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      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
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        <PersonNm>DR CARMEN JOHNSON MARTELL</PersonNm>
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          <AddressLine1Txt>2016 25TH ST</AddressLine1Txt>
          <CityNm>Newport News</CityNm>
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          <ZIPCd>23607</ZIPCd>
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      <OperateHospitalInd>false</OperateHospitalInd>
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      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
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        <ExplanationTxt>CONTRIBUTION MADE DRECTLY INTO ACCOUNT $6882.96</ExplanationTxt>
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        <FormAndLineReferenceDesc>PART III</FormAndLineReferenceDesc>
        <ExplanationTxt>240 BACKPACK DRIVE HAMPTON BOYS AND GIRLS CLUM</ExplanationTxt>
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        <FormAndLineReferenceDesc>PART III</FormAndLineReferenceDesc>
        <ExplanationTxt>HAMPTON SOCIAL SERVICES DEPARTMENT -FOSTER CHILDREN PHYSICALS AND TB FORM COIMPLETION TP PREVENT DISPLACEMENT DUE TO NON-COMPLIANCE --15</ExplanationTxt>
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        <FormAndLineReferenceDesc>PART III</FormAndLineReferenceDesc>
        <ExplanationTxt>FOSTER FAMILY APPLICANT PHYSICAL AND TB RISK ASSESSMENT 15</ExplanationTxt>
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        <FormAndLineReferenceDesc>PART III</FormAndLineReferenceDesc>
        <ExplanationTxt>MOTEL VISIT FOR PATIENT WHO CLAIMED TO BE SHUT IN (SUPPLIES/RESOURCES/FOOD WAS LEFT WITH INDIVIDUALS) 7</ExplanationTxt>
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        <FormAndLineReferenceDesc>PART III</FormAndLineReferenceDesc>
        <ExplanationTxt>PATIENT ADVOCACY (RESOURCE ALLOCATION) 70</ExplanationTxt>
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