Exhibit 2 - Statement of Financial Position and Statement of

400.2 - Exhibit 2 - Statement of Financial Position and Statement of Operations - SMI - (Rev. 5, 08-30-02) This report is a duplicate of the above Exhibit 1, Statement of Financial Position and Statement of Operations - HI, except: • The HI report, in the applicable line item descriptions, refers to "provider", and the SMI report refers to "provider, physician, and supplier". • For the SMI report (CMS-750B), the FI completes the items dealing with cost reports, PIP, and credit balances; but the carrier omits them. Also, the intermediary inserts data relating to the Provider Overpayment Report (POR), while the carrier inserts data relating to the Physician Supplier Overpayment Report (PSOR).