Transcription
FOR BHF USELL12019STATE OF ILLINOISDEPARTMENT OF HEALTHCARE AND FAMILY SERVICESFINANCIAL AND STATISTICAL REPORT (COST REPORT)FOR LONG-TERM CARE FACILITIES(FISCAL YEAR 2019)I.IDPH License ID Number:Facility Name:0040683II.CERTIFICATION BY AUTHORIZED FACILITY OFFICERALDEN LONG GROVE REHAB & HCCAddress:Box 2308, RFD Old Hicks RoadNumberCounty:LakeTelephone Number:(847) 438-8275Long GroveCity60047Zip CodeFax # (847) 438-3254Date of Initial License for Current Owners:03/01/95Type of Ownership:VOLUNTARY,NON-PROFITCharitable Corp.TrustIRS Exemption CodeI have examined the contents of the accompanying report to the01/01/2019to12/31/2019State of Illinois, for the period fromand certify to the best of my knowledge and belief that the said contentsare true, accurate and complete statements in accordance withapplicable instructions. Declaration of preparer (other than provider)is based on all information of which preparer has any knowledge.Intentional misrepresentation or falsification of any informationin this cost report may be punishable by fine and/or imprisonment.HFS ID tnershipCorporation"Sub-S" Corp.Limited Liability Co.TrustOtherIn the event there are further questions about this report, please contact:Name:Mark NovotnyTelephone Number:Email Address:HFS 3745 (N-4-99)IMPORTANT NOTICETHIS AGENCY IS REQUESTING DISCLOSURE OF INFORMATIONTHAT IS NECESSARY TO ACCOMPLISH THE STATUTORYPURPOSE AS OUTLINED IN 210 ILCS 45/3-208. DISCLOSUREOF THIS INFORMATION IS MANDATORY. FAILURE TO PROVIDEANY INFORMATION ON OR BEFORE THE DUE DATE WILLRESULT IN CESSATION OF PROGRAM PAYMENTS. THIS FORMHAS BEEN APPROVED BY THE FORMS MANAGEMENT CENTER.773-724-6362(Signed)Officer orAdministrator (Type or Print Name) Randi Schulloof Provider(Title) President, Alden Management Services, int Nameand Title)(Firm Name& Address)773-286-3883Fax #773-286-8038(Telephone)MAIL TO: BUREAU OF HEALTH FINANCEILLINOIS DEPT OF HEALTHCARE AND FAMILY SERVICES201 S. Grand Avenue EastPhone # (217) 782-1630Springfield, IL 62763-0001IL478-2471
STATE OF ILLINOISFacility Name & ID NumberALDEN LONG GROVE REHAB & HCCIII.STATISTICAL DATAA. Licensure/certification level(s) of care; enter number of beds/bed days,(must agree with license). Date of change in licensed beds12Beds atBeginning ofReport PeriodLicensureLevel of Care12345624872488910111213E. List all services provided by your facility for non-patients.(E.g., day care, "meals on wheels", outpatient therapy)N/A34Beds at End ofReport PeriodLicensedBed Days DuringReport PeriodSkilled (SNF)Skilled Pediatric (SNF/PED)Intermediate (ICF)Intermediate/DDSheltered Care (SC)ICF/DD 16 or Less248TOTALS24852,1153,334C. Percent Occupancy. (Column 5, line 14 divided by total licensedbed days on line 7, column 4.)71.50%HFS 3745 (N-4-99)9,272F. Does the facility maintain a daily midnight census?90,5200000012345690,5207B. Census-For the entire report period.12345Level of CarePatient Days by Level of Care and Primary Source of PaymentMedicaidRecipientPrivate 5056,14060,419ICF/DDSCDD 16 OR LESS14 TOTALSPage 2#0040683Report Period Beginning:01/01/2019Ending: 12/31/2019D. How many bed reserve days during this year were paid by the Department?0(Do not include bed reserve days in Section B.)64,721YesG. Do pages 3 & 4 include expenses for services orinvestments not directly related to patient care?YESNOxH. Does the BALANCE SHEET (page 17) reflect any non-care assets?YESNOxI. On what date did you start providing long term care at this location?Date started3/1/1995J. Was the facility purchased or leased after January 1, 1978?YESDate 3/1/1995NOK. Was the facility certified for Medicare during the reporting year?YESxNOIf YES, enter numberof beds certified208and days of care provided891011121314Medicare Intermediary2,725National Government Services, Inc.IV. ACCOUNTING BASISACCRUALxMODIFIEDCASH*Is your fiscal year identical to your tax year?CASH*YESxNOTax Year:12/31/19Fiscal Year:12/31/19* All facilities other than governmental must report on the accrual basis.IL478-2471
