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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:
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This form is used for reporting financial information to the Illinois government.
Individuals or businesses with financial activity in Illinois may be required to file this form.
The form must be filled out with accurate financial information and submitted online or by mail.
The purpose of the form is to report financial data to the Illinois government for regulatory purposes.
Financial information such as income, expenses, and assets must be reported on this form.
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