100 Amounts 0.27 Percent

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 0.01 Percent

100176 PALM BEACH GARDENS 00100 Amounts 0.04 Percent

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100234 WEST PALM HOSPITAL 00100 Amounts 0.11 Percent

100253 JUPITER MEDICAL CENTER 00100 Amounts 0.02 Percent

100258 DELRAY MEDICAL CENTER 00100 Amounts 0.03 Percent

100268 WEST BOCA MEDICAL CENTER 00100 Amounts 0.04 Percent

100269 PALMS WEST HOSPITAL 00100 Amounts 0.10 Percent

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 0.07 Percent

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 0.08 Percent

100288 ST MARYS MEDICAL CENTER 00100 Amounts 0.13 Percent

03100 DHS Adj - Percentage of Medicaid patient days to total days reported on Worksheet S-3, Part 1.

Percent














03200 DHS Adj - Sum of Lines 04 and 4.01 Percent










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03300 DHS Adj - Allowable Disproportionate Share Percentage (see instructions) Percent










03400 Worksheet E Part A Total DHS Adjustment - Disproportionate Share Adjustment (See Instructions)










03500 Total Uncompensated Care Amount (See Instructions)

100002 BETHESDA HOSPITAL INC 00200 Amounts 6,406,145,534.

100080 JFK MEDICAL CENTER 00100 Amounts 7,647,644,885.


100130 LAKESIDE MEDICAL CENTER 00200 Amounts 6,406,145,534.

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 7,647,644,885.


100176 PALM BEACH GARDENS 00100 Amounts 6,406,145,534.

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100234 WEST PALM HOSPITAL 00100 Amounts 7,647,644,885.

100234 WEST PALM HOSPITAL 00200 Amounts 6,405,785,388.

100253 JUPITER MEDICAL CENTER 00200 Amounts 6,406,145,534.

100258 DELRAY MEDICAL CENTER 00100 Amounts 6,406,145,534.


100269 PALMS WEST HOSPITAL 00100 Amounts 7,647,644,885.


03501 Total Uncompensanted Care Amount - Factor 3 (See Instructions)


100080 JFK MEDICAL CENTER 00100 Amounts 0.



100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 0.


100176 PALM BEACH GARDENS 00100 Amounts 0.


100234 WEST PALM HOSPITAL 00100 Amounts 0.


100253 JUPITER MEDICAL CENTER 00200 Amounts 0.

100258 DELRAY MEDICAL CENTER 00100 Amounts 0.


100269 PALMS WEST HOSPITAL 00100 Amounts 0.


03502 Hospital Uncompensanted Care Payment (If Line 34 is Zero, Enter Zero)








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03503 Pro Rata Share of the Hospital Uncompensanted Care Payment Amount (See Instructions)

















03600 Total Uncompensated Care Amount (Sum of Col 01 and 02 on Line 35.03)






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04700 Sub Total (see instructions)



100130 LAKESIDE MEDICAL CENTER 00100 Amounts 3,834,949.




100253 JUPITER MEDICAL CENTER 00100 Amounts 38,619,922.







04900 Total Payment for Inpateint Operating Cost SCH and MDH Only














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05000 Payment for Inpatient Program Captial (From Wkst L Parts 1,2 or 3)














05200 Direct Graduate Medical Education Payment (Wkst E-4 Line 49)






100258 DELRAY MEDICAL CENTER 00100 Amounts 810,404.



05300 Nursing and Allied Health Managed Care payment


100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 86,543.


05400 Special Addon Payments for New Technologies


100080 JFK MEDICAL CENTER 00100 Amounts 112,986.


100176 PALM BEACH GARDENS 00100 Amounts 211,295.

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05700 Routine Service Other Pass Through Costs



05800 Ancillary Service Other Pass Through Costs




05900 Total (Sum of Amounts on Lines 49 Through 58)














06000 Primary Payer Payments









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06100 Total Amount Payable for Program Beneficiaries (Line 59 Minus 60)














06200 Deductibles Billed to Program Beneficiaries














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06300 Coinsurance Billed to Program Beneficiaries














06400 Reimbursable Bad Debts














06500 Adjusted Reimbursable Bad Debts




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06600 Reimbursable Bad Debts for Dual Eligible Beneficiaries












06700 Sub Total (Lines 61 Plus Line 65 Minus Lines 62 and 63)










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06800 Credits received from manufactures for replaced devices applicable to MS-DRG.


07000 Other Adjustments (Specify) CC 07093

100002 BETHESDA HOSPITAL INC 00100 Amounts -243,490. CC 07093

100002 BETHESDA HOSPITAL INC 00100 Amounts -62,390. CC 07094

100080 JFK MEDICAL CENTER 00000 Description

100080 JFK MEDICAL CENTER 00000 Description CC 07001

100080 JFK MEDICAL CENTER 00100 Amounts -1.

100080 JFK MEDICAL CENTER 00100 Amounts -1,070,338. CC 07093

100080 JFK MEDICAL CENTER 00100 Amounts -254,795. CC 07094

100080 JFK MEDICAL CENTER 00100 Amounts 822,013. CC 07099

100130 LAKESIDE MEDICAL CENTER 00000 Description CC 07097

100130 LAKESIDE MEDICAL CENTER 00100 Amounts 10,261. CC 07093

100130 LAKESIDE MEDICAL CENTER 00100 Amounts -16,781. CC 07094


100168 BOCA RATON REGIONAL HOSPITAL 00000 Description

100168 BOCA RATON REGIONAL HOSPITAL 00000 Description CC 07001

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts -108,505. CC 07093

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts -553,476. CC 07094

100176 PALM BEACH GARDENS 00100 Amounts 182,027. CC 07093

100176 PALM BEACH GARDENS 00100 Amounts -205,003. CC 07094

100234 WEST PALM HOSPITAL 00100 Amounts -12,414. CC 07093

100234 WEST PALM HOSPITAL 00100 Amounts -4,582. CC 07094

100253 JUPITER MEDICAL CENTER 00100 Amounts 173,530. CC 07093

100253 JUPITER MEDICAL CENTER 00100 Amounts -406,857. CC 07094

100258 DELRAY MEDICAL CENTER 00100 Amounts -246,609. CC 07093

100258 DELRAY MEDICAL CENTER 00100 Amounts -221,488. CC 07094

100268 WEST BOCA MEDICAL CENTER 00100 Amounts -5,589. CC 07093

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100269 PALMS WEST HOSPITAL 00000 Description


