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EXHIBIT 177 (Rev. 85, Issued: 07-19-13, Effective: 07-19-13, Implementation: 07-19-13) ATTESTATION STATEMENT FOR FEDERALLY QUALIFIED HEALTH CENTER INSTRUCTIONS FOR COMPLETING 1. Name of Entity: The
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cms exhibit 177 is a form used to report certain financial information to regulatory authorities.
Certain financial institutions are required to file cms exhibit 177.
cms exhibit 177 must be filled out accurately and completely following the instructions provided by the regulatory authorities.
The purpose of cms exhibit 177 is to provide regulatory authorities with relevant financial information.
Information such as financial statements, balance sheets, income statements, and other financial data must be reported on cms exhibit 177.
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