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["Welcome to the Electronic Submission Form! We hope you enjoy using this"]
["spreadsheet for your submissions. If you have questions, please call your"]
["hospital association."]
[null,"Nebraska Hospital Association"]
[null,"3255 Salt Creek Circle, Suite 100"]
[null,"Lincoln NE, 68504-4761"]
[null,"402-742-8140"]
[null,"Fax: AssocFax"]
[null," www.databank.org"]

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[3,"Nebraska Hospital Association",null,null,"DATABANK Electronic Submission Input Form"]
[null,"3255 Salt Creek Circle, Suite 100"]
[null,"Lincoln NE, 68504-4761",{"$nulls":6},"Beds"]
[null,"402-742-8140",null,"Month","Year",null,null,null,"Available","Licensed"]
[null,"Hospital ID:"]
[]
[null,"Column Letters","A","B","C","D","E","F","G","H"]
[null,"Utilization"]
[1,"Discharges","Medicare","Medicaid","Self Pay","Champus/Tricare","Managed Care","Commercial","Others","Total",1]
["a","Acute Care",{"$nulls":7},0,"a"]
["b","Swing Bed",{"$nulls":7},0,"b"]
["c","Subacute/LTC",{"$nulls":7},0,"c"]
["d","DPU",{"$nulls":7},0,"d"]
["e","",{"$nulls":7},0,"e"]
["f","Total",0,0,0,0,0,0,0,0,"f"]
[]
[2,"Patient Days","Medicare","Medicaid","Self Pay","Champus/Tricare","Managed Care","Commercial","Others","Total",2]
["a","Acute Care",{"$nulls":7},0,"a"]
["b","Swing Bed",{"$nulls":7},0,"b"]
["c","Subacute/LTC",{"$nulls":7},0,"c"]
["d","DPU",{"$nulls":7},0,"d"]
["e","",{"$nulls":7},0,"e"]
["f","Total",0,0,0,0,0,0,0,0,"f"]
[]
[3,"Number of Inpatient Surgeries",{"$nulls":8},3]
[4,"Number of Births",{"$nulls":8},4]
[5,"Number of Newborn Patient Days",{"$nulls":8},5]
[6,"Number of Admissions from Emergency Department",{"$nulls":8},6]
[]
[7,"Emergency Department Visits",{"$nulls":8},7]
[8,"Ambulatory Surgery Visits",{"$nulls":8},8]
[9,"Observation Visits",{"$nulls":8},9]
[10,"Home Health Visits",{"$nulls":8},10]
[11,"All Other Visits",{"$nulls":8},11]
[12,"Total Outpatient Visits",null,null,"12 = 7 + 8 + 9 + 10 + 11",{"$nulls":4},0,12]
[]
[null,null,"A","B","C","D","E","F","G","H"]
[null,"Charges","Medicare","Medicaid","Self Pay","Champus/Tricare","Managed Care","Commercial","Others","Total"]
[13,"Inpatient - Acute",{"$nulls":7},0,13]
[14,"Outpatient - Acute",{"$nulls":7},0,14]
[15,"Swing Bed",{"$nulls":7},0,15]
[16,"Subacute/LTC",{"$nulls":7},0,16]
[17,"DPU",{"$nulls":7},0,17]
[18,"",{"$nulls":7},0,18]
[19,"Home Health",{"$nulls":7},0,19]
[20,"Total Charges",0,0,0,0,0,0,0,0,20]
[null,"Contractual Allowances","Medicare","Medicaid","Self Pay","Champus/Tricare","Managed Care","Commercial","Others","Total"]
[21,"Contractuals - Acute",{"$nulls":7},0,21]
[22,"Contractuals - Other",{"$nulls":7},0,22]
[23,"Total Contractual Allowances",0,0,0,0,0,0,0,0,23]
[{"$nulls":4},"Net Patient Revenue"]
[24,"Charity Care",null,"Net Patient","As a & of Gross",{"$nulls":5},24]
[30,"Bad Debt",null,"Revenue","Patient Charges",{"$nulls":5},30]
[null,null,null,0,0,{"$nulls":4},"Charity Care as % of Total Charges"]
[null,"Operating Expenses",{"$nulls":7},0]
[25,"Payroll Expense","Per Hour","Amount","Hours"]
["a","Facility Payroll",0,null,null,"d"]
["b","Physician Payroll",0,null,null,"e"]
["c","Total Payroll, Total Hours",0,0,0,"f"]
[]
[26,"Benefit Expense",null,null,26]
[27,"Supply Expense",null,null,27]
[28,"Depreciation Expense",null,null,28]
[29,"Interest Expense",null,null,29]
[31,"All Other Expense",null,null,31]
[32,"Total Operating Expense",null,0,"32 = 25c+26+27+28+29+31"]
[]
[null,"Other Financial Data"]
[33,"Other Operating Revenue",null,null,33]
[34,"Operating Margin",null,0,"34 = 20H - 23H - 24 -30 - 32 + 33"]
[35,"Net Nonoperating Gains",null,null,35]
[36,"Tax Subsidies",null,null,36]
[37,"Total Margin",null,0,"37 = 34 +/- 35 + 36"]
[null,null,"A","B","C","D","E","F","G","H"]
[]
[null,"Gross Patient","Medicare","Medicaid","Self Pay","Champus/Tricare","Managed Care","Commercial","Others","Total"]
[38,"Accounts Receivable",{"$nulls":7},0,38]
[]
[null,"Comments:"]
[]
[]
[null,"Click here to go to the Balance Sheet Input Form"]

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[null,"Nebraska Hospital Association"]
[null,"3255 Salt Creek Circle, Suite 100"]
[null,"Lincoln NE, 68504-4761"]
[null,"402-742-8140"]
[null,null,"Assets"]
[null,null,"Current Assets:"]
[null,1,"Cash and Short-Term Investments……………….",null,null,1]
[null,2,"Patient Accounts Receivable……………………..",null,null,2]
[null,3,"Allowance for Doubtful Accounts……………..",null,null,3]
[null,4,"Net Accounts Receivable………………………..",null,0,4]
[{"$nulls":4},"Net Accounts Receivable = 2 - 3 = 4"]
[null,5,"Inventories………………………………………",null,null,5]
[null,6,"Other Current Assets…………………………….",null,null,6]
[null,7,"Total Current Assets…………………………..",null,0,7]
[{"$nulls":4},"Total Current Assets = 1 + 4 + 5 + 6 = 7"]
[null,null,"Assets Whose use is Limited"]
[null,8,"By Board Action………………………………..",null,null,8]
[null,9,"By Donors………………………………………",null,null,9]
[]
[null,10,"Long Term Investments……………………………",null,null,10]
[]
[null,11,"Property, Plant & Equipment………………………",null,null,11]
[null,12,"Less Accumulated Depreciation………………….",null,null,12]
[null,13,"Property, Plant & Equipment, Net……………………",null,0,13]
[{"$nulls":4},"Property, Plant & Equipment, Net = 11 - 12 = 13"]
[null,14,"Other Assets……………………………………….",null,null,14]
[]
[null,15,"Hospital Foundation……………………………….",null,null,15]
[]
[null,16,"Total Assets………………………………………..",null,0,16]
[{"$nulls":4},"Total Assets = 7 + 8 + 9 + 10 + 13 + 14 + 15 = 16"]
[null,null,"Liabilities and Net Assets"]
[null,null,"Current Liabilities:"]
[null,17,"Current Portion of Long-Term Debt……………..",null,null,17]
[null,18,"Accounts Payable/Accrued Expenses……………",null,null,18]
[null,19,"Other Current Liabilities…………………………",null,null,19]
[null,20,"Deferred Revenues………………………………",null,null,20]
[null,21,"Total Current Liabilities………………………",null,0,21]
[{"$nulls":4},"Total Current Liabilities = 17 + 18 + 19 + 20 + 21 = 22"]
[null,22,"Long Term Debt……………………………………",null,null,22]
[null,23,"Other Liabilities…………………………………….",null,null,23]
[]
[null,null,"Net Assets:"]
[null,24,"Unrestricted……………………………………..",null,null,24]
[null,25,"Temporarily Restricted…………………………..",null,null,25]
[null,26,"Permanently Restricted…………………………..",null,null,26]
[null,27,"Total Net Assets…………………………………..",null,0,27]
[{"$nulls":4},"Total Net Assets =24 + 25 + 26  = 27"]
[null,28,"Total Liabilities & Net Assets…………………….",null,0,28]
[{"$nulls":4},"Total Liabilities & Net Assets = 21 + 22 + 23 + 27 = 28"]
[null,null,"Supplemental Data"]
[null,29,"Principal Payment on Long Term Debt…………..",null,null,29]
[null,30,"Premium Revenue……………………………….",null,null,30]

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["Name","Nebraska Hospital Association"]
["Program Name","DATABANK"]
["Address","3255 Salt Creek Circle, Suite 100"]
["CityStateZip","Lincoln NE, 68504-4761"]
["Phone","402-742-8140"]
["Fax","402-742-8191"]
["OptPayor1","Champus/Tricare"]
["OptPayor2","Managed Care"]
["OptPayor3","Commercial"]
["OptLOS1Discharges","Swing Bed"]
["OptLOS2Discharges","Subacute/LTC"]
["OptLOS3Discharges","DPU"]
["OptLOS4Discharges",""]
["OptLOS1PatDays","Swing Bed"]
["OptLOS2PatDays","Subacute/LTC"]
["OptLOS3PatDays","DPU"]
["OptLOS4PatDays",""]
["OptLOS1Charges","Swing Bed"]
["OptLOS2Charges","Subacute/LTC"]
["OptLOS3Charges","DPU"]
["OptLOS4Charges",""]

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