STATE OF ILLINOISFacility Name & ID NumberALDEN LONG GROVE REHAB & HCC#0040683Report Period Beginning:V. COST CENTER EXPENSES (throughout the report, please round to the nearest dollar)Costs Per General LedgerReclassReclassifiedAdjustOperating lmentsA. General 370476,190(5,453)Food ,15920,378105,537272105,809Heat and Other 87267,734318,921172319,09354,464Other (specify):* related party7,3641234567TOTAL General ServicesB. Health Care and ProgramsMedical DirectorNursing and Medical RecordsTherapyActivitiesSocial ServicesCNA TrainingProgram TransportationOther (specify):* related 5,59524,0004,319,972372,952179,28373,94416 TOTAL Health Care and 252627C. General AdministrationAdministrativeDirectors FeesProfessional ServicesDues, Fees, Subscriptions & PromotionsClerical & General Office ExpensesEmployee Benefits & Payroll TaxesInservice Training & EducationTravel and SeminarOther Admin. Staff TransportationInsurance-Prop.Liab.MalpracticeOther (specify):* related party28 TOTAL General AdministrationTOTAL Operating HFS 3745 (N-4-99)Page 312/31/2019FOR BHF USE 4(20,031)10,244,613(570,236)*Attach a schedule if more than one type of cost is included on this line, or if the total exceeds 1000.NOTE: Include a separate schedule detailing the reclassifications made in column 5. Be sure to include a detailed explanation of each reclassification.29 (sum of lines 8, 16 & 01/2019IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683#Report Period Beginning:01/01/2019Ending:Page 412/31/2019V. COST CENTER EXPENSES (continued)30313233343536Capital ExpenseD. OwnershipDepreciationAmortization of Pre-Op. & Org.InterestReal Estate TaxesRent-Facility & GroundsRent-Equipment & VehiclesOther (specify):*Salary/Wage1Cost Per General 53113,874,86337 TOTAL Ownership383940414243Ancillary ExpenseE. Special Cost CentersMedically Necessary TransportationAncillary Service CentersBarber and Beauty ShopsCoffee and Gift ShopsProvider Participation FeeOther (specify):*561,49144 TOTAL Special Cost CentersGRAND TOTAL COST45 (sum of lines 29, 37 & 08)521,38120,031FOR BHF USE 2,945,28445*Attach a schedule if more than one type of cost is included on this line, or if the total exceeds 1000.HFS 3745 (N-4-99)IL478-2471
0040683Period Beginning:Period Ending:IDPH License No.00406831/1/201912/31/2019Reclassifications - Pages 3 & 4From Line To LineAmount2222213461011211039HFS 3745 (N-4-99)Description(34,246.00) Employee Meals34,246.00 Employee 37.73330.60Uniform ReclassUniform ReclassUniform ReclassUniform ReclassUniform ReclassUniform ReclassUniform ReclassUniform Reclass(20,031.00) Oxygen Cost Reclass20,031.00 Oxygen Cost ReclassIL478-2471
