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{"sheet":"422 HRSA 99-1 1","index":0,"n_rows":41,"n_cols":9,"rows_kept":41,"cut":false,"hidden":false,"merged":[[0,7,0,8],[14,8,15,8],[5,2,5,8],[12,1,13,5],[12,7,12,8],[8,0,8,2],[6,3,6,6],[7,0,7,1],[1,6,1,8],[7,2,7,8],[18,1,18,5],[17,1,17,5],[16,1,16,5],[9,6,9,8],[3,0,4,8],[24,1,24,5],[23,1,23,5],[10,0,11,7],[10,8,11,8],[12,0,13,0],[5,0,5,1],[20,1,20,5],[14,0,15,0],[19,1,19,5],[34,1,34,5],[35,1,35,5],[14,7,15,7],[14,1,15,3],[14,4,14,5],[15,4,15,5],[29,1,29,5],[30,1,30,5],[31,1,31,5],[32,1,32,5],[21,1,21,5],[8,4,8,8],[33,1,33,5],[28,1,28,5],[22,1,22,5],[25,1,25,5],[27,1,27,5],[26,1,26,5],[9,0,9,2],[9,3,9,4]],"flags":["formulas_cached_only"]}
["Department of Health and Human Services",{"$nulls":6},"OMB N0. 0915-0247"]
["Health Resources and Services Administration",{"$nulls":5},"Expiration Date:"]
[]
["Children's Hospitals Graduate Medical Education Payment Program                                                                                                                                                               Determination of Weighted and Unweighted Resident FTE Counts"]
[]
["Name of Applicant:"]
["City:",null,"State:",{"$nulls":4},"Zip Code:"]
["Medicare Provider Number:"]
["Fiscal Year in which applying for funding:",null,null,"FFY"," "]
["Type of Application (check  box to the left)",null,null,"_____Initial Application",null,null,"_____Reconciliation Application"]
["Are you a new children's hospital that has not completed three full Medicare cost reporting periods?                                       (Please place  'n' for no or 'y' for yes  in the cell to the right)"]
[]
["Section 1","DETERMINATION OF RESIDENT FTE CAP                                                                             FOR THE HOSPITAL'S MOST RECENT COST REPORTING PERIOD                          ENDING ON OR BEFORE DECEMBER 31, 1996",{"$nulls":4},"To be completed by hospital","For CHGME FI          Use Only"]
[{"$nulls":6},"HOSPITAL DATA","MCR DATA","FI      DATA"]
[1.01,"Inclusive dates of the subject cost reporting period",null,null,"(From)",null," "]
[{"$nulls":4},"(To)"]
[1.02,"Status of MCR"]
[1.03,"Unweighted resident FTE count for allopathic and osteopathic programs (from the 1996 cap year)",{"$nulls":4},0,0,0]
["Section 2","AVERAGE OF UNWEIGHTED RESIDENT FTE COUNTS",{"$nulls":4},"HOSPITAL DATA","MCR DATA","FI      DATA"]
[2.01,"Total unweighted resident FTE count for the hospital's most recently completed cost reporting period",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[2.02,"Total unweighted resident FTE count for the hospital's prior cost reporting period",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[2.03,"Total unweighted resident FTE count for the hospital's penultimate cost reporting period",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[2.04,"Rolling average of unweighted resident FTE count",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[2.05,"Add On:  Unweighted resident FTE count meeting the criteria for an exception",{"$nulls":4},0,0,0]
[2.06,"Adjusted rolling average of unweighted resident FTE count",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[2.07,"Add On:  Unweighted resident FTE count from MMA §422 ",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[2.08,"Grand Total:  Unweighted resident FTE Count",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
["Section 3","AVERAGE OF WEIGHTED RESIDENT FTE COUNTS",{"$nulls":4},"HOSPITAL DATA","MCR DATA","FI      DATA"]
[3.01,"Total weighted resident FTE count for the hospital's most recently completed cost reporting period",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[3.02,"Total weighted resident FTE count for the hospital's prior cost reporting period",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[3.03,"Total weighted resident FTE count for the hospital's penultimate cost reporting period",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[3.04,"Rolling average of weighted resident FTE count",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[3.05,"Add On:  Weighted resident FTE count meeting the criteria for an exception",{"$nulls":4},0,0,0]
[3.06,"Adjusted rolling average of weighted resident FTE count",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[3.07,"Add On:  Weighted resident FTE count from MMA §422 ",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[3.08,"Grand Total:  Weighted resident FTE Count",{"$nulls":4},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]
[]
[]
[]
["HRSA 99-1 PAGE 1 OF 4",{"$nulls":6},"Created in MS Excel 7.0"]
["(Rev. 06-2006)"]

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["Department of Health and Human Services",{"$nulls":6},"OMB N0. 0915-0247"]
["Health Resources and Services Administration",{"$nulls":5},"Expiration Date: "]
[]
["Children's Hospitals Graduate Medical Education Payment Program                                                                Government Performance and Results Act (GPRA) Tables"]
[]
["Name of Applicant: ",null,0]
["City:",0,"State:",0,null,null,null,"Zip Code:",0]
["Medicare Provider Number:",null,0]
["Fiscal Year in which applying for funding:          FFY",null,null,null," "]
["Type of Application (check box to the left)                  For submission with Reconciliation Application only."]
