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PRINTED: 10/02/2017 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:MICHIGAN SURGERY CENTER LLC (X4)

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Printed 1002 is a form related to the reporting of transaction data for specific departments, often used for financial and tax reporting purposes.

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Organizations, businesses, or individuals that meet certain criteria set by the department related to financial transactions or tax obligations are required to file the printed 1002.

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To fill out printed 1002, one needs to provide detailed information about financial transactions, including dates, amounts, and types of transactions, following the official guidelines provided by the department.

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The purpose of printed 1002 is to ensure compliance with reporting requirements, facilitate audits, and contribute to transparency in financial activities.

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The information that must be reported includes transaction details, participant data, amounts involved, and relevant dates, as specified by the department's guidelines.

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