100269 PALMS WEST HOSPITAL 00100 Amounts -16,651. CC 07093

100269 PALMS WEST HOSPITAL 00100 Amounts -56,568. CC 07094

100275 WELLINGTON REGL MEDICAL CENTER 00000 Description


100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts -89,963. CC 07093

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts -237,197. CC 07094

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 57,829. CC 07099

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts -123,405. CC 07093

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts -19,265. CC 07094

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 234,846. CC 07099

100288 ST MARYS MEDICAL CENTER 00100 Amounts -52,758. CC 07093

100288 ST MARYS MEDICAL CENTER 00100 Amounts -65,507. CC 07094

07100 Amount Due Provider (Line 67 Minus Lines 68 Plus/Minus Lines 69 and 70)


100002 BETHESDA HOSPITAL INC 00100 Amounts 1,362,795. CC 07101


100080 JFK MEDICAL CENTER 00100 Amounts 2,012,532. CC 07101




100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 1,786,052. CC 07101




100234 WEST PALM HOSPITAL 00100 Amounts 158,097. CC 07101




100258 DELRAY MEDICAL CENTER 00100 Amounts 1,591,820. CC 07101

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100268 WEST BOCA MEDICAL CENTER 00100 Amounts 337,962. CC 07101


100269 PALMS WEST HOSPITAL 00100 Amounts 475,718. CC 07101






100288 ST MARYS MEDICAL CENTER 00100 Amounts 568,570. CC 07101

07200 Interim Payments














07400 Balance Due Provider(Program) (Line 71 Minus the Sum of Lines 72 and 73)


100080 JFK MEDICAL CENTER 00100 Amounts -2,392,762.



100176 PALM BEACH GARDENS 00100 Amounts -235,108.



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100268 WEST BOCA MEDICAL CENTER 00100 Amounts -187,003.


100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts -49,388.

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts -146,752.

100288 ST MARYS MEDICAL CENTER 00100 Amounts -946,454.

07500 Protested Amounts (Non Allowable Cost Report Items) in Accordance with CMS Pub. 15-2 Section 115.2












09000 Operating Outlier Reconciliation Amount from Wkst E Part A Line 02














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09100 Capital Outlier From Wkst L Part 1 Line 02














B Part B - Medical and Other Health Services


00100 Medical and Other Services (See Instructions)














102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Amounts 94,593.

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00200 Medical and other services reimbrused under OPPS (see instructions).














104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 Amounts 640,751.

00300 PPS Payments Received















00400 Outlir Payments (See Instructions)


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00900 Ancillary Service Other Pass Through Costs (Wkst D Part 4 Col 13 Line 200




01100 Total Cost (Sum of Lines 01 and 10)















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01400 Reasonable Charges - Total Reasonable Charges (Sum of Lines 12 and 13)















01800 Customary Charges - Total















01900 Excess of Customary Charges Over Reasonable Cost (Complete Only If Line 14 Exceeds 05)


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02100 Lesser of Cost or Charges (Line 11 Minus Line 20) (For CAH, See Instructions)















02400 Total Prospective Payment (Sum of Lines 03,04,08,09)




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02500 Reimbursement Settlement - Deductibles and Coinsurance (See Instructions)






100268 WEST BOCA MEDICAL CENTER 00100 Amounts 372.





02600 Reimbursement Settlement - Deductibles and Coinsurance relating to amount on line 17.01.










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02700 Reimbursement Settlement - Sub Total (Line 21 and 24 Minus Lines 25 and 26)














102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Amounts -29,202.


02800 Reimbursement Settlement - Direct Graduate Medical Education Payments (Wkst E-4 Line 50)









03000 Reimbursement Settlement - Sub Total (Sum of Lines 27 Through 29)



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03100 Reimbursement Settlement - Primary Payer Payments














03200 Reimbursement Settlement - Sub Total (Line 30 Minus Line 31)





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03300 Bad Debts - Composite reate ESRD (Wkst I-5 Line 11)


03400 Bad Debts - Allowable Bad Debts
















03500 Bad Debts - Adjusted Reimbursalbe Bad Debts



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102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Amounts 822.


03600 Bad Debts - Reimbursable Bad Debts for Dual Eligible Beneficiaries














03700 Bad Debts - Sub Total (Sum of Lines 32, 33, 34 and 35)(Line 35 Hospital and Subprovider Only))





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03800 MSP-LCC Reconciliation Amount From PS&R



100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts -43.

100176 PALM BEACH GARDENS 00100 Amounts -411.

100253 JUPITER MEDICAL CENTER 00100 Amounts 541.



100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 38.

100288 ST MARYS MEDICAL CENTER 00100 Amounts 1.

03900 SEQUESTRATION





100253 JUPITER MEDICAL CENTER 00000 Description


04000 Sub Total (Line 37 Plus or Minus Lines 39 Minus Line 38)


100002 BETHESDA HOSPITAL INC 00100 Amounts 441,641. CC 04001


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100080 JFK MEDICAL CENTER 00100 Amounts 408,459. CC 04001












100258 DELRAY MEDICAL CENTER 00100 Amounts 373,096. CC 04001


100268 WEST BOCA MEDICAL CENTER 00100 Amounts 72,439. CC 04001


100269 PALMS WEST HOSPITAL 00100 Amounts 42,834. CC 04001









104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 Amounts 17,048. CC 04001







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04200 Worksheet E Part B Tenative Settlement (For Contractor Use Only)


04300 Balance Due Provider/Program (Line 40 Minus the Sum of Lines 41 and 42)







100253 JUPITER MEDICAL CENTER 00100 Amounts -15,767.









04400 Worksheet E Part B Protested Amounts (Nonallowable Cost Report Items) in Accordance With CMS 15-2





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09000 Completed by Contractor - Original Outlier Amount














B18 IPF Medicare
















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03400 Bad Debts - Allowable Bad Debts


03500 Bad Debts - Adjusted Reimbursalbe Bad Debts


03600 Bad Debts - Reimbursable Bad Debts for Dual Eligible Beneficiaries









100080 JFK MEDICAL CENTER 00100 Amounts 165. CC 04001

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100258 DELRAY MEDICAL CENTER 00100 Amounts 45. CC 04001


100288 ST MARYS MEDICAL CENTER 00100 Amounts 104. CC 04001











C18 IRF Medicare















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100002 BETHESDA HOSPITAL INC 00100 Amounts 1. CC 04001


100258 DELRAY MEDICAL CENTER 00100 Amounts 20. CC 04001


100288 ST MARYS MEDICAL CENTER 00100 Amounts 7. CC 04001






100002 BETHESDA HOSPITAL INC 00100 Amounts -202.


100288 ST MARYS MEDICAL CENTER 00100 Amounts -90.

E10 Wkst E-1 Analysis of Payments to Providers for Services Rendered

1 Part 1 - Analysis of Payment to Providers for Services Rendered


00100 Total interim payments paid to provider

100002 BETHESDA HOSPITAL INC 00200 Part A Amount 65,404,246.

100002 BETHESDA HOSPITAL INC 00400 Part B Amount 21,097,265.

100080 JFK MEDICAL CENTER 00200 Part A Amount 100,929,109.

100080 JFK MEDICAL CENTER 00400 Part B Amount 19,945,213.

100130 LAKESIDE MEDICAL CENTER 00200 Part A Amount 4,444,201.

100130 LAKESIDE MEDICAL CENTER 00400 Part B Amount 876,081.

100168 BOCA RATON REGIONAL HOSPITAL 00200 Part A Amount 85,949,194.

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100168 BOCA RATON REGIONAL HOSPITAL 00400 Part B Amount 74,364,804.