STATE OF ILLINOISPage 5Facility Name & ID Number ALDEN LONG GROVE REHAB & HCC# 0040683Report Period Beginning:01/01/2019Ending:12/31/2019VI. ADJUSTMENT DETAILA. The expenses indicated below are non-allowable and should be adjusted out of Schedule V, pages 3 or 4 via column 7.In column 2 below, reference the line on which the particular cost was included. (See instructions.)123ReferBHF USEB. If there are expenses experienced by the facility which do not appear in theNON-ALLOWABLE EXPENSESAmountenceONLYgeneral ledger, they should be entered below.(See instructions.)1 Day Care 1122 Other Care for Outpatients2AmountReference3 Governmental Sponsored Special Programs331 Non-Paid Workers-Attach Schedule* 4 Non-Patient Meals(80) 2432 Donated Goods-Attach Schedule*5 Telephone, TV & Radio in Resident Rooms(12,636) 65Amortization of Organization &6 Rented Facility Space633 Pre-Operating Expense7 Sale of Supplies to Non-Patients7Adjustments for Related Organization8 Laundry for Non-Patients834 Costs (Schedule VII)(291,901)9 Non-Straightline Depreciation935 Other- Attach Schedule(125,008)10 Interest and Other Investment Income(10,755) 321036 SUBTOTAL (B): (sum of lines 31-35) (416,909)11 Discounts, Allowances, Rebates & Refunds11(sum of SUBTOTALS12 Non-Working Officer's or Owner's Salary1237 TOTAL ADJUSTMENTS (A) and (B) ) (929,579)13 Sales Tax(1,299) 21314 Non-Care Related Interest14*These costs are only allowable if they are necessary to meet minimum15 Non-Care Related Owner's Transactions15licensing standards. Attach a schedule detailing the items included16 Personal Expenses (Including Transportation)16on these lines.17 Non-Care Related Fees(30,255) 211718 Fines and Penalties(23,841) 3218C. Are the following expenses included in Sections A to D of pages 319 Entertainment19and 4? If so, they should be reclassified into Section E. Please20 Contributions(5,309) 2020reference the line on which they appear before reclassification.21 Owner or Key-Man Insurance21(See instructions.)123422 Special Legal Fees & Legal Retainers(26,552) 1922Yes NoAmountReference23 Malpractice Insurance for Individuals2338 Medically Necessary Transport.x 24 Bad Debt(311,994) 272439x25 Fund Raising, Advertising and Promotional(89,950) 202540 Gift and Coffee ShopsxIncome Taxes and Illinois Personal41 Barber and Beauty Shopsx26 Property Replacement Tax2642 Laboratory and Radiologyx27 CNA Training for Non-Employees2743 Prescription Drugsx28 Yellow Page Advertising2844x29 Other-Attach Schedule2945 Other-Attach Schedulex30 SUBTOTAL (A): (Sum of lines 1-29) (512,670) 3046 Other-Attach Schedulex47 TOTAL (C): (sum of lines 38-46) BHF USE ONLY4849505152HFS 3745 71
STATE OF ILLINOISALDEN LONG GROVE REHAB & HCCID#0040683Report Period Beginning:01/01/2019Ending:12/31/2019Page 5ANON-ALLOWABLE EXPENSESAmount123456789Elim Deprec Exp on Pg 12 items under 2,500 Elim Deprec Exp on Pg 13 items under 2500 Expense Pg 12 items under 2,500 - curr yr purchs Expense Pg 13 items under 2,500 - curr yr purchs 101112131415161718Late Fees on utilitiesOther nursing incomeIntercompany interest is not allowed (gl 7031)Intercompany interest is not allowed (gl 7053)A/P Adjustments (vendor discounts)Miscellaneous Income - Medical RecordsMiscellaneous Income - Incentives from United Health CCollection Fees (gl6965)Dues, Fees & SubscriptionsElim ABC Deprec Exp from Pg 12 seriesAdj for ABC Related Party Profit - Pg 1319 AMS Depreciation Adj20 Depreciation Adj21222324252627282930Sch. V 445464041424344454647474849 TotalHFS 3745 (N-4-99)(125,008)4849IL478-2471