["Table 1.  Number of FTE Residents Enrolled in Approved Residency Programs Supported by or Rotating at the Children's Hospital"]
[]
[]
["Number of FTE Residents Enrolled in Approved Residency Programs",null,null,null,"General Pediatric Residents","Subspecialty  Pediatric Residents (Fellows)",null,"Non-Pediatric Residents","Total"]
[]
[]
[]
[1.01,"Sponsored by the Children's Hospital and Rotating at the Children's Hospital",null,null,0,0,null,0,0]
[]
[]
[1.02,"Sponsored by the Children's Hospital and Rotating at Non-Provider sites",null,null,0,0,null,0,0]
[]
[]
[1.03,"Sponsored by Other Hospitals and Rotating at the Children's Hospital",null,null,0,0,null,0,0]
[]
[]
[1.04,"Sum of Lines 1.01 through 1.03 (above)",null,null,0,0,null,0,0]
[]
[]
[1.05,"Sponsored by the Children's Hospital and Rotating at Other Hospitals",null,null,0,0,null,0,0]
[]
[]
[]
[]
[]
["Table 2.  Hospital's Total and Operating Margins"]
[]
[]
["Total Margins"]
[]
["Operating Margins"]
[]
[]
[]
[]
["HRSA 99-4 PAGE 1 OF 2",{"$nulls":6},"Created in MS Excel 7.0"]
["(Rev. 06-2006)"]

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["Department of Health and Human Services",{"$nulls":6},"OMB N0. 0915-0247"]
["Health Resources and Services Administration",{"$nulls":5},"Expiration Date:  01/31/2007"]
[]
["Children's Hospitals Graduate Medical Education Payment Program                                                                Government Performance and Results Act (GPRA) Tables"]
[]
["Name of Applicant: ",null,0]
["City:",0,"State:",0,null,null,null,"Zip Code:",0]
["Medicare Provider Number:",null,0]
["Fiscal Year in which applying for funding:           FFY",null,null,null," "]
["Type of Application (check box to the left)                  For submission with Reconciliation Application only."]
["Table 3.  Hospital's Allowable Operating Expenses"]
[]
[]
["Total Allowable Operating Expenses"]
[]
[]
[]
[]
["Table 4. Hospital's Revenue, Gross Revenue and Expenses Attributed to Patient Care"]
[]
[]
["Revenue and Expense Type",{"$nulls":4},"Inpatient",null,"Outpatient"]
[]
["1.  Hospital's gross revenue attributed to Medicaid & SCHIP"]
["2.  Hospital's gross revenue attributed to Medicare"]
["3.  Hospital's gross revenue attributed to self-pay"]
["4.  Hospital's gross revenue attributed to other sources"]
["5.  Hospital's total gross revenue attributed to patient care",{"$nulls":4},0,null,0]
["6.  Hospital's total expenses attributed to uncompensated care (bad debt)"]
["7.  Hospital's total expenses attributed to charity care"]
{"$rows_empty":16}
["HRSA 99-4 PAGE 2 OF 2",{"$nulls":6},"Created in MS Excel 7.0"]
["(Rev. 06-2006)"]