100176 PALM BEACH GARDENS 00200 Part A Amount 43,451,007.

100176 PALM BEACH GARDENS 00400 Part B Amount 14,559,830.

100234 WEST PALM HOSPITAL 00200 Part A Amount 7,508,864.

100234 WEST PALM HOSPITAL 00400 Part B Amount 1,825,055.

100253 JUPITER MEDICAL CENTER 00200 Part A Amount 36,653,050.

100253 JUPITER MEDICAL CENTER 00400 Part B Amount 25,471,584.

100258 DELRAY MEDICAL CENTER 00200 Part A Amount 75,641,971.

100258 DELRAY MEDICAL CENTER 00400 Part B Amount 17,991,539.

100268 WEST BOCA MEDICAL CENTER 00200 Part A Amount 16,698,580.

100268 WEST BOCA MEDICAL CENTER 00400 Part B Amount 3,456,516.

100269 PALMS WEST HOSPITAL 00200 Part A Amount 23,289,537.

100269 PALMS WEST HOSPITAL 00400 Part B Amount 2,076,006.

100275 WELLINGTON REGL MEDICAL CENTER 00200 Part A Amount 22,670,940.

100275 WELLINGTON REGL MEDICAL CENTER 00400 Part B Amount 5,444,536.

100287 GOOD SAMARITAN HOSPITAL 00200 Part A Amount 29,948,164.

100287 GOOD SAMARITAN HOSPITAL 00400 Part B Amount 9,946,212.

100288 ST MARYS MEDICAL CENTER 00200 Part A Amount 28,909,790.

100288 ST MARYS MEDICAL CENTER 00400 Part B Amount 2,258,991.

102023 SSH - PALM BEACH LLC 00200 Part A Amount 14,889,321.

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 Part A Amount 11,909,430.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00200 Part A Amount 848,148.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00400 Part B Amount 796,593.

00300 Retroactive Lump Sum Adjustment - Provider to Program Date

100002 BETHESDA HOSPITAL INC 00100 Part A Info 05/17/2016 Date


100002 BETHESDA HOSPITAL INC 00200 Part A Amount 556,056. CC 00301



100002 BETHESDA HOSPITAL INC 00300 Part B Info 05/17/2016 Date

100002 BETHESDA HOSPITAL INC 00300 Part B Info 09/01/2016 Date

100002 BETHESDA HOSPITAL INC 00400 Part B Amount 148,914. CC 00301

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100080 JFK MEDICAL CENTER 00100 Part A Info 12/21/2015 Date

100080 JFK MEDICAL CENTER 00200 Part A Amount 77,700. CC 00301

100080 JFK MEDICAL CENTER 00200 Part A Amount 77,700. CC 00399

100168 BOCA RATON REGIONAL HOSPITAL 00100 Part A Info 05/19/2016 Date

100168 BOCA RATON REGIONAL HOSPITAL 00200 Part A Amount 1,086,816. CC 00301

100168 BOCA RATON REGIONAL HOSPITAL 00200 Part A Amount 1,086,816. CC 00399

100168 BOCA RATON REGIONAL HOSPITAL 00300 Part B Info 05/19/2016 Date

100168 BOCA RATON REGIONAL HOSPITAL 00400 Part B Amount 306,907. CC 00301

100168 BOCA RATON REGIONAL HOSPITAL 00400 Part B Amount 306,907. CC 00399

100176 PALM BEACH GARDENS 00100 Part A Info 09/21/2016 Date

100176 PALM BEACH GARDENS 00200 Part A Amount 64,177. CC 00301

100176 PALM BEACH GARDENS 00200 Part A Amount 64,177. CC 00399

100253 JUPITER MEDICAL CENTER 00100 Part A Info 06/06/2016 Date

100253 JUPITER MEDICAL CENTER 00200 Part A Amount 42,325. CC 00301

100253 JUPITER MEDICAL CENTER 00200 Part A Amount 42,325. CC 00399

100253 JUPITER MEDICAL CENTER 00300 Part B Info 06/06/2016 Date

100253 JUPITER MEDICAL CENTER 00400 Part B Amount 69,815. CC 00301

100253 JUPITER MEDICAL CENTER 00400 Part B Amount 69,815. CC 00399

100258 DELRAY MEDICAL CENTER 00100 Part A Info 09/08/2016 Date


100258 DELRAY MEDICAL CENTER 00200 Part A Amount 134,810. CC 00301



100268 WEST BOCA MEDICAL CENTER 00100 Part A Info 11/29/2016 Date

100268 WEST BOCA MEDICAL CENTER 00200 Part A Amount 48,542. CC 00301

100268 WEST BOCA MEDICAL CENTER 00200 Part A Amount 48,542. CC 00399

100269 PALMS WEST HOSPITAL 00100 Part A Info 02/12/2016 Date

100269 PALMS WEST HOSPITAL 00200 Part A Amount 19,905. CC 00301

100269 PALMS WEST HOSPITAL 00200 Part A Amount 19,905. CC 00399

100269 PALMS WEST HOSPITAL 00300 Part B Info 02/12/2016 Date

9/4/2017


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100269 PALMS WEST HOSPITAL 00400 Part B Amount 3,501. CC 00350

100269 PALMS WEST HOSPITAL 00400 Part B Amount -3,501. CC 00399

100275 WELLINGTON REGL MEDICAL CENTER 00100 Part A Info 10/21/2016 Date

100275 WELLINGTON REGL MEDICAL CENTER 00100 Part A Info 12/21/2016 Date

100275 WELLINGTON REGL MEDICAL CENTER 00200 Part A Amount 102,703. CC 00301



100287 GOOD SAMARITAN HOSPITAL 00100 Part A Info 03/03/2016 Date

100287 GOOD SAMARITAN HOSPITAL 00200 Part A Amount 119,443. CC 00301

100287 GOOD SAMARITAN HOSPITAL 00200 Part A Amount 119,443. CC 00399

100288 ST MARYS MEDICAL CENTER 00100 Part A Info 03/09/2016 Date

100288 ST MARYS MEDICAL CENTER 00200 Part A Amount 103,394. CC 00351

100288 ST MARYS MEDICAL CENTER 00200 Part A Amount -103,394. CC 00399

102023 SSH - PALM BEACH LLC 00100 Part A Info 09/01/2016 Date

102023 SSH - PALM BEACH LLC 00100 Part A Info 10/26/2016 Date

102023 SSH - PALM BEACH LLC 00200 Part A Amount 160,300. CC 00301

102023 SSH - PALM BEACH LLC 00200 Part A Amount 457,688. CC 00350

102023 SSH - PALM BEACH LLC 00200 Part A Amount -297,388. CC 00399

102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Part A Info 07/12/2016 Date


102025 KINDRED HOSPITAL THE PALM BEACHES 00200 Part A Amount 1,923,774. CC 00301

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 Part A Amount 49,460. CC 00350

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 Part A Amount 1,874,314. CC 00399

00400 Total Interim Payments (Sum of Lines 01,02 & 3.99) (Transfer to Wkst E or E-3 As Appropriate)









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00500 Tentative Settlement Payment - Provider to Program Date




102025 KINDRED HOSPITAL THE PALM BEACHES 00300 Part B Info 03/06/2017 Date

102025 KINDRED HOSPITAL THE PALM BEACHES 00400 Part B Amount 38,740. CC 00550

102025 KINDRED HOSPITAL THE PALM BEACHES 00400 Part B Amount -38,740. CC 00599

00602 Tentative Settlement Payment - Provider to Program


100176 PALM BEACH GARDENS 00200 Part A Amount 235,108.

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100253 JUPITER MEDICAL CENTER 00400 Part B Amount 15,767.

