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PRINTED: 05/19/2022 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:CEDARHURST OF BLOOMINGTON (X4)

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Online revenue wi lc-110 is a form used to report revenue generated through online sales or services.

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Online revenue wi lc-110 requires information such as total revenue, expenses, tax deductions, and other relevant financial data.

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