2010 Bad Debt and Charity Care (BDCC) Report - Chief Financial Officer (CFO) Certification

Hospital Name: ________________________________________________________________

Hospital Opcert: ___________________________________________________________

I hereby certify as Chief Fiscal Officer of the ______________________________________________________________________ Hospital that for the year 2010, except as noted below on this certification page, there were no significant changes in the method and policies of determining the expenses write-off for uncollectible accounts, using either the reserve method, direct write-off method or any combination of both, (including changes in the dollar parameters or in the number of days that elapse from date of service to write off or a combination of both) from that used in the preceding year. Significant changes are defined as those that resulted in an amount of expense write-off which, on an annual basis was greater than 20 percent of the amount that would have been recorded had the changes not been made.

In detailing the exception(s) noted below, I have provided full disclosure of the methods and policies used, their derivation and full explanation of why such changes were made.

CFO Signature: ________________________________________________________________________________________________________________

Date:____________________________________________________________________

Print Name: ___________________________________________________________________________________________________________________

Name and Title of Person to Contact: ________________________________________________________________________________________________________________________

Telephone Number (include area code) __________________________________________

Name & Title of Person to Contact: _________________________________________________________________________________________________

CFO E-mail address: _____________________________________________________________________________________________________________

Exceptions: ___________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

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