100268 WEST BOCA MEDICAL CENTER 00200 Part A Amount 187,003.

100275 WELLINGTON REGL MEDICAL CENTER 00200 Part A Amount 49,388.

100275 WELLINGTON REGL MEDICAL CENTER 00400 Part B Amount 30,251.

100287 GOOD SAMARITAN HOSPITAL 00200 Part A Amount 146,752.

100288 ST MARYS MEDICAL CENTER 00200 Part A Amount 946,454.

00700 Worksheet E-1 Total Medicare Program Liability (See Instructions)


























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102025 KINDRED HOSPITAL THE PALM BEACHES 00400 Part B Amount -28,380.



00800 FLORIDA

100002 BETHESDA HOSPITAL INC 00000 Description

100002 BETHESDA HOSPITAL INC 00100 Part A Info 09001 Date


100080 JFK MEDICAL CENTER 00100 Part A Info 05901 Date

100130 LAKESIDE MEDICAL CENTER 00000 Description

100130 LAKESIDE MEDICAL CENTER 00100 Part A Info 09001 Date


100168 BOCA RATON REGIONAL HOSPITAL 00100 Part A Info 09001 Date

100176 PALM BEACH GARDENS 00000 Description

100176 PALM BEACH GARDENS 00100 Part A Info 04011 Date

100234 WEST PALM HOSPITAL 00000 Description

100234 WEST PALM HOSPITAL 00100 Part A Info 05901 Date


100253 JUPITER MEDICAL CENTER 00100 Part A Info 09001 Date

100258 DELRAY MEDICAL CENTER 00000 Description

100258 DELRAY MEDICAL CENTER 00100 Part A Info 04011 Date

100268 WEST BOCA MEDICAL CENTER 00000 Description

100268 WEST BOCA MEDICAL CENTER 00100 Part A Info 04011 Date


100269 PALMS WEST HOSPITAL 00100 Part A Info 09001 Date


100275 WELLINGTON REGL MEDICAL CENTER 00100 Part A Info 12001 Date

100287 GOOD SAMARITAN HOSPITAL 00000 Description

100287 GOOD SAMARITAN HOSPITAL 00100 Part A Info 04011 Date

100288 ST MARYS MEDICAL CENTER 00000 Description

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100288 ST MARYS MEDICAL CENTER 00100 Part A Info 04011 Date

102023 SSH - PALM BEACH LLC 00000 Description

102023 SSH - PALM BEACH LLC 00100 Part A Info 09001 Date

102025 KINDRED HOSPITAL THE PALM BEACHES 00000 Description

102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Part A Info 09001 Date

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 Part A Amount 05/08/2017

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00000 Description

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 Part A Info 05901 Date

B18 IPF Medicare



100080 JFK MEDICAL CENTER 00400 Part B Amount 8,081.


100234 WEST PALM HOSPITAL 00400 Part B Amount 184,037.


100258 DELRAY MEDICAL CENTER 00400 Part B Amount 2,041.


100288 ST MARYS MEDICAL CENTER 00400 Part B Amount 5,045.







100288 ST MARYS MEDICAL CENTER 00200 Part A Amount -4,654. CC 00399








9/4/2017


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100080 JFK MEDICAL CENTER 00400 Part B Amount 13.

100258 DELRAY MEDICAL CENTER 00200 Part A Amount 7,738.










00800 WISCONSIN PHYSICIAN SERVICES


100080 JFK MEDICAL CENTER 00100 Part A Info 05901 Date


100234 WEST PALM HOSPITAL 00100 Part A Info 05901 Date





C18 IRF Medicare



100002 BETHESDA HOSPITAL INC 00400 Part B Amount 269.


100258 DELRAY MEDICAL CENTER 00400 Part B Amount 969.


100288 ST MARYS MEDICAL CENTER 00400 Part B Amount 448.

9/4/2017


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100002 BETHESDA HOSPITAL INC 00200 Part A Amount -58,668. CC 00399












100002 BETHESDA HOSPITAL INC 00200 Part A Amount 161,813.


100258 DELRAY MEDICAL CENTER 00200 Part A Amount 154,821.









00800 FLORIDA


100002 BETHESDA HOSPITAL INC 00100 Part A Info 09001 Date




9/4/2017


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2 Part 2 - Health Information Technology Data Collection and Calculation


00100 Total Hospital Discharges as Defined in AARA 4102 from Wkst S-3 Part 1 Line 14 Col 15

Discharges

100002 BETHESDA HOSPITAL INC 00100 Amount 22,225. Discharges

100080 JFK MEDICAL CENTER 00100 Amount 28,294. Discharges

100130 LAKESIDE MEDICAL CENTER 00100 Amount 1,993. Discharges

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amount 18,808. Discharges

100176 PALM BEACH GARDENS 00100 Amount 9,768. Discharges

100253 JUPITER MEDICAL CENTER 00100 Amount 12,038. Discharges

100258 DELRAY MEDICAL CENTER 00100 Amount 15,811. Discharges

100268 WEST BOCA MEDICAL CENTER 00100 Amount 11,282. Discharges

100269 PALMS WEST HOSPITAL 00100 Amount 14,125. Discharges

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amount 11,894. Discharges

100287 GOOD SAMARITAN HOSPITAL 00100 Amount 10,932. Discharges

100288 ST MARYS MEDICAL CENTER 00100 Amount 16,174. Discharges

102023 SSH - PALM BEACH LLC 00100 Amount 611. Discharges

00200 Medicare Days From Wkst S-3 Part 1 Col 6 Sum of Lines 01 and 08 to 12 Days

100002 BETHESDA HOSPITAL INC 00100 Amount 31,854. Days

100080 JFK MEDICAL CENTER 00100 Amount 43,122. Days

100130 LAKESIDE MEDICAL CENTER 00100 Amount 1,857. Days

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amount 47,789. Days

100176 PALM BEACH GARDENS 00100 Amount 22,205. Days

100253 JUPITER MEDICAL CENTER 00100 Amount 20,491. Days

100258 DELRAY MEDICAL CENTER 00100 Amount 39,979. Days

100268 WEST BOCA MEDICAL CENTER 00100 Amount 8,392. Days

100269 PALMS WEST HOSPITAL 00100 Amount 12,366. Days

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amount 9,665. Days

9/4/2017


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100287 GOOD SAMARITAN HOSPITAL 00100 Amount 17,640. Days

100288 ST MARYS MEDICAL CENTER 00100 Amount 9,214. Days

102023 SSH - PALM BEACH LLC 00100 Amount 8,965. Days

00300 Medicare HMO Days From Wkst S-3 Part 1 Col 06 Line 2 Days














00400 Total Inpatient Bed Days From S-3 Part 1 Col 08 Sum of Lines 01 and 08 to 12. Days














9/4/2017


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00500 Total Hospital Charges From Wkst C Part 1 Col 08 Line 200

100002 BETHESDA HOSPITAL INC 00100 Amount 1,678,082,690.

100080 JFK MEDICAL CENTER 00100 Amount 3,961,336,000.

100130 LAKESIDE MEDICAL CENTER 00100 Amount 127,349,655.

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amount 1,897,933,156.

