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FOR BHF USELL1 2015 STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2015)I.DPH License ID Number: Facility
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Column 5 line 14 is where specific income information should be reported on a form.
Individuals or entities who have income to report in that section are required to file column 5 line 14.
Column 5 line 14 should be filled out by entering the relevant income information as per the instructions provided on the form.
The purpose of column 5 line 14 is to accurately report income information for tax or other regulatory purposes.
The specific income details that need to be reported on column 5 line 14 will be outlined on the form or accompanying instructions.
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