3890 (Cont.),,     FORM CMS-1984-99,,,,09-00
,BALANCE   SHEET,,PROVIDER NO:,PERIOD:,,
   (If you are nonproprietary and do not maintain fund-type,,,,FROM, WORKSHEET  G,
"    accounting records,  complete the ""General Fund"" column only)",,,,TO,,
,,,Specific,,,
,Assets,General,Purpose,Endowment,Plant,
,(Omit cents),Fund,Fund,Fund,Fund,
,,1,2,3,4,
,CURRENT  ASSETS,,,,,
1 ,Cash on hand and in banks,,,,,1 
2 ,Temporary investments,,,,,2 
3 ,Notes receivable,,,,,3 
4 ,Accounts receivable,,,,,4 
5 ,Other receivables,,,,,5 
6 ,Less: allowances for uncollectible notes,,,,,6 
,and accounts receivable,,,,,
7 ,Inventory,,,,,7 
8 ,Prepaid expenses,,,,,8 
9 ,Other current assets,,,,,9 
10 ,Due from other funds,,,,,10 
11 ,TOTAL  CURRENT  ASSETS,,,,,11 
,(Sum of lines 1 - 10),,,,,
,FIXED  ASSETS,,,,,
12 ,Land,,,,,12 
13 ,Land improvements,,,,,13 
14 ,Less: Accumulated depreciation,,,,,14 
15 ,Buildings,,,,,15 
16 ,Less Accumulated depreciation,,,,,16 
17 ,Leasehold improvements,,,,,17 
18 ,Less: Accumulated Amortization,,,,,18 
19 ,Fixed equipment,,,,,19 
20 ,Less: Accumulated depreciation,,,,,20 
21 ,Automobiles and trucks,,,,,21 
22 ,Less: Accumulated depreciation,,,,,22 
23 ,Major movable equipment,,,,,23 
24 ,Less: Accumulated depreciation,,,,,24 
25 ,Minor equipment nondepreciable,,,,,25 
26 ,Other fixed assets,,,,,26 
27 ,TOTAL  FIXED  ASSETS,,,,,27 
,(Sum of lines 12 - 26),,,,,
,OTHER  ASSETS,,,,,
28 ,Investments,,,,,28 
29 ,Deposits on leases,,,,,29 
30 ,Due from owners/officers,,,,,30 
31 ,Other assets,,,,,31 
32 ,TOTAL  OTHER  ASSETS,,,,,32 
,(Sum of lines 28 - 31),,,,,
33 ,TOTAL  ASSETS ,,,,,
," (Sum of lines 11, 27, and 32)",,,,,33 
,(         ) = contra amount,,,,,
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FORM CMS-1984-99 (4/99) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II SECTION 3850),,,,,,
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38-120,,,,,,Rev.  2