100176 PALM BEACH GARDENS 00100 Amount 1,250,442,108.

100253 JUPITER MEDICAL CENTER 00100 Amount 886,306,242.

100258 DELRAY MEDICAL CENTER 00100 Amount 2,515,364,097.

100268 WEST BOCA MEDICAL CENTER 00100 Amount 742,974,675.

100269 PALMS WEST HOSPITAL 00100 Amount 1,357,920,590.

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amount 1,133,494,751.

100287 GOOD SAMARITAN HOSPITAL 00100 Amount 1,212,817,810.

100288 ST MARYS MEDICAL CENTER 00100 Amount 1,579,462,305.

102023 SSH - PALM BEACH LLC 00100 Amount 95,109,608.

00600 Total Hospital Charity Care Charges From Wkst S-10 Col 03 Line 20

100002 BETHESDA HOSPITAL INC 00100 Amount 42,480,683.

100080 JFK MEDICAL CENTER 00100 Amount 84,342,893.

100130 LAKESIDE MEDICAL CENTER 00100 Amount 2,108,235.

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amount 33,358,011.

100176 PALM BEACH GARDENS 00100 Amount 9,968,871.

100253 JUPITER MEDICAL CENTER 00100 Amount 10,929,856.

100258 DELRAY MEDICAL CENTER 00100 Amount 4,859,580.

100268 WEST BOCA MEDICAL CENTER 00100 Amount 908,007.

100269 PALMS WEST HOSPITAL 00100 Amount 25,002,645.

100275 WELLINGTON REGL MEDICAL CENTER 00100 Amount 34,695,257.

100287 GOOD SAMARITAN HOSPITAL 00100 Amount 5,467,344.

100288 ST MARYS MEDICAL CENTER 00100 Amount 6,913,212.

00800 Calculation of the HIT Iincentive Payment (See Instructions)

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amount 981,203.

100287 GOOD SAMARITAN HOSPITAL 00100 Amount 516,930.

100288 ST MARYS MEDICAL CENTER 00100 Amount 206,081.

9/4/2017


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00900 Sequestation Adjustment Amount (See Instructions)




01000 Calculation of the HIT Incentive Payment After Sequestration (See Instructions)




03000 Initial/Interim HIT Payments

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amount 1,082,084.



03200 Balance Due Provider (Line 08 Minus Line 30 Plus/Minus Line 31)

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amount -120,505.


100288 ST MARYS MEDICAL CENTER 00100 Amount -112.

G10 Wkst G-1 Statement of Changes in Fund Balances

00100 Fund Balances at Beginning of Period

100002 BETHESDA HOSPITAL INC 00200 General Fund 295,789,488.

100080 JFK MEDICAL CENTER 00200 General Fund 203,951,226.

100130 LAKESIDE MEDICAL CENTER 00200 General Fund 44,045,524.

100168 BOCA RATON REGIONAL HOSPITAL 00200 General Fund 345,369,234.

100176 PALM BEACH GARDENS 00200 General Fund 153,549,196.

100234 WEST PALM HOSPITAL 00200 General Fund -56,347,518.

100253 JUPITER MEDICAL CENTER 00200 General Fund 123,141,721.

100258 DELRAY MEDICAL CENTER 00200 General Fund 145,933,868.

100268 WEST BOCA MEDICAL CENTER 00200 General Fund 83,602,387.

100269 PALMS WEST HOSPITAL 00200 General Fund 244,938,281.

100275 WELLINGTON REGL MEDICAL CENTER 00200 General Fund 42,728,792.

100287 GOOD SAMARITAN HOSPITAL 00200 General Fund 154,853,999.

100288 ST MARYS MEDICAL CENTER 00200 General Fund 182,036,006.

102023 SSH - PALM BEACH LLC 00200 General Fund -17,954,137.

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102025 KINDRED HOSPITAL THE PALM BEACHES 00200 General Fund -2,740,007.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00200 General Fund 6,501,569.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00400 Specific Purpose Fund

172,789.

00200 Net Income(Loss) (Worksheet G-3 Line 29)

100002 BETHESDA HOSPITAL INC 00200 General Fund -10,312,752.


100130 LAKESIDE MEDICAL CENTER 00200 General Fund -44,885.











102023 SSH - PALM BEACH LLC 00200 General Fund -655,796.

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 General Fund 3,625,285.


00300 Total (Sum of Lines 01 and 02)












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102025 KINDRED HOSPITAL THE PALM BEACHES 00200 General Fund 885,278.



172,789.

00400 NON-OPERATING GAINS CC 00500

100002 BETHESDA HOSPITAL INC 00000 Description CC 00500


100002 BETHESDA HOSPITAL INC 00100 General Fund - Changes

6,419,640. CC 00500


1,065,373. CC 00600


100080 JFK MEDICAL CENTER 00100 General Fund - Changes

90.

100176 PALM BEACH GARDENS 00000 Description CC 00500





100176 PALM BEACH GARDENS 00100 General Fund - Changes

1. CC 00600


176,550. CC 00700


100234 WEST PALM HOSPITAL 00000 Description CC 00500

100234 WEST PALM HOSPITAL 00100 General Fund - Changes

2,227,788.

100234 WEST PALM HOSPITAL 00100 General Fund - Changes

19. CC 00500

100258 DELRAY MEDICAL CENTER 00000 Description CC 00500





9/4/2017


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100258 DELRAY MEDICAL CENTER 00100 General Fund - Changes

15,567,503. CC 00500


45. CC 00600

100268 WEST BOCA MEDICAL CENTER 00000 Description CC 00500





100268 WEST BOCA MEDICAL CENTER 00100 General Fund - Changes

54. CC 00600

100287 GOOD SAMARITAN HOSPITAL 00000 Description CC 00600


100287 GOOD SAMARITAN HOSPITAL 00100 General Fund - Changes

123,843. CC 00600

100288 ST MARYS MEDICAL CENTER 00000 Description CC 00500

100288 ST MARYS MEDICAL CENTER 00100 General Fund - Changes

385,797. CC 00500

102023 SSH - PALM BEACH LLC 00000 Description CC 00500


102025 KINDRED HOSPITAL THE PALM BEACHES 00000 Description CC 00500

102025 KINDRED HOSPITAL THE PALM BEACHES 00100 General Fund - Changes

3. CC 00500


104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 General Fund - Changes

1,019,181.

