10-96			          FORM CMS-2552-96						   3690 (Cont.)	
STATEMENT OF CHANGES IN FUND BALANCES					PROVIDER NO.:		PERIOD:		WORKSHEET G-1	
							FROM _________			
					______________		TO ___________			
		              GENERAL FUND		     SPECIFIC PURPOSE FUND		         ENDOWMENT FUND		           PLANT FUND		
		1	2	3	4	5	6	7	8	
1 	Fund balances at beginning of period									1 
2 	"Net income (loss) (from Wkst. G-3, line 31)"									2 
3 	Total (sum of line 1 and line 2)									3 
4 	Additions (credit adjustments) (specify)									4 
5 										5 
6 										6 
7 										7 
8 										8 
9 										9 
10 	Total additions (sum of lines 4-9)									10 
11 	Subtotal (line 3 plus line 10)									11 
12 	Deductions (debit adjustments) (specify)									12 
13 										13 
14 										14 
15 										15 
16 										16 
17 										17 
18 	Total deductions (sum of lines 12-17)									18 
19 	Fund balance at end of period per balance									19 
	sheet (line 11 minus line 18)									
										
										
										
										
										
										
										
										
										
										
										
										
										
										
										
										
										
										
										
"FORM CMS-2552-96 (9/96)  (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 3640)"										
										
										
										
Rev. 1									         36-602