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DEPARTMENT OF HEALTH SERVICES Division of Long Term Reinstate OF WISCONSINF01812 (9/2016)WISCONSIN MEDICAID PROGRAM 2016 NURSING HOME COST REPORT Completion of this form is required by Section 1.171

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The Benedictine Living Community is a residential community following the Benedictine way of life.

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The purpose is to report on the activities and financial status of the Benedictine Living Community.

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Information such as financial statements, activities, and any changes in governing structure must be reported.

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