01000 Total Additions (Sum of Lines 04 to 09)


100080 JFK MEDICAL CENTER 00200 General Fund 90.

100176 PALM BEACH GARDENS 00200 General Fund 176,551.

100234 WEST PALM HOSPITAL 00200 General Fund 2,227,807.


100268 WEST BOCA MEDICAL CENTER 00200 General Fund 54.

100287 GOOD SAMARITAN HOSPITAL 00200 General Fund 123,843.

100288 ST MARYS MEDICAL CENTER 00200 General Fund 385,797.

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 General Fund 3.


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01100 Sub Total (Line 03 Plus Line 10)


















172,789.

01200 BAD DEBT CC 01300



12,781,198. CC 01300



100080 JFK MEDICAL CENTER 00100 General Fund - Changes

21,736,317.







9,777,002. CC 01300

9/4/2017


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35,737. CC 01700







1. CC 01400


48,148. CC 01700







24,681,547. CC 01300


72,186. CC 01700


100269 PALMS WEST HOSPITAL 00000 Description CC 01300

100269 PALMS WEST HOSPITAL 00100 General Fund - Changes

13,322,472.

100269 PALMS WEST HOSPITAL 00100 General Fund - Changes

1. CC 01300


100287 GOOD SAMARITAN HOSPITAL 00100 General Fund - Changes

16,898,993. CC 01300

100288 ST MARYS MEDICAL CENTER 00000 Description CC 01300

100288 ST MARYS MEDICAL CENTER 00100 General Fund - Changes

32,685,528. CC 01300


102025 KINDRED HOSPITAL THE PALM BEACHES 00000 Description CC 01300


01800 Deductions Line 12 to 17 (Debit Adjustments) (Specify)



9/4/2017


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100258 DELRAY MEDICAL CENTER 00200 General Fund 48,149.





01900 Fund Balance at End of Period Per Balance Sheet (Line 11 Minus 18)


















172,789.

G20 Wkst G-2 Statement of Patient Revenues and Operating Expenses

00100 Hospital

100002 BETHESDA HOSPITAL INC 00100 Inpatient Revenue 84,258,132.

100002 BETHESDA HOSPITAL INC 00300 Total Revenue 84,258,132.

100080 JFK MEDICAL CENTER 00100 Inpatient Revenue 304,926,106.

100080 JFK MEDICAL CENTER 00300 Total Revenue 304,926,106.

100130 LAKESIDE MEDICAL CENTER 00100 Inpatient Revenue 10,641,784.

100130 LAKESIDE MEDICAL CENTER 00300 Total Revenue 10,641,784.

9/4/2017


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100168 BOCA RATON REGIONAL HOSPITAL 00100 Inpatient Revenue 103,659,174.

100168 BOCA RATON REGIONAL HOSPITAL 00300 Total Revenue 103,659,174.

100176 PALM BEACH GARDENS 00100 Inpatient Revenue 88,219,093.

100176 PALM BEACH GARDENS 00300 Total Revenue 88,219,093.

100234 WEST PALM HOSPITAL 00100 Inpatient Revenue 51,923,577.

100234 WEST PALM HOSPITAL 00300 Total Revenue 51,923,577.

100253 JUPITER MEDICAL CENTER 00100 Inpatient Revenue 40,082,355.

100253 JUPITER MEDICAL CENTER 00300 Total Revenue 40,082,355.

100258 DELRAY MEDICAL CENTER 00100 Inpatient Revenue 189,337,331.

100258 DELRAY MEDICAL CENTER 00300 Total Revenue 189,337,331.

100268 WEST BOCA MEDICAL CENTER 00100 Inpatient Revenue 58,436,950.

100268 WEST BOCA MEDICAL CENTER 00300 Total Revenue 58,436,950.

100269 PALMS WEST HOSPITAL 00100 Inpatient Revenue 91,632,777.

100269 PALMS WEST HOSPITAL 00300 Total Revenue 91,632,777.

100275 WELLINGTON REGL MEDICAL CENTER 00100 Inpatient Revenue 108,217,370.

100275 WELLINGTON REGL MEDICAL CENTER 00300 Total Revenue 108,217,370.

100287 GOOD SAMARITAN HOSPITAL 00100 Inpatient Revenue 98,551,148.

100287 GOOD SAMARITAN HOSPITAL 00300 Total Revenue 98,551,148.

100288 ST MARYS MEDICAL CENTER 00100 Inpatient Revenue 141,835,208.

100288 ST MARYS MEDICAL CENTER 00300 Total Revenue 141,835,208.

102023 SSH - PALM BEACH LLC 00100 Inpatient Revenue 38,329,213.

102023 SSH - PALM BEACH LLC 00300 Total Revenue 38,329,213.

102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Inpatient Revenue 30,493,697.

102025 KINDRED HOSPITAL THE PALM BEACHES 00300 Total Revenue 30,493,697.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 Inpatient Revenue 11,673,185.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00300 Total Revenue 11,673,185.

00200 Subprovider - IPF






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00300 Subprovider - IRF







01000 Worksheet G-2 Total General Inpatient Care Services






















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01100 Intensive Care Unit






100168 BOCA RATON REGIONAL HOSPITAL 00100 Inpatient Revenue 4,095,394. CC 01101


100168 BOCA RATON REGIONAL HOSPITAL 00300 Total Revenue 4,095,394. CC 01101













9/4/2017


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100275 WELLINGTON REGL MEDICAL CENTER 00100 Inpatient Revenue 13,380,900. CC 01101


100275 WELLINGTON REGL MEDICAL CENTER 00300 Total Revenue 13,380,900. CC 01101







01200 Coronary Care Unit


100002 BETHESDA HOSPITAL INC 00100 Inpatient Revenue 1,129,300. CC 01201


100002 BETHESDA HOSPITAL INC 00300 Total Revenue 1,129,300. CC 01201

01400 Surgurical Intensive Care Unit



01500 Other Special Care




100268 WEST BOCA MEDICAL CENTER 00100 Inpatient Revenue 2,488,893. CC 01501


100268 WEST BOCA MEDICAL CENTER 00300 Total Revenue 2,488,893. CC 01501

100287 GOOD SAMARITAN HOSPITAL 00100 Inpatient Revenue 533,835.

100287 GOOD SAMARITAN HOSPITAL 00300 Total Revenue 533,835.



01600 Worksheet G-2 Total Intensive Care Type Inpatient Hospital Services



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01700 Worksheet G-2 Total Inpatient Routine Care Services






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01800 Ancillary Services



100080 JFK MEDICAL CENTER 00100 Inpatient Revenue 2,095,612,674.

100080 JFK MEDICAL CENTER 00200 Outpatient Revenue

1,130,221,456.

