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DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION FORM DFSF5DWC90A (UB04) COMPLETION INSTRUCTIONS FOR HOSPITALS SHALL COMPLETE THE DFSF5DWC90 (UB04) ACCORDING TO THESE INSTRUCTIONS

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The purpose of department of financial services is to monitor and ensure compliance with financial regulations and laws.

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Financial transactions, assets, liabilities, income, and expenses must be reported on department of financial services.

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