(5) Subject to the specifications and instructions detailed in the Data Submission Manual, and unless otherwise specified by the MA-RPO Program, an Annual Filing shall include the following information about the Provider Organization:

1. (a) Information about the ownership, governance, and operational structure, including organizational charts, narrative descriptions of the type and kind of Corporate Affiliations and Contracting Affiliations, information on incentive structures and compensation models, including Funds Flow within the Provider Organization, information on Significant Equity Investors, Real Estate Investment Trusts, and Management Services Organizations, and information on the characteristics of any Clinical Affiliations and the role of Community Advisory Boards;
2. (b) The number of Health Care Professional Full-Time Equivalents by license type and specialty, each Health Care Professional's name, address of principal location of work, national provider identifier, or other identifying information, and whether the Health Care Professional is employed by or affiliated with the Provider Organization and the nature of that relationship, including whether provisions exist in physician participation or employment agreements such as referral requirements;
3. (c) The name and address of each Facility and Practice Site, including by license number, license type, tax identification number, national provider identifier, and capacity in each major service category;
4. (d) The name, address, and capacity of all other locations where the Provider Organization delivers Health Care Services, including those services listed in M.G.L. c. 6D, § 22(a);
5. (e) Comprehensive financial statements, including audited financial statements, consolidating schedules and standardized filings that shall include a balance sheet and a statement of operations, and including information on the Uppermost Corporate Parent, including their out-of-state operations, and Corporate Affiliates, including Significant Equity Investors, Health Care Real Estate Investment trusts and Management Services Organizations as applicable, and including details regarding annual costs, annual receipts, realized capital gains and losses, accumulated surplus and accumulated reserves;
6. (f) Information on clinical quality, care coordination and patient referral practices;
7. (g) Information regarding expenditures and funding sources for payroll, teaching, research, advertising, taxes or payments-in-lieu-of-taxes and other non-clinical functions;
8. (h) Information regarding charitable care and community benefit programs;
9. (i) For Risk-bearing Provider Organizations, a statement certifying that the RBPO has received a risk certificate or a waiver from the Division as required by M.G.L. c. 176T or any regulations promulgated thereunder;
10. (j) Information regarding other assets and liabilities that may affect the financial condition of the Provider Organization or the Provider Organization's Facilities including, but not limited to, real estate sale-leaseback arrangements with Health Care Real Estate Investment Trusts;
11. (k) Information regarding any discounts, rebates or any other type of refunds or remuneration in exchange for, or in any way related to, the provision of heath care services;
12. (l) Information on stop-loss insurance and any non-fee-for-service payment arrangements;
13. (m) Information on utilization by major service category;
14. (n) Total revenue by payer under pay for performance arrangements, risk contracts, and other fee-for-service arrangements;
15. (o) Attestations completed by two duly authorized officers of the Provider Organization that the Registration information is true and accurate; and
16. (p) A registration fee payable to the Health Policy Commission as specified by the Commission.