9/4/2017


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100080 JFK MEDICAL CENTER 00300 Total Revenue 3,225,834,130.


100130 LAKESIDE MEDICAL CENTER 00200 Outpatient Revenue

42,374,993.



100168 BOCA RATON REGIONAL HOSPITAL 00200 Outpatient Revenue

1,030,359,801.

100168 BOCA RATON REGIONAL HOSPITAL 00300 Total Revenue 1,666,470,831.


100176 PALM BEACH GARDENS 00200 Outpatient Revenue

458,065,742.

100176 PALM BEACH GARDENS 00300 Total Revenue 1,105,640,995.


100234 WEST PALM HOSPITAL 00200 Outpatient Revenue

182,334,549.



100253 JUPITER MEDICAL CENTER 00200 Outpatient Revenue

409,270,486.


100258 DELRAY MEDICAL CENTER 00100 Inpatient Revenue 1,509,519,194.

100258 DELRAY MEDICAL CENTER 00200 Outpatient Revenue

664,888,217.

100258 DELRAY MEDICAL CENTER 00300 Total Revenue 2,174,407,411.


100268 WEST BOCA MEDICAL CENTER 00200 Outpatient Revenue

290,853,036.



100269 PALMS WEST HOSPITAL 00200 Outpatient Revenue

397,816,056.

100269 PALMS WEST HOSPITAL 00300 Total Revenue 1,137,606,968.


100275 WELLINGTON REGL MEDICAL CENTER 00200 Outpatient Revenue

349,915,629.



9/4/2017


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100287 GOOD SAMARITAN HOSPITAL 00200 Outpatient Revenue

578,414,831.

100287 GOOD SAMARITAN HOSPITAL 00300 Total Revenue 1,094,221,779.


100288 ST MARYS MEDICAL CENTER 00200 Outpatient Revenue

407,027,635.

100288 ST MARYS MEDICAL CENTER 00300 Total Revenue 1,278,976,293.





104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00200 Outpatient Revenue

12,098,925.


01900 Outpatient Services

100002 BETHESDA HOSPITAL INC 00100 Inpatient Revenue 109,013.

100002 BETHESDA HOSPITAL INC 00200 Outpatient Revenue

657,669,767.




183,115,620.




22,469,229.




71,204,658.




46,009,188.




53,891,330.

9/4/2017


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64,773,210.




95,176,771.


02200 Home Health Agency


4,726,276.


02700 HOSPICE CHRG FOR NON-PATIENTS

100002 BETHESDA HOSPITAL INC 00000 Text Information

100002 BETHESDA HOSPITAL INC 00000 Text Information CC 02701


100002 BETHESDA HOSPITAL INC 00100 Inpatient Revenue 6,977,861. CC 02701


100002 BETHESDA HOSPITAL INC 00300 Total Revenue 6,977,861. CC 02701

100080 JFK MEDICAL CENTER 00000 Text Information

100130 LAKESIDE MEDICAL CENTER 00000 Text Information


496,856.

100130 LAKESIDE MEDICAL CENTER 00300 Total Revenue 496,856.

100168 BOCA RATON REGIONAL HOSPITAL 00000 Text Information

100168 BOCA RATON REGIONAL HOSPITAL 00000 Text Information CC 02701

100168 BOCA RATON REGIONAL HOSPITAL 00100 Inpatient Revenue 319,760.


819,859.


13,407,600. CC 02701


100168 BOCA RATON REGIONAL HOSPITAL 00300 Total Revenue 13,407,600. CC 02701

100268 WEST BOCA MEDICAL CENTER 00000 Text Information


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100287 GOOD SAMARITAN HOSPITAL 00000 Text Information



100288 ST MARYS MEDICAL CENTER 00000 Text Information



104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00000 Text Information


522,282.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00300 Total Revenue 522,282.

02800 Worksheet G-2 Total Patient Revenues (Transfer to G-3 Line 01)

100002 BETHESDA HOSPITAL INC 00100 Inpatient Revenue 1,024,511,225.

100002 BETHESDA HOSPITAL INC 00200 Outpatient Revenue

657,669,767.

100002 BETHESDA HOSPITAL INC 00300 Total Revenue 1,682,180,992.

100080 JFK MEDICAL CENTER 00100 Inpatient Revenue 2,647,998,924.


1,313,337,076.

100080 JFK MEDICAL CENTER 00300 Total Revenue 3,961,336,000.



65,341,078.




1,120,518,194.

100168 BOCA RATON REGIONAL HOSPITAL 00300 Total Revenue 1,912,480,370.


100176 PALM BEACH GARDENS 00200 Outpatient Revenue

458,065,742.

100176 PALM BEACH GARDENS 00300 Total Revenue 1,248,185,512.



228,343,737.



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463,161,816.


100258 DELRAY MEDICAL CENTER 00100 Inpatient Revenue 1,834,802,131.

100258 DELRAY MEDICAL CENTER 00200 Outpatient Revenue

664,888,217.

100258 DELRAY MEDICAL CENTER 00300 Total Revenue 2,499,690,348.


100268 WEST BOCA MEDICAL CENTER 00200 Outpatient Revenue

290,853,036.




462,589,266.

100269 PALMS WEST HOSPITAL 00300 Total Revenue 1,357,920,590.



445,092,400.

100275 WELLINGTON REGL MEDICAL CENTER 00300 Total Revenue 1,133,494,749.


100287 GOOD SAMARITAN HOSPITAL 00200 Outpatient Revenue

578,414,831.

100287 GOOD SAMARITAN HOSPITAL 00300 Total Revenue 1,213,554,639.

100288 ST MARYS MEDICAL CENTER 00100 Inpatient Revenue 1,169,116,183.

100288 ST MARYS MEDICAL CENTER 00200 Outpatient Revenue

407,027,635.

100288 ST MARYS MEDICAL CENTER 00300 Total Revenue 1,576,143,818.







12,621,207.


02900 Operating Expenses (Worksheet A Column 3 Line 200)

100002 BETHESDA HOSPITAL INC 00200 Operating Expense

318,075,144.

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100080 JFK MEDICAL CENTER 00200 Operating Expense

426,739,778.

100130 LAKESIDE MEDICAL CENTER 00200 Operating Expense

44,466,084.

100168 BOCA RATON REGIONAL HOSPITAL 00200 Operating Expense

419,896,411.

100176 PALM BEACH GARDENS 00200 Operating Expense

186,935,312.

100234 WEST PALM HOSPITAL 00200 Operating Expense

67,151,108.

100253 JUPITER MEDICAL CENTER 00200 Operating Expense

207,843,995.

100258 DELRAY MEDICAL CENTER 00200 Operating Expense

298,646,163.

100268 WEST BOCA MEDICAL CENTER 00200 Operating Expense

145,953,635.

100269 PALMS WEST HOSPITAL 00200 Operating Expense

145,995,921.

