Read instructions on page 2 before completing the form.
Suggested format: the Model Balance Sheet is a suggested format; however, the same basic information is required when using another format.
Other formats: other balance sheet formats containing the required information will be accepted.
Total assets: total assets must equal the sum total of owner's total liabilities and owner's equity (net worth).
Current assets: assets that are usually converted to cash within one year.
Current liabilities: those obligations that are usually paid within 12 months.
| Question | Answer |
|---|---|
| Form Name | F-62674A |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 6 min |
| Edition | Rev 10/2023 |
| Issuing agency | Department of Health Services, Division of Quality Assurance, State of Wisconsin |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | F-62674A, F62674A, F 62674A, Model Balance Sheet, Wisconsin Model Balance Sheet, DHS Model Balance Sheet |
| Official source | F-62674A (Rev 10/2023), Wisconsin Department of Health Services |
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