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Adult Day Health Care (ADHC) Forms

Adult Day Health Care Annual Cost Report

These documents have been made available to Adult Day Health Care (ADHC) centers for the preparation of the Annual Cost Report (ACR), ADH 0011, Revision 09/00. Use of this version is required for all centers beginning with the fiscal year ending 06/30/00 and thereafter.

Following are the download choices for text files:

• Instructions ADH0011 Rev 09-00
  Prepared in Word 97 These instructions are mandatory and provide guidance and terminology on completing the required ACR format.
  File size: 57KB.
• Acct Descr ADH0011 Rev 09-00
  Prepared in Word 97 This file contains the chart of accounts recommended for use by ADHCs. While not mandatory, review of the file is recommended as it is helpful in defining account names and structures that support the ACR format.
  File size: 87 KB.

Select one of the following spreadsheet files:

• Cost Report Form Only ADH0011 Rev 09-00
  Prepared in Excel 97
  This file provides the mandatory ACR format. Centers that are planning to type or hand-write their ACRs from data compiled elsewhere should download this file.
  File size: 63 KB.
• Cost Report Electronic ADH0011 Rev 09-00
  Prepared in Microsoft Excel 97
  This file contains both the mandatory ACR format and supplemental worksheets that can be used by the center to assist in ACR completion. Using the supplemental worksheets for data entry, a center can work from the recommended chart of accounts and their financial documentation to gather the data. Totals are automatically posted to the ACR format, which can then be printed for submission. Centers completing this format also have the option of participating in a trend analysis and benchmarking study. Instructions for completing this enhanced electronic version of the ACR appear on the first worksheet in the workbook.
  File size: 2.1 MB.