List of Required Documents

  1. Business Tax Returns (3 Years)
  2. Tax Asset Summary (from the most recent tax return)
  3. Income Statement (3 Years, also referred to as a Statement of Profit and Loss) plus a trailing 12 month P&L. Meaning a P&L from the most recent 12 months. Example July 1,2020 – June 30, 2021
  4. Balance Sheet (3 Years though not as critical as the Income Statements)
  5. Procedure by Provider Report – Two Years plus YTD. Plus a procedure by Provider report to cover the same period in the TTM period above in #3. Please include the number of new starts in an Ortho practice. Please include the total value of any open contracts in an Ortho Practice
  6. Salary Report broken out by staff member – One year
  7. Staff member name, hire date, hours, rate of pay, and position
  8. Copy of the current lease
  9. Fixed Asset Description (this maybe on the tax return)
  10. Current Fee Schedule
  11. List of all payors you are in network with especially if you are a Delta Premier provider. If Delta Premier please provide the number of Premier patients and revenue generated by those patients one year plus YTD.
  12. Practice analysis report from the software.
  13. Production/collection/adjustment report for the most recent 12 months covering the trailing P&L from #3 above.
  14. Payroll reports for the last full year, YTD current year, and the TTM period please.