Note X – Concentration of Credit Risk

Note XConcentration of Credit Risk

The (district) grants credit without collateral to its patients, most of whom are local residents and are insured under third-party payor agreements. No single patient comprises more than five percent of total receivables at year-end. [1]

The mix of patient receivables at December 31, 20__ was as follows:

Medicare

_____%

Medicaid

_____%

Self-Pay (and Private Insurance)

_____%

Other Third Party Payors

_____%

Instructions to preparer:

[1] Modify this statement accordingly.