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[null,null,null,"Specific"]
[null,"Assets","General","Purpose","Endowment","Plant"]
[null,"(Omit cents)","Fund","Fund","Fund","Fund"]
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[9,"Other current assets",{"$nulls":4},9]
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[11,"Total current assets (sum of lines 1-10)",{"$nulls":4},11]
[null,"FIXED ASSETS"]
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[14,"   Accumulated depreciation ",{"$nulls":4},14]
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[23,"Major movable equipment ",{"$nulls":4},23]
[24,"   Accumulated depreciation ",{"$nulls":4},24]
[25,"Minor equipment depreciable ",{"$nulls":4},25]
[26,"   Accumulated depreciation ",{"$nulls":4},26]
[27,"HIT designated Assets",{"$nulls":4},27]
[28,"   Accumulated depreciation ",{"$nulls":4},28]
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[null,"Liabilities and Fund",null,"Specific"]
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[null,"(Omit cents)","Fund","Fund","Fund","Fund"]
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[null,"CURRENT LIABILITIES"]
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[41,"Deferred income",{"$nulls":4},41]
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[44,"Other current liabilities",{"$nulls":4},44]
[45,"Total current liabilities (sum of",{"$nulls":4},45]
[null,"   lines 37 thru 44)"]
[]
[null,"LONG TERM LIABILITIES"]
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[47,"Notes payable",{"$nulls":4},47]
[48,"Unsecured loans",{"$nulls":4},48]
[49,"Other long term liabilities",{"$nulls":4},49]
[50,"Total long term liabilities (sum of",{"$nulls":4},50]
[null,"   lines 46 thru 49)"]
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[null,"CAPITAL ACCOUNTS"]
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[53,"Specific purpose fund",{"$nulls":4},53]
[54,"Donor created - endowment fund",{"$nulls":4},54]
[null,"balance - restricted"]
[55,"Donor created - endowment fund",{"$nulls":4},55]
[null,"balance - unrestricted"]
[56,"Governing body created - endowment",{"$nulls":4},56]
[null,"fund balance"]
[57,"Plant fund balance - invested in plant",{"$nulls":4},57]
[58,"Plant fund balance - reserve for plant",{"$nulls":4},58]
[null,"improvement, replacement, and expansion"]
[59,"Total fund balances (sum of lines 52 thru 58)",{"$nulls":4},59]
[60,"Total liabilities and fund balances (sum of",{"$nulls":4},60]
[null,"   lines 51 and 59)"]
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[{"$nulls":7},"FROM _________"]
[{"$nulls":5},"______________",null,"TO ___________"]
[null,null,"              GENERAL FUND",null,"     SPECIFIC PURPOSE FUND",null,"         ENDOWMENT FUND",null,"           PLANT FUND"]
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[3,"Total (sum of line 1 and line 2)",{"$nulls":8},3]
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["PART I - PATIENT REVENUES"]
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[null,null,null,"INPATIENT","OUTPATIENT"," TOTAL"]
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[null,"   of lines 11-15)"]
[17,"Total inpatient routine care services (sum of lines 10 and 16)",{"$nulls":4},17]
[18,"Ancillary services",{"$nulls":4},18]
[19,"Outpatient services",{"$nulls":4},19]
[20,"Home health agency",{"$nulls":4},20]
[21,"Ambulance",{"$nulls":4},21]
[22,"Outpatient rehabilitation providers",{"$nulls":4},22]
[23,"ASC",{"$nulls":4},23]
[24,"Hospice",{"$nulls":4},24]
[25,"Other (specify)",{"$nulls":4},25]
[26,"Total patient revenues (sum of lines 17-25) (transfer column 3 to",{"$nulls":4},26]
[null,"   Wkst. G-3, line 1)"]
[]
["PART II - OPERATING EXPENSES"]
[{"$nulls":4},"1","2"]
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[28,"Add (specify)",{"$nulls":4},28]
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[30,{"$nulls":5},30]
[31,{"$nulls":5},31]
[32,{"$nulls":5},32]
[33,{"$nulls":5},33]
[34,"Total additions (sum of lines 28-33)",{"$nulls":4},34]
[35,"Deduct (specify)",{"$nulls":4},35]
[36,{"$nulls":5},36]
[37,{"$nulls":5},37]
[38,{"$nulls":5},38]
[39,{"$nulls":5},39]
[40,"Total deductions (sum of lines 35-39)",{"$nulls":4},40]
[41,"Total operating expenses (sum of lines 27 and 34 minus line 40) (transfer to Wkst. G-3, line 4)",{"$nulls":4},41]
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["Rev. 1",{"$nulls":5},"40-603"]

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[]
[null,"Description"]
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[3,"Net patient revenues (line 1 minus line 2)",null,null,null,3]
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[]
[null,"OTHER INCOME"]
[]
[6," Contributions, donations, bequests, etc",null,null,null,6]
[7," Income from investments",null,null,null,7]
[8," Revenues from telephone and telegraph service",null,null,null,8]
[9," Revenue from television and radio service",null,null,null,9]
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[15," Revenue from rental of living quarters",null,null,null,15]
[16," Revenue from sale of medical and surgical supplies to other than patients",null,null,null,16]
[17," Revenue from sale of drugs to other than patients",null,null,null,17]
[18," Revenue from sale of medical records and abstracts",null,null,null,18]
[19," Tuition (fees, sale of textbooks, uniforms, etc.)",null,null,null,19]
[20," Revenue from gifts, flowers, coffee shops, and canteen",null,null,null,20]
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[23," Governmental appropriations",null,null,null,23]
[24," Other (specify)",null,null,null,24]
[25," Total other income (sum of lines 6-24)",null,null,null,25]
[26," Total (line 5 plus line 25)",null,null,null,26]
[27," Other expenses (specify)",null,null,null,27]
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