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cms = Centers for Medicare and Medicaid Services F5 A P C M N P S T 1 YTD Statement of Revenue Income by Source

cms = Centers for Medicare and Medicaid Services

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F5 A P C M N P S T 1 YTD Statement of Revenue Income by Source 2 3 % of Income Year to Date insurance private and other 4 Sources CMS Private Revenue 6 Medicare Revenue 7 Medicaid Revenue $75,000.00 $1,225,400.00 nue 9 Other Revenu 10 Totals $25,000.00 $2.461.100 00 11 12 13 Complete %'s of income, of CMS, of insurance and private and other pay. 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Sheet1 Sheet2 Sheet3 Sheet4 4 Ready 11:12 PM a w Type here to search S 6/9/2019

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