Electronic Funds Transfer (Eft) Authorization - Minnesota Department Of Revenue Page 12
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15Lines 8–12
Line 8
Line 10
medical social services provided
by a social worker under the
Sponsors of health-care research
Total exempt from tax
supervision of a physician
Of the total on line 1, determine the
Add lines 2 through 9, and fill in
amount you received from sources
the total on line 10. This is the
physician services
other than the government that was
portion of line 1 that is exempt
dentist services
designated by the sponsor to be
from MinnesotaCare tax.
applied to your costs of providing
optometrist services
health-care services that were part
Line 11
chiropractor services
of the research. You must have
Total subject to tax
conducted the research in confor-
counseling services for patients
Subtract line 10 from line 1, and fill
mity with federal regulations
and/or family members
in the result on line 11. This is the
governing research on humans.
portion of line 1 that is subject to
home health-aide services and
MinnesotaCare tax.
Do not include amounts you
homemaker services
received from patients or patients’
physical therapy, occupational
Line 12
insurers for services you provided
therapy and speech therapy
as part of the research.
Tax for the quarter (or month)
Include amounts you received from
Multiply line 11 by .015 (1.5 per-
Fill in the total on line 8.
the sale of health-care supplies and
cent), and fill in the result on line
equipment, including drugs, used
12. This is the amount of your
Line 9
as part of the services you provided
MinnesotaCare tax for the quarter.
Hospice services
in the patient’s residence or hospice
Or, if you are a hospital or surgery
Of the total on line 1, determine the
facility.
center, this is the amount of your
amount you received from patients
MinnesotaCare tax for the month.
Do not include amounts you
and/or patients’ insurers for the
included on lines 2 through 8 of
For information about your quar-
following health-care services that
your worksheet.
terly or monthly payment options,
were provided under a hospice
read page 4.
program in a patient’s residence or
Fill in the total on line 9.
in a hospice facility other than a
If you are determining the amount
hospital:
of your tax for the calendar year,
refer to the 2001 annual tax return
nursing services provided by or
worksheet and instructions you
under the supervision of a
will receive during the last week of
registered nurse
January 2002.
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