STATE OF ILLINOIS# 0040683Facility Name & ID Number ALDEN LONG GROVE REHAB & HCCSUMMARY OF PAGES 5, 5A, 6, 6A, 6B, 6C, 6D, 6E, 6F, 6G, 6H AND 6IOperating ExpensesA. General ServicesDietaryFood PurchaseHousekeepingLaundryHeat and Other UtilitiesMaintenanceOther (specify):*TOTAL General ServicesB. Health Care and ProgramsMedical DirectorNursing and Medical RecordsTherapyActivitiesSocial ServicesCNA TrainingProgram TransportationOther (specify):*PAGES5 & 2,814) 280(132,392)19,879(8,199)01,1862,900000(570,236) 8)(30,255)(5,380)0000(311,994)0000000000028 TOTAL General Administration(469,439)TOTAL Operating Expense29 (sum of lines 8,16 & 28)(453,610)16 TOTAL Health Care and Programs1718192021222324252627C. General AdministrationAdministrativeDirectors FeesProfessional ServicesFees, Subscriptions & PromotionsClerical & General Office ExpensesEmployee Benefits & Payroll TaxesInservice Training & EducationTravel and SeminarOther Admin. Staff TransportationInsurance-Prop.Liab.MalpracticeOther (specify):*HFS 3745 1501/01/2019SUMMARYTOTALS(to Sch V, col.7)(5,453) 113,172 214,642 30 41,199 554,464 67,364 785,388 80(1,379)00(3,448)21,720016,89312345678Report Period Beginning:Summary L478-2471
Facility Name & ID NumberSTATE OF ILLINOISALDEN LONG GROVE REHAB & HCC#0040683Report Period Beginning:Summary B12/31/201901/01/2019 Ending:SUMMARY OF PAGES 5, 5A, 6, 6A, 6B, 6C, 6D, 6E, 6F, 6G, 6H AND 6I30313233343536Capital ExpenseD. OwnershipDepreciationAmortization of Pre-Op. & Org.InterestReal Estate TaxesRent-Facility & GroundsRent-Equipment & VehiclesOther (specify):*37 TOTAL Ownership383940414243Ancillary ExpenseE. Special Cost CentersMedically Necessary TransportationAncillary Service CentersBarber and Beauty ShopsCoffee and Gift ShopsProvider Participation FeeOther (specify):*44 TOTAL Special Cost CentersPAGES5 & E6DPAGE6EPAGE6FPAGE6GPAGE6HPAGE6ISUMMARYTOTALS(to Sch V, col.7)(25,353) 300 31(20,339) 325,770 330 3444,287 350 0000(363,708) 900000(929,579) 454,36537383940414243GRAND TOTAL COST45 (sum of lines 29, 37 & 44)HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 612/31/2019VII. RELATED PARTIESA. Enter below the names of ALL owners and related organizations (parties) as defined in the instructions. Use Page 6-Supplemental as necessary.123OWNERSRELATED NURSING HOMESOTHER RELATED BUSINESS ENTITIESNameOwnership %NameCityNameCityType of BusinessThe Alden Group, Ltd.100See PG-SuppSee PG-SuppB. Are any costs included in this report which are a result of transactions with related organizations? This includes rent,management fees, purchase of supplies, and so forth.x YESNOIf yes, costs incurred as a result of transactions with related organizations must be fully itemized in accordance withthe instructions for determining costs as specified for this form.45 Cost to Related Organization123 Cost Per General LedgerSchedule VLineVVVVVVVVVVVVV14 Total12345678910111213ItemAmount Name of Related Organization678 Difference:Operating CostAdjustments forPercentofof RelatedRelated OrganizationCosts (7 minus 4)OwnershipOrganization0.00% *1234567891011121314* Total must agree with the amount recorded on line 34 of Schedule VI.HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 6A12/31/2019VII. RELATED PARTIES (continued)B. Are any costs included in this report which are a result of transactions with related organizations? This includes rent,management fees, purchase of supplies, and so forth.x YESNOIf yes, costs incurred as a result of transactions with related organizations must be fully itemized in accordance withthe instructions for determining costs as specified for this form.123 Cost Per General Ledger45 Cost to Related OrganizationSchedule VLineItemVVVVVVVVVVVVVVVVVVVVVVVV39 vel/SeminarOther Admin TravelInsuranceDues/SubscriptionsDepreciationReal Estate TaxRent-Equip/VehiclesInterestDietary Aide Coordinator SalaryHousekeeping Coordinator SalaryEmployee Benef % -Gen'l ServsNurs/Med Records SalaryEmployee Benef % -Health CareAdministrative SalaryEmployee Benef %-AdministrativeProfessional FeesGen'l & AdminRepairs & 435363738Amount 1,033,55841,34039,318 1,114,216Name of Related OrganizationAlden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.Alden Management Services, Inc.678 Difference:PercentOperating CostAdjustments forofof RelatedRelated OrganizationOwnershipOrganizationCosts (7 minus 4)0.00% 4,647 ,2435,646293,58981,36750,385390,94267,976 1,170,257 33343536373839* Total must agree with the amount recorded on line 34 of Schedule VI.HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 6B12/31/2019VII. RELATED PARTIES (continued)B. Are any costs included in this report which are a result of transactions with related organizations? This includes rent,management fees, purchase of supplies, and so forth.x YESNOIf yes, costs incurred as a result of transactions with related organizations must be fully itemized in accordance withthe instructions for determining costs as specified for this form.123 Cost Per General Ledger45 Cost to Related OrganizationSchedule VLineVVVVVVVVVVVVVVVVVVVVVVVV39 3132333435363738ItemDietary Consult.Dietary SalaryTube feedingEquip. RentalAncillary suppliesGen'l & Admin & benefitsGen'l & Admin & benefitsGen'l & Admin & benefitsGen'l & Admin & benefitsAmount 24,1685,0216,660194,525 230,374Name of Related OrganizationPrism Health Care Services, Inc.Prism Health Care Services, Inc.Prism Health Care Services, Inc.Prism Health Care Services, Inc.Prism Health Care Services, Inc.Prism Health Care Services, Inc.Prism Health Care Services, Inc.Prism Health Care Services, Inc.Prism Health Care Services, Inc.678 Difference:PercentOperating CostAdjustments forofof RelatedRelated OrganizationOwnershipOrganizationCosts (7 minus 4)0.00% 7,415)4,3924,39214,93014,9304,3774,37728,46228,462 141,300 89,074) 39* Total must agree with the amount recorded on line 34 of Schedule VI.HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 6C12/31/2019VII. RELATED PARTIES (continued)B. Are any costs included in this report which are a result of transactions with related organizations? This includes rent,management fees, purchase of supplies, and so forth.x YESNOIf yes, costs incurred as a result of transactions with related organizations must be fully itemized in accordance withthe instructions for determining costs as specified for this form.123 Cost Per General Ledger45 Cost to Related OrganizationSchedule VLineVVVVVVVVVVVVVVVVVVVVVVVV39 03132333435363738ItemDrugsI.V.Wound Care-Product onlyHouse StockPharm ConsultEmployee VaccinationsEmployee VaccinationsAmount 269,94422,82674,19624,4925,9526,783 404,193Name of Related OrganizationForum Extended Care II, Inc.Forum Extended Care II, Inc.Forum Extended Care II, Inc.Forum Extended Care II, Inc.Forum Extended Care II, Inc.Forum Extended Care II, Inc.678 Difference:PercentOperating CostAdjustments forofof RelatedRelated OrganizationOwnershipOrganizationCosts (7 minus 4)0.00% 257,386 75(277)(6,783)6,4666,466 385,390 18,803) 39* Total must agree with the amount recorded on line 34 of Schedule VI.HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 6D12/31/2019VII. RELATED PARTIES (continued)B. Are any costs included in this report which are a result of transactions with related organizations? This includes rent,management fees, purchase of supplies, and so forth.x YESNOIf yes, costs incurred as a result of transactions with related organizations must be fully itemized in accordance withthe instructions for determining costs as specified for this form.123 Cost Per General Ledger45 Cost to Related