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FOR OH FUSE LL1 2004 STATE OF ILLINOIS DEPARTMENT OF PUBLIC AID FINANCIAL AND STATISTICAL REPORT FOR LONGER CARE FACILITIES (FISCAL YEAR 2004) I. DPH Facility ID Number: Facility Name: 0026385 II.
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It is a specific group home identified by its unique file number.
The group home manager or owner is required to file this form.
The form must be completed with accurate information about the group home's activities and finances.
The purpose is to report information about the group home's operations.
Information such as income, expenses, resident demographics, and services provided must be reported.
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