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FOR BHF USELL1 2021STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2021) I.DPH License ID Number:

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Start by writing the recipient's name on the first line.

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Write the street address '201 Spring St' on the second line.

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Include any apartment or suite number on the same line as the street address, if applicable.

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People who need to send mail or packages to a specific location at 201 Spring St.

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201 spring st box is a mailing address or location identifier.

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