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FOR BHF USELL1
2016
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2016)I.DPH License ID Number:
Facility
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Namefred a is a form used for reporting financial information.
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Namefred a should be filled out by providing accurate financial information as per the instructions provided.
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