100275 WELLINGTON REGL MEDICAL CENTER 00200 Operating Expense

179,780,659.

100287 GOOD SAMARITAN HOSPITAL 00200 Operating Expense

166,357,494.

100288 ST MARYS MEDICAL CENTER 00200 Operating Expense

275,754,069.

102023 SSH - PALM BEACH LLC 00200 Operating Expense

27,908,815.

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 Operating Expense

24,719,113.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00200 Operating Expense

24,997,530.

03000 REBATES APPLIED TO EXPENSES

100002 BETHESDA HOSPITAL INC 00000 Text Information


-2,049,894.



43,210.

100234 WEST PALM HOSPITAL 00000 Text Information


13.


731,625.

100269 PALMS WEST HOSPITAL 00000 Text Information


20.

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5,461.

03600 Total Additions to Operating Expense (Lines 30 to 35)


-2,049,894.


43,210.


13.


731,625.


20.


5,461.

03700 REVENUE IN EXPENSE ACCTS


100080 JFK MEDICAL CENTER 00000 Text Information CC 03800


302,414.

100080 JFK MEDICAL CENTER 00100 Inpatient Revenue 417. CC 03800

100176 PALM BEACH GARDENS 00000 Text Information CC 03900

100176 PALM BEACH GARDENS 00100 Inpatient Revenue 26. CC 03900

100234 WEST PALM HOSPITAL 00000 Text Information


176,914.

100258 DELRAY MEDICAL CENTER 00000 Text Information


2,810,597.

100269 PALMS WEST HOSPITAL 00000 Text Information


78,253.

100275 WELLINGTON REGL MEDICAL CENTER 00000 Text Information


641.


8,695.

102023 SSH - PALM BEACH LLC 00000 Text Information


420,465.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00000 Text Information

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3.

04200 Total Deductions to Operating Expenses (Lines 37 to 41)


302,831.


26.


176,914.


2,810,597.


78,253.


641.


8,695.


420,465.


3.

04300 Worksheet G-2 Total Operating Expenses (Lines 29 and 36 Minus 42)


316,025,250.


426,436,947.

100130 LAKESIDE MEDICAL CENTER 00200 Operating Expense

44,466,084.

100168 BOCA RATON REGIONAL HOSPITAL 00200 Operating Expense

419,896,411.


186,978,496.


66,974,207.

100253 JUPITER MEDICAL CENTER 00200 Operating Expense

207,843,995.


295,835,566.


146,685,260.


145,917,688.


179,780,018.


166,362,955.


275,745,374.

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27,488,350.

102025 KINDRED HOSPITAL THE PALM BEACHES 00200 Operating Expense

24,719,113.


24,997,527.

G30 Wkst G-3 Statement of Revenues and Expenses

00100 Worksheet G-3 Total Patient Revenues (Wkst G-2 Part 1 Col 3 Line 28)











100275 WELLINGTON REGL MEDICAL CENTER 00100 Amounts 1,133,494,749.

100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 1,213,554,639.

100288 ST MARYS MEDICAL CENTER 00100 Amounts 1,576,143,818.

102023 SSH - PALM BEACH LLC 00100 Amounts 95,109,608.

102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Amounts 112,962,268.

104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 Amounts 24,294,392.

00200 Worksheet G-3 Contractual Allowances and Discounts on Patient Accounts










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100287 GOOD SAMARITAN HOSPITAL 00100 Amounts 1,030,054,374.

100288 ST MARYS MEDICAL CENTER 00100 Amounts 1,256,528,092.



00300 Worksheet G-3 Net Patient Revenues (Line 01 Minus 02)

















00400 Worksheet G-3 Total Operating Expenses (Wkst G-2 Part 2 Line 43)









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00500 Worksheet G-3 Net Margin from Service to Patients (Line 03 Minus 04)

100002 BETHESDA HOSPITAL INC 00100 Amounts -18,046,695.


100130 LAKESIDE MEDICAL CENTER 00100 Amounts -14,610,376.



100234 WEST PALM HOSPITAL 00100 Amounts -7,117,877.

100253 JUPITER MEDICAL CENTER 00100 Amounts -4,742,002.







102023 SSH - PALM BEACH LLC 00100 Amounts 249,814.


104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 Amounts -703,135.

00600 Contributions, Donations, Bequests, etc.







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00700 Income from Investments



100176 PALM BEACH GARDENS 00100 Amounts -1,719.


100258 DELRAY MEDICAL CENTER 00100 Amounts -5,079.


100287 GOOD SAMARITAN HOSPITAL 00100 Amounts -175.



01000 Purchase Discounts









104008 THE JEROME GOLDEN CENTER FOR BEHAVOR 00100 Amounts 913.

01100 Rebates and Refunds from Expenses








01400 Revenue from Meals Sold to Employees and Guests




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100253 JUPITER MEDICAL CENTER 00100 Amounts -15,197.





01700 Revenue from Sale of Druges to Other Than Patients


01800 Revenue from Sale of Medical Records and Abstracts










01900 Tuition (Fee, Sales of Textbooks, Uniforms, etc)






02100 Rental of Vending Machines



100287 GOOD SAMARITAN HOSPITAL 00100 Amounts -88.

102025 KINDRED HOSPITAL THE PALM BEACHES 00100 Amounts 198.

02200 Rental of Hospital Space




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02300 Governmental Appropriations


02400 MISCELLANEOUS INCOMES

























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100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 5. CC 02402

100168 BOCA RATON REGIONAL HOSPITAL 00100 Amounts 11,297. CC 02403












100253 JUPITER MEDICAL CENTER 00000 Description CC 02401







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100253 JUPITER MEDICAL CENTER 00100 Amounts 12,893,734. CC 02405














100287 GOOD SAMARITAN HOSPITAL 00100 Amounts -70. CC 02403






102023 SSH - PALM BEACH LLC 00100 Amounts 144,107. CC 02401



02500 Worksheet G-3 Total Other Income (Lines 06 to 24)


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02600 Worksheet G-3 Total Revenue(Lines 05 Plus 25)



100130 LAKESIDE MEDICAL CENTER 00100 Amounts -27,418.














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02700 LOSS ON SALE OF ASSET(S)














100253 JUPITER MEDICAL CENTER 00100 Amounts 1,458,377. CC 02703






102023 SSH - PALM BEACH LLC 00100 Amounts -8. CC 02701

102023 SSH - PALM BEACH LLC 00100 Amounts -306,936. CC 02702


02800 Worksheet G-3 Total Other Expenses (Lines 27 and subscripts)





02900 Worksheet G-3 Net Income or Loss From the Period



100130 LAKESIDE MEDICAL CENTER 00100 Amounts -44,885.

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102023 SSH - PALM BEACH LLC 00100 Amounts -655,796.



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Documents

RPT CR Analysis - Microsofthalmanac.blob.core.windows.net/...V2_Analysis_2016... · 100258 DELRAY MEDICAL CENTER 00100 Amounts 0.048364 Ratio 100269 PALMS WEST HOSPITAL 00100 Amounts