04-99,,,           FORM CMS-1984-99,,,,,,,,3890 (Cont.)
RECLASSIFICATIONS ADJUSTMENTS TO EXPENSES,,,,PROVIDER NO:,,,PERIOD:,,,WORKSHEET A-6,
,,,,,,,FROM,,,,
,,,,,,,TO,,,,
,,,,INCREASES,,,,DECREASES,,,
,,CODE,,,,,,,,,
,EXPLANATION OF RECLASSIFICATION(S),(1),COST CENTER,LINE #,SALARY,OTHER,COST CENTER,LINE #,SALARY,OTHER,
,,1,2,3,4,5,6,7,8,9,
1 ,,,,,,,,,,,1 
2 ,,,,,,,,,,,2 
3 ,,,,,,,,,,,3 
4 ,,,,,,,,,,,4 
5 ,,,,,,,,,,,5 
6 ,,,,,,,,,,,6 
7 ,,,,,,,,,,,7 
8 ,,,,,,,,,,,8 
9 ,,,,,,,,,,,9 
10 ,,,,,,,,,,,10 
11 ,,,,,,,,,,,11 
12 ,,,,,,,,,,,12 
13 ,,,,,,,,,,,13 
14 ,,,,,,,,,,,14 
15 ,,,,,,,,,,,15 
16 ,,,,,,,,,,,16 
17 ,,,,,,,,,,,17 
18 ,,,,,,,,,,,18 
19 ,,,,,,,,,,,19 
20 ,,,,,,,,,,,20 
21 ,,,,,,,,,,,21 
22 ,,,,,,,,,,,22 
23 ,,,,,,,,,,,23 
24 ,,,,,,,,,,,24 
25 ,,,,,,,,,,,25 
26 ,,,,,,,,,,,26 
27 ,,,,,,,,,,,27 
28 ,,,,,,,,,,,28 
29 ,,,,,,,,,,,29 
30 ,,,,,,,,,,,30 
31 ,,,,,,,,,,,31 
32 ,,,,,,,,,,,32 
33 ,,,,,,,,,,,33 
34 ,,,,,,,,,,,34 
35 ,,,,,,,,,,,35 
100 ,Total reclassifications (sum of col. 4 and 5,,,,,,,,,,
,must equal sum of col. 8 and 9),,,,,,,,,,100 
" (1) A letter (A, B, etc.) must be entered on each line to identify each reclassification entry.",,,,,,,,,,,
" Transfer the amounts in columns 4, 5, 8, and 9 to Worksheet A, column 5, lines as appropriate.",,,,,,,,,,,
,,,,,,,,,,,
"FORM CMS-1984-99 (4/99) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 3816) ",,,,,,,,,,,
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Rev. 1,,,,,,,,,,,  38-113