OrganizationSchedule VLineVVVVVVVVVVVVVVVVVVVVVVVV39 63738ItemTherapyAmount 984,287Name of Related OrganizationCommunity Physical Therapy & Associates, Ltd.678 Difference:PercentOperating CostAdjustments forofof RelatedRelated OrganizationOwnershipOrganizationCosts (7 minus 4)0.00% 740,136 (244,151) 151617181920212223242526272829303132333435363738 984,287 740,136 *(244,151) 39* Total must agree with the amount recorded on line 34 of Schedule VI.HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 6E12/31/2019VII. RELATED PARTIES (continued)B. Are any costs included in this report which are a result of transactions with related organizations? This includes rent,management fees, purchase of supplies, and so forth.x YESNOIf yes, costs incurred as a result of transactions with related organizations must be fully itemized in accordance withthe instructions for determining costs as specified for this form.123 Cost Per General Ledger45 Cost to Related OrganizationSchedule VLineVVVVVVVVVVVVVVVVVVVVVVVV39 3738ItemRepairs & MaintenanceAmount 16,861Name of Related OrganizationAlden Bennett Construction Company, Inc.678 Difference:PercentOperating CostAdjustments forofof RelatedRelated OrganizationOwnershipOrganizationCosts (7 minus 4)0.00% 18,047 1,186 151617181920212223242526272829303132333435363738 16,861 18,047 *1,18639* Total must agree with the amount recorded on line 34 of Schedule VI.HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 6F12/31/2019VII. RELATED PARTIES (continued)B. Are any costs included in this report which are a result of transactions with related organizations? This includes rent,management fees, purchase of supplies, and so forth.x YESNOIf yes, costs incurred as a result of transactions with related organizations must be fully itemized in accordance withthe instructions for determining costs as specified for this form.123 Cost Per General Ledger45 Cost to Related OrganizationSchedule VLineVVVVVVVVVVVVVVVVVVVVVVVV39 3738ItemRepairs & MaintenanceAmount 3,857Name of Related OrganizationAlden Design Group, Ltd.678 Difference:PercentOperating CostAdjustments forofof RelatedRelated OrganizationOwnershipOrganizationCosts (7 minus 4)0.00% 6,757 2,900 151617181920212223242526272829303132333435363738 3,857 6,757 *2,90039* Total must agree with the amount recorded on line 34 of Schedule VI.HFS 3745 (N-4-99)IL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:Page 6-Supplemental01/01/2019 Ending:12/31/2019VII. RELATED PARTIESA. (Continued)Enter below the names of ALL owners and related organizations (parties) as defined in the instructions123OWNERSRELATED NURSING HOMESOTHER RELATED BUSINESS ENTITIESNameOwnership %NameCityNameCityType of Business1 The Alden Group, 2930HFS 3745 (N-4-99)100%Heather Health Care Center, Inc.HarveyAlden-Lincoln Park Rehabilitation and Health CChicagoAlden-Northmoor Rehabilitation and Health Ca ChicagoAlden-Lakeland Rehabilitation and Health Care ChicagoAlden of Old Town East, Inc.BloomingdaleAlden Terrace of McHenry Rehabilitation and HMcHenryWentworth Rehabilitation and Health Care Cen ChicagoAlden Estates of Naperville, Inc.NapervilleAlden - Valley Ridge Rehabilitation and Health CBloomingdaleAlden Village Health Facility for Children and YBloomingdaleAlden - Orland Park Rehabilitation and Health COrland ParkPrinceton Rehabilitation and Health Care CenteChicagoAlden of Old Town West, Inc.BloomingdaleAlden - Town Manor Rehabilitation and Health CiceroAlden Trails, Inc.BloomingdaleAlden - Poplar Creek Rehabilitation and Health Hoffman EstatesAlden - North Shore Rehabilitation and Health CSkokieAlden - Des Plaines Rehabilitation and Health C Des PlainesAlden Estates of Evanston, Inc.EvanstonAlden - Alma Nelson Manor, Inc.RockfordAlden - Park Strathmoor, Inc.RockfordAlden - Meadow Park Health Care Center, Inc. Clinton, WIAlden Estates of Barrington, Inc.BarringtonAlden of Waterford, LLCAuroraAlden Springs, Inc.BloomingdaleAlden Village North, Inc.ChicagoAlden Estates of Skokie, Inc.SkokieAlden Estates of Countryside, Inc.Jefferson, WIAlden Estates of Shorewood, Inc.Shorewood, ILAlden - Long Grove Rehabilitation and Health CLong GroveThe Forum ProfessionaChicagoForum Extended Care ChicagoFECS of Central Illino SpringfieldAlden Management Se ChicagoAlden Gardens of Bloo BloomingdaleAlden Garden Courts oDesPlainesAlden Courts of WaterAuroraAlden Gardens of Wat AuroraPrism Health Care Ser SchaumburgCommunity Physical TAddisonAlden Bennett ConstruChicagoFort Medical Equipme Fort AtkinsonAlden Design Group, I ChicagoFamily Solutions for SeAddisonFamily Home Health S AddisonAlden Courts of ShorewShorewoodAlden Estates-Courts oHuntley12Pharmacy3Pharmacy4Management5Supportive Living F 6Assisted Living/Alzh 7SNF & Alzheimers F 8Assisted Living9Nursing and Durabl 10Therapy Provider11General Contractor 12Nursing and Durabl 13Design & Engineerin 1415Private duty care16Home health & hosp 171819202122232425SNF26SNF27282930Rental propertyIL478-2471
Facility Name & ID NumberALDEN LONG GROVE REHAB & HCCSTATE OF ILLINOIS#0040683Report Period Beginning:01/01/2019Ending:Page 712/31/2019VII. RELATED PARTIES (continued)C. Statement of Compensation and Other Payments to Owners, Relatives and Members of Board of Directors.NOTE: ALL owners ( even those with less than 5% ownership) and their relatives who receive any type of compensation from this homemust be listed on this nReceivedFrom OtherNursing age Hours Per WorkWeek Devoted to thisFacility and % of TotalWork 871.9484.871.70454.8778Compensation Includedin Costs for thisReporting Period**DescriptionAmountSalary alary9,007Schedule V.Line &ColumnReference17-710-76-717-721-76-7, 17-7Floyd A. Schlossberg A.Chairman-Board of DChairmanLauren Magnusson B.Dir. Of Clinical ServicTechnical NursingTerry MagnussonC.Dir. of PurchasingSupervise MaintenIna SchlossbergD.Board MemberGeneral OperationAudra EliscoF.Training CoordinatorTrain employeesRandi Schlossberg-Schullo F. PresidentGeneral OperationA. Floyd Schlossberg is the Chairman of the Board of Directors, Alden Management Services, Inc.B. Lauren Magnusson is the daughter of Floyd Schlossberg. Lauren is the Director of Clinical Services and provides technical support for the entire nursing staff.C. Terry Magnusson is the son-in-law of Floyd Schlossberg. Terry coordinates the purchase of all building maintenance items as well as supervise building engineers.D. Ina Schlossberg is the wife of Floyd Schlossberg. Ina is on the Board of Directors and participates in the general operations of the company.E. Audra Elisco is the daughter of Floyd Schlossberg. Audra is a training coordinator for our Quality Assurance Program.F.
Facility Name & ID Number ALDEN LONG GROVE REHAB & HCC # 0040683 Report Period Beginning: 01/01/2019 Ending: 12/31/2019 III. STATISTICAL DATA D. How many bed reserve days during this year were paid by the Department? A. Licensure/certification level(s) of care; enter number of beds/bed days, 0 (Do not include bed reserve days in Section B.)
![2020-21 Florida's Optional Innovative Reopening Plan [Hillsborough County]](/img/27/hillsborough-reopenplan.jpg)
