Mendota Lutheran Home-2001-0011593 - HFS - State of Illinois

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Mendota Lutheran Home XX General Information Question 12 2001 14 TOTALS 9,660 34,711 44,371 14 Is your fiscal year identical to your tax year? YES X NO C. Percent Occupancy. (Column 5, line 14 divided by total licensed Tax Year: Fiscal Year: bed days on line 7, column 4.) 91.40% * All facilities other than governmental must report on the accrual basis. 31 of 31
Mendota Lutheran Home XX General Information Question 12 2001 Facility Name & ID Number Mendota Lutheran Home STATE OF ILLINOIS # 0011593 Report Period Beginning: 01/01/01 Ending: Page 3 12/31/01 V. COST CENTER EXPENSES (throughout the report, please round to the nearest dollar) Costs Per General Ledger Reclass- Reclassified Adjust- Adjusted FOR OHF USE ONLY Operating Expenses Salary/Wage Supplies Other Total ification Total ments Total A. General Services 1 2 3 4 5 6 7 8 9 10 1 Dietary 278,703 43,087 7,267 329,057 329,057 (5,024) 324,033 1 2 Food Purchase 322,967 322,967 322,967 (10,200) 312,767 2 3 Housekeeping 111,495 31,736 143,231 143,231 143,231 3 4 Laundry 77,133 13,222 90,355 90,355 90,355 4 5 Heat and Other Utilities 133,108 133,108 133,108 (1,028) 132,080 5 6 Maintenance 69,472 25,338 14,974 109,784 109,784 (2,194) 107,590 6 7 Other (specify):* 7 8 TOTAL General Services B. Health Care and Programs 536,803 436,350 155,349 1,128,502 1,128,502 (18,446) 1,110,056 8 9 Medical Director 9,000 9,000 9,000 9,000 9 10 Nursing and Medical Records 2,091,098 132,342 308,053 2,531,493 (47,813) 2,483,680 2,483,680 10 10a Therapy 10a 11 Activities 83,057 5,654 3,265 91,976 47,813 139,789 139,789 11 12 Social Services 46,666 154 186 47,006 47,006 47,006 12 13 Nurse Aide Training 45,698 7,500 140 53,338 53,338 (13,494) 39,844 13 14 Program Transportation 4,597 4,597 4,597 (1,456) 3,141 14 15 Other (specify):* 15 16 TOTAL Health Care and Programs C. General Administration 2,266,519 150,247 320,644 2,737,410 2,737,410 (14,950) 2,722,460 16 17 Administrative 70,357 1,537 71,894 71,894 71,894 17 18 Directors Fees 18 19 Professional Services 32,521 32,521 32,521 32,521 19 20 Dues, Fees, Subscriptions & Promotions 40,902 40,902 (94) 40,808 (9,213) 31,595 20 21 Clerical & General Office Expenses 132,004 14,472 9,255 155,731 94 155,825 (29) 155,796 21 22 Employee Benefits & Payroll Taxes 491,723 491,723 491,723 491,723 22 23 Inservice Training & Education 2,000 2,000 2,000 2,000 23 24 Travel and Seminar 11,502 11,502 11,502 11,502 24 25 Other Admin. Staff Transportation 25 26 Insurance-Prop.Liab.Malpractice 51,507 51,507 51,507 (20,604) 30,903 26 27 Other (specify):* 27 28 TOTAL General Administration 202,361 14,472 640,947 857,780 857,780 (29,846) 827,934 28 30 of 31
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Nelson, Tammie 239 $1,482.61 Dietar
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Mendota Lutheran Home-2001-0011593 - HFS - State of Illinois

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