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IDPH Facility ID Number Facility Name 0040428 II. IMPORTANT NOTICE THIS AGENCY IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY TO ACCOMPLISH THE STATUTORY PURPOSE AS OUTLINED IN 210 ILCS 45/3-208. DISCLOSURE OF THIS INFORMATION IS MANDATORY. FAILURE TO PROVIDE ANY INFORMATION ON OR BEFORE THE DUE DATE WILL RESULT IN CESSATION OF PROGRAM PAYMENTS. THIS FORM HAS BEEN APPROVED BY THE FORMS MANAGEMENT CENTER. CERTIFICATION BY AUTHORIZED FAC...
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How to fill out FINANCIAL AND STATISTICAL REPORT FOR LONG-TERM CARE FACILITIES

01
Gather necessary financial documents, including budget reports and expenditure statements.
02
Collect patient data, including demographic information and care statistics.
03
Review previous reports for consistency and reference points.
04
Fill in the financial sections by accurately reporting revenue sources and expenses.
05
Complete statistical sections with data on admissions, discharges, and average length of stay.
06
Ensure all figures are supported by the appropriate documentation to validate accuracy.
07
Review the entire report for completeness and compliance with state and federal guidelines.
08
Submit the report to the appropriate regulatory body by the deadline.

Who needs FINANCIAL AND STATISTICAL REPORT FOR LONG-TERM CARE FACILITIES?

01
Long-term care facility administrators.
02
State health department officials.
03
Regulatory agencies monitoring healthcare facilities.
04
Financial managers within healthcare organizations.
05
Researchers analyzing healthcare trends.
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People Also Ask about

In the U.S., long-term care costs individuals and their families thousands of dollars annually, with nursing home care often costing more than $100,000 a year (Exhibit 1). Given that many who use these services will need it for at least one year, costs can quickly become burdensome.
Medicaid — a government program that helps cover medical costs for people with limited income and assets — is the major source of funding for LTC in the United States.
Cost of care trends and insights Type of service and rate type2024 national median values2023 national median values Adult day health care Daily $100 $95 Assisted living community Monthly $5,900 $5,350 Nursing home semi-private room Monthly $9,277 $8,669 Nursing home private room Monthly $10,646 $9,7332 more rows
How much is long-term care insurance? ing to the 2024 American Association for Long-Term Care Insurance (AALTCI) annual Price Index survey, the average annual premium for a $165,000-benefit policy with no inflation protection is $950 for a single male (age 55) and $1,500 for a single female (age 55).
Cost of care trends and insights Type of service and rate type2024 national median values2023 national median values Adult day health care Daily $100 $95 Assisted living community Monthly $5,900 $5,350 Nursing home semi-private room Monthly $9,277 $8,669 Nursing home private room Monthly $10,646 $9,7332 more rows
In the United States, long-term care costs between $35,000 and $108,000 a year in 2021. Out of the three different types of long-term care we compared, private rooms in nursing homes are the most costly, with an average of $108,405 a year.
Long-term care Long-term supports and services can be provided at home, in the community, in assisted living, or in nursing homes. Individuals may need long-term supports and services at any age. Medicare and most health insurance plans don't pay for long-term care.

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The Financial and Statistical Report for Long-Term Care Facilities is a regulatory document that collects financial and operational data from long-term care providers to ensure compliance with federal and state regulations, assess the economic status of the facilities, and aid in policy-making.
Long-term care facilities such as nursing homes, assisted living facilities, and other residential care providers are typically required to file this report, often mandated by state health departments or regulatory agencies.
To fill out the report, facilities must gather financial information including income, expenses, and occupancy rates. They should follow the specific guidelines and templates provided by the regulatory authority, ensuring all sections are complete and accurate before submission.
The purpose of the report is to monitor the financial health and operational performance of long-term care facilities, to ensure compliance with funding requirements, and to provide data for the assessment of care quality and resource allocation.
Information that must be reported typically includes revenue sources, expenses (operational and capital), total number of residents, staff-to-resident ratios, occupancy rates, and other key performance indicators relevant to the facilities’ operations.
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