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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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What is intermediatedd?
Intermediatedd is a form used to report financial transactions conducted by intermediaries.
Who is required to file intermediatedd?
Intermediaries such as banks, financial institutions, and other entities facilitating financial transactions are required to file intermediatedd.
How to fill out intermediatedd?
Intermediatedd can be filled out electronically or manually by providing details of the financial transactions conducted by the intermediary.
What is the purpose of intermediatedd?
The purpose of intermediatedd is to ensure transparency and compliance with financial regulations by reporting financial transactions conducted through intermediaries.
What information must be reported on intermediatedd?
Information such as the type of transaction, parties involved, transaction amount, and date of transaction must be reported on intermediatedd.
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