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FOR OH FUSE LL1 2004 STATE OF ILLINOIS DEPARTMENT OF PUBLIC AID FINANCIAL AND STATISTICAL REPORT FOR LONG-TERM CARE FACILITIES (FISCAL YEAR 2004) I. DPH Facility ID Number: Facility Name: 0026112
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It is a community center located in Moultrie County with the identification number 0026112.
Any organization or entity associated with the community center must file the form.
The form must be filled out with accurate and up-to-date information about the community center.
The purpose of the form is to report information about the community center's activities and finances.
Information such as financial data, activities, and any changes in the organization must be reported.
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