Applicants should enter the most recent revenues number from its federal tax return of 2017, 2018, or 2019.
If the applicant for tax purposes is a:
• Sole proprietor or disregarded entity owned by an individual: Enter Line 3 from IRS Form 1040, Schedule C excluding any income reported on W-2.
• Partnership: Enter Line 1c minus Line 12 from IRS Form 1065.
• C corporation: Enter Line 1c minus Line 15 from IRS Form 1120.
• S corporation: Enter Line 1c minus Line 10 from IRS Form 1120-S.
• Tax-exempt organization: Enter Line 9 from IRS Form 990 minus any joint venture income, if included in Part VIII lines 2a – 2f.
• Trust or estate: Enter Line 3 from IRS Form 1040, Schedule C.
• Entity not required to file any of the previously mentioned IRS forms: Enter a “net patient service revenue” number or equivalent from the applicant’s most recent audited financial statements (or management-prepared financial statements)
• Applicants with gross revenue adjustments should enter an adjusted gross revenues number as calculated using the Gross Revenues Worksheet in Field 15 available at: