esrd facility profile - illinois...14-2662 ara-south barrington dialysis 33 w. higgins road suite...
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14-2619
Alton Dialysis309 Homer Adams ParkwayAltonMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare Inc.Legal Entity Owner:
Property Owner: Pinetree Alton 1, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Mathew
In-Center Treatments in calendar year: 9,120Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 56
Patients treated as of 12/31/2016: (Ending patients) 63
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
22 0 35 21 33 24 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 29Transient Patients: 7Patients Re-Started: 3Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 13Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 375
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
31Total:
40Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 67
58%66%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
56
84.8%
Medicaid
3
Private Insurance
6
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
66
4.5% 9.1% 1.5%0.0% 1.5% 100.0%
Patients
TOTAL 00
180
49
0670
0
04
11105
02
11168
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
67
06
2226136730 37
67
$1,765,307 $16,497 $1,194,927 $21,672$0 $803,315 $3,780,045
46.7% 0.4% 31.6% 0.6%0.0% 21.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2664
ARA- Crystal Lake Dialysis6298 Northwest Hwy. Suite # 300Crystal LakeMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: ARA N.W. Chicago LLCLegal Entity Owner:
Property Owner: Centro Bradley Crystal Lake, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Total Net Revenue does not compute Total is 543,026
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Mohammed Zahid
In-Center Treatments in calendar year: 4,726Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 36
Patients treated as of 12/31/2016: (Ending patients) 29
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 316
Oct 40
Oct 516
Oct 60
Oct 716
0 0 31 0 31 0 31
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 13Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 13Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 112
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
17Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 32%Use Rate (including Missed Treatments): 32%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 52
38%30%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2.5Dialysis Technician : 3Dietician : 0.5Social Worker: 0.33LPN : 0Other Health : 0.33Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
43
82.7%
Medicaid
2
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
52
3.8% 13.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 1030
48
10420
0
02
1396
02785
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
52
04
2017115230 22
52
$1,030,593 $0 $752,677 $0($1,227,091) ($13,153) $543,026
189.8% 0.0% 138.6% 0.0%-226.0% -2.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2737
ARA-McHenry County4209 West Shamrock LaneMcHenryMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: American Renal AssociatesLegal Entity Owner:
Property Owner: Riggsby Companies LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohammad Zahid
In-Center Treatments in calendar year: 4,165Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 29
Patients treated as of 12/31/2016: (Ending patients) 31
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 60
Oct 714
0 0 28 0 29 0 30
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 8Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 17Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 110
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
24Total:
13Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 37%Use Rate (including Missed Treatments): 38%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 52
40%43%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 3.5Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
45
86.5%
Medicaid
0
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
52
0.0% 13.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 1010
50
3490
0
00
111011
03287
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
52
03
1318185232 20
52
$1,081,898 $0 $1,513,163 $0$1,513,722 $14,290 $4,123,073
26.2% 0.0% 36.7% 0.0%36.7% 0.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2662
ARA-South Barrington Dialysis33 W. Higgins Road Suite 920-945South BarringtonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: ARA-N.W. ChicagoLegal Entity Owner:
Property Owner: Stonegate Properties
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Total revenue for is $845,814.78. unable to type in total revenue on pg. 12
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Zahid
In-Center Treatments in calendar year: 7,366Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 56
Patients treated as of 12/31/2016: (Ending patients) 57
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 111
Oct 20
Oct 316
Oct 411
Oct 516
Oct 611
Oct 716
12 0 31 15 29 16 31
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 18Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 35
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
21Total:
41Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 79
67%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 43Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
58
74.4%
Medicaid
4
Private Insurance
16
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
78
5.1% 20.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10060
63
29500
0
03
23159
028
127
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
79
05
3127167950 29
79
$1,027,762 $17,644 $2,290,775 $0$0 $0 $3,336,180
30.8% 0.5% 68.7% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2736
Barrington Creek Dialysis28160 West Northwest HighwayLake BarringtonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Camino Dialysis, LLCLegal Entity Owner:
Property Owner: Barrington Medical Development, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Sumit Bector
In-Center Treatments in calendar year: 3,470Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 280
Patients treated as of 12/31/2016: (Ending patients) 285
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 60
Oct 714
0 0 26 0 22 0 24
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 26Transient Patients: 11Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 23Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 68
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
38Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 31%Use Rate (including Missed Treatments): 31%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 55
389%396%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 30Registered Nurse : 1Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
41
75.9%
Medicaid
5
Private Insurance
8
Charity Care
1
Private Pay
0
Other Public
0
TOTAL
54
9.3% 14.8% 1.9%0.0% 0.0% 100.0%
Patients
TOTAL 2010
47
30
52
5
012144
10
02544
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
55
01419
8145540 15
55
$6,070 $609,935 $935,838 $0$7,670 $71,167 $1,630,680
0.4% 37.4% 57.4% 0.0%0.5% 4.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2795
Belvidere Dialysis1751 Henry Lucklow LaneBelvidereBoone1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Dialysis of Northern Illinois, LLCLegal Entity Owner:
Property Owner: Dialysis of Northern Illinois, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
We do not yet have a Medicaid provider ID number and so it is appearing that we have not treated patients when in fact we have. We are a Denovo facility that opened for treatment in Feb of 2016 with our state audit being completed 3/28/16.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mashood Ahmad
In-Center Treatments in calendar year: 2,840Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 0
Patients treated as of 12/31/2016: (Ending patients) 29
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 10
Oct 20
Oct 316
Oct 49
Oct 516
Oct 69
Oct 716
0 0 29 0 27 0 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 39Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 13Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 108
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
43Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 25%Use Rate (including Missed Treatments): 26%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 43
0%40%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
33
76.7%
Medicaid
3
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
43
7.0% 14.0% 0.0%0.0% 2.3% 100.0%
Patients
TOTAL 2050
36
13300
0
01
1056
0254
10
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
43
03
159
164322 21
43
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20162/15/2016 to
14-2608
Benton Dialysis1151 State Route #14 WestBentonFranklin5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life Link, Inc.Legal Entity Owner:
Property Owner: Steven J. Zelman
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Cheryl Emmons
In-Center Treatments in calendar year: 5,865Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 46
Patients treated as of 12/31/2016: (Ending patients) 42
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 195.0
Oct 18
Oct 20
Oct 310
Oct 49
Oct 510
Oct 69
Oct 710
13 0 23 16 24 12 24
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 29Transient Patients: 7Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 2Patients transferred out: 11Patients voluntarily discontinued: 6Patients lost to follow up: 1Patients deceased: 11
Number of Missed Treatments: 2
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
38Total:
USE RATE for the FACILITY12,168Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 48%Use Rate (including Missed Treatments): 48%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 70
59%54%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 13Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 3Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 13Certified Stations by CMS: 13Peak Authorized Stations Operated: 13
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
57
76.0%
Medicaid
6
Private Insurance
6
Charity Care
1
Private Pay
0
Other Public
6
TOTAL
75
8.0% 8.0% 1.3%0.0% 8.0% 100.0%
Patients
TOTAL 1020
67
0700
0
04
18119
0278
11
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
70
06
2519207042 28
70
$1,244,194 $27,791 $654,991 $15,930$0 $301,987 $2,228,962
55.8% 1.2% 29.4% 0.7%0.0% 13.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2638
Beverly Dialysis Center8109 South Western AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life Link, Inc.Legal Entity Owner:
Property Owner: Dr. Mazhar M. Butt
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: James .J. Rydel MD
In-Center Treatments in calendar year: 13,653Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 96
Patients treated as of 12/31/2016: (Ending patients) 100
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 213.0
Oct 115.5
Oct 20
Oct 317.5
Oct 415.5
Oct 517.5
Oct 615.5
Oct 717.5
35 0 45 37 46 37 45
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 30Transient Patients: 40Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 29Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 1,402
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
45Total:
70Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 91%Use Rate (including Missed Treatments): 101%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 125
100%104%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
85
68.5%
Medicaid
4
Private Insurance
20
Charity Care
1
Private Pay
11
Other Public
4
TOTAL
124
3.2% 16.1% 0.8%8.9% 3.2% 100.0%
Patients
TOTAL 10
11806
3122
0
0
01037118
09
29129
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
125
019662317
12566 59
125
$2,002,064 $60,307 $2,738,895 $11,505$11,505 $1,041,190 $5,853,961
34.2% 1.0% 46.8% 0.2%0.2% 17.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2712
Big Oaks Dialysis Center5623 West TouhyNilesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Mid-America Asset Management, Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Daiva Valaitis
In-Center Treatments in calendar year: 5,091Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 33
Patients treated as of 12/31/2016: (Ending patients) 33
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 198.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 60
Oct 714
0 0 32 0 31 0 31
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 22Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 11Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 126
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
19Total:
30Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 45%Use Rate (including Missed Treatments): 46%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 49
46%46%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 3Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0.5Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
27
55.1%
Medicaid
2
Private Insurance
10
Charity Care
1
Private Pay
1
Other Public
9
TOTAL
49
4.1% 20.4% 2.0%2.0% 18.4% 100.0%
Patients
TOTAL 16010
28
2434
4
04
1277
01981
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
49
05
2115
84930 19
49
$735,958 $20,106 $927,026 $885$885 $383,590 $2,067,565
35.6% 1.0% 44.8% 0.0%0.0% 18.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2708
Blessing Dialysis Center of Pittsfield640 West Washington StreetPittsfieldPike3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Caer Inc.Legal Entity Owner:
Property Owner: Blessing Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Hrishikesh Ghanekar
In-Center Treatments in calendar year: 1,561Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 7
Patients treated as of 12/31/2016: (Ending patients) 12
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 10
Oct 20
Oct 314.5
Oct 40
Oct 514
Oct 60
Oct 713
0 0 14 0 13 0 12
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 9Transient Patients: 1Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 3Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 135
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
4Total:
11Total:
USE RATE for the FACILITY4,680Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 33%Use Rate (including Missed Treatments): 36%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 16
23%40%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 5Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 2Dietician : 1Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 5Certified Stations by CMS: 5Peak Authorized Stations Operated: 5
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
14
87.5%
Medicaid
0
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
16
0.0% 6.3% 0.0%0.0% 6.3% 100.0%
Patients
TOTAL 0000
16
0160
0
02344
00120
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
16
02464
1613 3
16
$427,458 $0 $140,070 $0$0 $41,705 $609,233
70.2% 0.0% 23.0% 0.0%0.0% 6.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2711
Blessing Hospital Renal Dialysis436 North 10th StreetQuincyAdams1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care Inc.Legal Entity Owner:
Property Owner: Blessing Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Hrishikesh Ghanekar
In-Center Treatments in calendar year: 7,556Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 48
Patients treated as of 12/31/2016: (Ending patients) 58
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 111
Oct 20
Oct 312.5
Oct 411
Oct 512.5
Oct 611
Oct 712.5
23 0 26 22 26 22 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 34Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 0Patients transferred out: 53Patients voluntarily discontinued: 8Patients lost to follow up: 0Patients deceased: 15
Number of Missed Treatments: 732
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
79Total:
77Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 45%Use Rate (including Missed Treatments): 49%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 117
44%54%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 6Dietician : 1Social Worker: 0LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
91
77.8%
Medicaid
5
Private Insurance
10
Charity Care
0
Private Pay
0
Other Public
11
TOTAL
117
4.3% 8.5% 0.0%0.0% 9.4% 100.0%
Patients
TOTAL 00
180
99
1116
0
0
05
292116
04
121218
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
117
09
413334
11771 46
117
$1,646,470 $38,119 $1,403,748 $0$0 $538,863 $3,627,200
45.4% 1.1% 38.7% 0.0%0.0% 14.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2663
Center for Renal Replacement7301 N. Lincoln Ave.LincolnwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Center for Renal Replacement, LLCLegal Entity Owner:
Property Owner: Imperial Realty
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: James K. Yeung, MD
In-Center Treatments in calendar year: 9,707Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 62
Patients treated as of 12/31/2016: (Ending patients) 65
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 114
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
29 0 33 28 31 27 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 17Transient Patients: 0Patients Re-Started: 4Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 12Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 4
Number of Missed Treatments: 104
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
21Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 65%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 75
65%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 15Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 36Registered Nurse : 4Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
52
69.3%
Medicaid
13
Private Insurance
9
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
75
17.3% 12.0% 0.0%1.3% 0.0% 100.0%
Patients
TOTAL 200
207
26
2730
2
02
121613
01
1399
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
75
03
2525227543 32
75
$1,239,598 $60,080 $411,367 $0$8,050 $0 $1,719,096
72.1% 3.5% 23.9% 0.0%0.5% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2609
Centralia Dialysis1231 State Route 161 EastCentraliaMarion5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life, Inc.Legal Entity Owner:
Property Owner: Steven J. Zelman
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Faisal Rashid
In-Center Treatments in calendar year: 5,352Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 55
Patients treated as of 12/31/2016: (Ending patients) 50
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 215.0
Oct 19
Oct 20
Oct 311
Oct 49
Oct 511
Oct 69
Oct 711
22 0 23 20 25 21 22
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 21Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 6Transplant Recipients: 2Patients transferred out: 11Patients voluntarily discontinued: 5Patients lost to follow up: 1Patients deceased: 14
Number of Missed Treatments: 424
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
28Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 41%Use Rate (including Missed Treatments): 44%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 87
65%60%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
71
81.6%
Medicaid
2
Private Insurance
14
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
87
2.3% 16.1% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
140
73
0870
0
05
181515
00
101311
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
87
05
2828268753 34
87
$1,926,946 $10,315 $1,032,832 $2,400,299$0 $0 $2,970,093
64.9% 0.3% 34.8% 80.8%0.0% 0.0% 100.0%Net Revenue
12/16/20161/16/2016 to
14-2635
Chicago Heights Dialysis177 East Joe Orr RoadChicago HeightsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Chicago Height Dialysis LLCLegal Entity Owner:
Property Owner: Matanky Realty
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Donald Hollandsworth
In-Center Treatments in calendar year: 11,791Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 78
Patients treated as of 12/31/2016: (Ending patients) 94
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 116.5
Oct 20
Oct 316.5
Oct 416.5
Oct 516.5
Oct 616.5
Oct 716.5
39 0 41 37 39 32 44
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 41Transient Patients: 9Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 43Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 632
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
60Total:
53Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 79%Use Rate (including Missed Treatments): 83%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 130
81%98%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 11Dietician : 1Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
94
72.3%
Medicaid
26
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
130
20.0% 4.6% 0.0%0.0% 3.1% 100.0%
Patients
TOTAL 00
970
33
18112
0
0
06
322016
09
251210
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
130
015573226
13074 56
130
$1,754,405 $47,076 $1,027,373 $40,415$40,415 $1,084,006 $3,953,275
44.4% 1.2% 26.0% 1.0%1.0% 27.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2793
Chicago Ridge Dialysis10511 S. Harlem Ave.Chicago RidgeCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Cagles Dialysis, LLCLegal Entity Owner:
Property Owner: Palestra RE Partners, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Sreya Pallath
In-Center Treatments in calendar year: 2,152Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 1
Patients treated as of 12/31/2016: (Ending patients) 36
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 311
Oct 40
Oct 511
Oct 60
Oct 711
0 0 25 0 22 0 22
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 40Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 12Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 202
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
51Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 14%Use Rate (including Missed Treatments): 16%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 40
1%38%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 13Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
27
69.2%
Medicaid
8
Private Insurance
3
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
39
20.5% 7.7% 2.6%0.0% 2.6% 100.0%
Patients
TOTAL 00
100
25
2330
0
01967
01443
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
35
02
1310103523 12
35
$404,562 $9,874 $504,112 $5,015$0 $72,454 $991,002
40.8% 1.0% 50.9% 0.5%0.0% 7.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2540
Circle Medical Management1426 West Washington Blvd.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Circle Medical Management, IncLegal Entity Owner:
Property Owner: Respiratory Health Associates of Chicago
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Stephe M. Korbet, M.D.
In-Center Treatments in calendar year: 15,667Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 105
Patients treated as of 12/31/2016: (Ending patients) 103
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 247.0
Oct 112
Oct 20
Oct 313
Oct 413
Oct 513
Oct 613
Oct 713
47 0 52 47 50 46 51
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 30Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 6Patients transferred out: 19Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 565
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
37Total:
USE RATE for the FACILITY25,272Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 62%Use Rate (including Missed Treatments): 64%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 142
65%64%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 27Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 72Registered Nurse : 7Dialysis Technician : 17Dietician : 1.5Social Worker: 2LPN : 2Other Health : 2Other Non-Health: 6.5
Authorized Stations as of 12/31/2016: 27Certified Stations by CMS: 27Peak Authorized Stations Operated: 27
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
114
80.3%
Medicaid
12
Private Insurance
16
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
142
8.5% 11.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
1070
35
16126
0
0
06
251214
011302519
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
142
017553733
14257 85
142
$6,152,360 $628,927 $1,754,649 $0$84,501 $0 $8,620,437
71.4% 7.3% 20.4% 0.0%1.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2715
Cobblestone Dialysis836 Dundee AvenueElginKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Cobblestone DialysisLegal Entity Owner:
Property Owner: Palestra Properties Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Ravi Damaraju
In-Center Treatments in calendar year: 12,211Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 76
Patients treated as of 12/31/2016: (Ending patients) 90
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 115
Oct 20
Oct 318
Oct 415
Oct 518
Oct 615
Oct 718
36 0 49 36 46 37 47
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 36Transient Patients: 27Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 31Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 556
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
63Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 82%Use Rate (including Missed Treatments): 85%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 117
79%94%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3.5Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
79
71.2%
Medicaid
12
Private Insurance
19
Charity Care
6
Private Pay
0
Other Public
1
TOTAL
111
10.8% 17.1% 5.4%0.0% 0.9% 100.0%
Patients
TOTAL 70
160
94
54630
0
010381212
03
171114
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
117
013552326
11772 45
117
$1,711,928 $148,320 $2,325,868 $138,945$0 $504,274 $4,690,389
36.5% 3.2% 49.6% 3.0%0.0% 10.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2698
Community Dialysis of Harvey16657 South Halsted StreetHarveyCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Yousef Musleh
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Edwin Cook
In-Center Treatments in calendar year: 9,798Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 64
Patients treated as of 12/31/2016: (Ending patients) 68
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
33 0 35 31 33 29 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 34Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 57Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 7
Number of Missed Treatments: 547
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
61Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 125
59%63%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 8Dietician : 0Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
85
68.0%
Medicaid
11
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
21
TOTAL
125
8.8% 6.4% 0.0%0.0% 16.8% 100.0%
Patients
TOTAL 10
11005
9116
0
9
014439
14
06
10209
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
125
020532923
12580 45
125
$1,537,896 $51,873 $1,025,728 $0$0 $691,045 $3,306,542
46.5% 1.6% 31.0% 0.0%0.0% 20.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2655
Concerto Dialysis LLC14255 Cicero AvenueCrestwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Concerto Dialysis LLCLegal Entity Owner:
Property Owner: Eclipse Kensington Properties LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Samson
In-Center Treatments in calendar year: 3,114Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 21
Patients treated as of 12/31/2016: (Ending patients) 19
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 10
Oct 20
Oct 315
Oct 40
Oct 515
Oct 60
Oct 715
0 0 20 0 19 0 18
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 7Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 10Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 270
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
10Total:
7Total:
USE RATE for the FACILITY8,424Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 37%Use Rate (including Missed Treatments): 40%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 29
39%35%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 9Isolation Stations Set up in Oct 1-7: 9
Full-Time Work Week: 40Registered Nurse : 1Dialysis Technician : 3Dietician : 0.2Social Worker: 0.2LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 9Certified Stations by CMS: 9Peak Authorized Stations Operated: 9
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
25
86.2%
Medicaid
2
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
29
6.9% 6.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
2207
0290
0
02546
02442
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
29
04988
2917 12
29
$696,828 $80,686 $125,653 $0$0 $0 $903,167
77.2% 8.9% 13.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2575
Country Hills Dialysis4215 W. 167th StreetCountry Club HillsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Country Hills DialysisLegal Entity Owner:
Property Owner: Stenstrom
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kenneth Cline
In-Center Treatments in calendar year: 15,109Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 107
Patients treated as of 12/31/2016: (Ending patients) 103
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 517
Oct 612
Oct 717
42 0 60 40 58 41 53
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 62Transient Patients: 23Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 56Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 18
Number of Missed Treatments: 1,526
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
82Total:
87Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 74%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 174
74%72%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
129
75.4%
Medicaid
22
Private Insurance
20
Charity Care
3
Private Pay
0
Other Public
0
TOTAL
171
12.9% 11.7% 1.8%0.0% 0.0% 100.0%
Patients
TOTAL 10
1421
28
12160
2
2
012443117
08
232712
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
174
020675829
174104 70
174
$2,328,283 $70,091 $1,653,083 $47,495$47,495 $1,216,472 $5,315,423
43.8% 1.3% 31.1% 0.9%0.9% 22.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2716
Crystal Springs Dialysis720 Cog CircleCrystal LakeMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Apex 720, LLC/Satish Patel
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sumit Bector
In-Center Treatments in calendar year: 9,007Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 45
Patients treated as of 12/31/2016: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 112
Oct 20
Oct 315
Oct 412
Oct 515
Oct 612
Oct 715
22 0 35 22 30 22 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 24Patients Re-Started: 4Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 37Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 3
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
56Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 97
54%71%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 38Registered Nurse : 2Dialysis Technician : 4Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
70
73.7%
Medicaid
4
Private Insurance
17
Charity Care
2
Private Pay
1
Other Public
3
TOTAL
95
4.2% 17.9% 2.1%1.1% 3.2% 100.0%
Patients
TOTAL 3050
89
14830
0
05
23189
03
141411
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
97
08
3732209755 42
97
$1,647,274 $32,946 $1,607,936 $51,625$51,625 $203,134 $3,542,915
46.5% 0.9% 45.4% 1.5%1.5% 5.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2625
Danville Dialysis Services LLC910 West Clay StreetDanvilleVermilion4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Danville Dialysis Services, L.L.C.Legal Entity Owner:
Property Owner: Brijnandan S. Sodhi, M.D.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Brijnandan S. Sodhi
In-Center Treatments in calendar year: 12,063Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 77
Patients treated as of 12/31/2016: (Ending patients) 79
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 111.5
Oct 20
Oct 312
Oct 411.5
Oct 512
Oct 611.5
Oct 712
34 0 45 35 47 30 46
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 22
Number of Missed Treatments: 342
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
35Total:
USE RATE for the FACILITY17,784Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 70%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 109
68%69%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 19Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 8Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 19Certified Stations by CMS: 19Peak Authorized Stations Operated: 19
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
95
87.2%
Medicaid
7
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
109
6.4% 6.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
480
61
2107
0
0
08
131720
07
151415
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
109
015283135
10958 51
109
$2,089,193 $15,752 $2,522,971 $0$0 $0 $4,627,916
45.1% 0.3% 54.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2590
DaVita - Montvale2930 Montvale Drive Suite ASpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare. INC.Legal Entity Owner:
Property Owner: Marriott Properties
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
We have a 4th shift nocturnal program on Sunday-Tuesday-Thursday
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Pradeep Mehta
In-Center Treatments in calendar year:
Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 72
Patients treated as of 12/31/2016: (Ending patients) 69
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 227.0
Oct 111
Oct 26
Oct 315
Oct 417
Oct 513
Oct 617
Oct 715
20 12 31 27 29 32 28
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 18Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 11Patients voluntarily discontinued: 5Patients lost to follow up: 1Patients deceased: 11
Number of Missed Treatments: 956
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
53Total:
USE RATE for the FACILITY15,912Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity):Use Rate (including Missed Treatments):Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 107
71%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 17Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 3Other Non-Health: 0
Authorized Stations as of 12/31/2016: 17Certified Stations by CMS: 17Peak Authorized Stations Operated: 17
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
69
62.2%
Medicaid
3
Private Insurance
35
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
111
2.7% 31.5% 0.0%0.0% 3.6% 100.0%
Patients
TOTAL 10
320
74
3104
0
0
04
181415
099
2018
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
107
013273433
10751 56
107
$1,615,733 $13,973 $1,470,249 $0$0 $627,366 $3,727,321
43.3% 0.4% 39.4% 0.0%0.0% 16.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2640
Davita - Churchview Dialysis417 Ware AvenueRockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers-Illinois, Inc.Legal Entity Owner:
Property Owner: DYN 417 LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Charles Sweeney
In-Center Treatments in calendar year: 16,204Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 124
Patients treated as of 12/31/2016: (Ending patients) 97
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 221.0
Oct 113
Oct 20
Oct 317
Oct 413
Oct 517
Oct 613
Oct 717
40 0 61 44 60 42 62
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 66Transient Patients: 30Patients Re-Started: 4Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 85Patients voluntarily discontinued: 4Patients lost to follow up: 2Patients deceased: 22
Number of Missed Treatments: 891
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
117Total:
101Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 72%Use Rate (including Missed Treatments): 76%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 214
86%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 30Registered Nurse : 5Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
170
79.8%
Medicaid
15
Private Insurance
21
Charity Care
1
Private Pay
0
Other Public
7
TOTAL
213
7.0% 9.9% 0.5%0.0% 3.3% 100.0%
Patients
TOTAL 41
482
159
29185
0
0
015462725
013332431
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
214
028795156
214113 101
214
$3,765,927 $78,855 $3,918,638 $16,520$16,520 $1,496,268 $9,276,208
40.6% 0.9% 42.2% 0.2%0.2% 16.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2599
DaVita - Decatur East Wood794 East Wood StreetDecaturMacon4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: DVA Renal Healthcare, Inc.Legal Entity Owner:
Property Owner: Shams Siddiqui
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Hasnain, MD
In-Center Treatments in calendar year: 9,040Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 65
Patients treated as of 12/31/2016: (Ending patients) 61
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 199.0
Oct 111
Oct 20
Oct 311
Oct 411
Oct 511
Oct 611
Oct 711
23 0 26 28 28 25 28
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 25Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 11Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 290
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
40Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 54%Use Rate (including Missed Treatments): 55%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 109
60%56%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 6Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
85
78.0%
Medicaid
10
Private Insurance
10
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
109
9.2% 9.2% 0.0%0.0% 3.7% 100.0%
Patients
TOTAL 00
561
52
1108
0
0
012241412
08
22143
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
109
020462815
10962 47
109
$1,927,595 $13,201 $1,666,872 $0$0 $445,990 $4,053,657
47.6% 0.3% 41.1% 0.0%0.0% 11.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2651
Davita - Dixon Kidney Center1131 North Galena AvenueDixonLee1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Center, ILLegal Entity Owner:
Property Owner: Senstrom
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Charles Sweeney
In-Center Treatments in calendar year: 3,067Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 23
Patients treated as of 12/31/2016: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 216.0
Oct 10
Oct 20
Oct 313
Oct 40
Oct 513
Oct 60
Oct 713
0 0 18 0 18 0 18
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 16Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 16Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 99
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
26Total:
25Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 41%Use Rate (including Missed Treatments): 42%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 46
48%48%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 30Registered Nurse : 2Dialysis Technician : 2.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 0.2
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
36
78.3%
Medicaid
3
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
46
6.5% 13.0% 0.0%0.0% 2.2% 100.0%
Patients
TOTAL 0060
40
2440
0
03
1446
02584
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
46
05
1912104627 19
46
$940,934 $33,220 $1,404,273 $0$0 $118,586 $2,497,012
37.7% 1.3% 56.2% 0.0%0.0% 4.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2642
DaVita - Freeport Dialysis Unit1028 Kunkle AvenueFreeportStephenson1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers-Illinois, Inc.Legal Entity Owner:
Property Owner: Edmund and Siham Totah
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: John Maynard
In-Center Treatments in calendar year: 3,796Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 27
Patients treated as of 12/31/2016: (Ending patients) 30
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 255.0
Oct 17
Oct 20
Oct 312
Oct 47
Oct 512
Oct 67
Oct 712
7 0 18 8 18 9 19
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 16Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 7Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 354
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
28Total:
USE RATE for the FACILITY9,360Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 41%Use Rate (including Missed Treatments): 44%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 53
45%50%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 10Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 1.5Dialysis Technician : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1.2Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 10Certified Stations by CMS: 10Peak Authorized Stations Operated: 10
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
44
83.0%
Medicaid
7
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
53
13.2% 1.9% 0.0%0.0% 1.9% 100.0%
Patients
TOTAL 00
200
33
2510
0
02
1499
02656
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
53
04
2014155334 19
53
$702,951 $38,972 $217,231 $0$0 $151,624 $1,110,778
63.3% 3.5% 19.6% 0.0%0.0% 13.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2552
DaVita - Lake County Dialysis Ctr565 Lakeview Parkway STE 176Vernon HillsLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Globe Corporation
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Leon Sujata
In-Center Treatments in calendar year: 10,059Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 75
Patients treated as of 12/31/2016: (Ending patients) 70
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 252.0
Oct 119
Oct 20
Oct 319
Oct 419
Oct 519
Oct 619
Oct 719
20 0 46 18 41 16 44
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 43Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 51Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 565
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
79Total:
75Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 71%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 138
78%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 5.88Dialysis Technician : 6.65Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1.3
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
107
79.9%
Medicaid
6
Private Insurance
15
Charity Care
2
Private Pay
0
Other Public
6
TOTAL
134
4.5% 11.2% 1.5%0.0% 4.5% 100.0%
Patients
TOTAL 90
162
87
268923
24
011242028
010201015
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
138
021443043
13883 55
138
$1,920,696 $19,130 $1,648,518 $13,425$0 $327,851 $3,916,196
49.0% 0.5% 42.1% 0.3%0.0% 8.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2528
DaVita - Lincoln Park Dialysis Center2484 N. Elston Ave.,ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Lincoln Park Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Chicago Title Land Trust Company
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Melvin K. Roseman, MD
In-Center Treatments in calendar year: 13,066Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 91
Patients treated as of 12/31/2016: (Ending patients) 92
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 115
Oct 20
Oct 315
Oct 415
Oct 515
Oct 615
Oct 715
45 0 44 42 46 44 41
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 41Patients Re-Started: 0Post-Transplant Patien 4
Recovered patients: 4Transplant Recipients: 2Patients transferred out: 67Patients voluntarily discontinued: 4Patients lost to follow up: 2Patients deceased: 8
Number of Missed Treatments: 592
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
87Total:
87Total:
USE RATE for the FACILITY20,592Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 178
69%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 2Other Non-Health: 1
Authorized Stations as of 12/31/2016: 22Certified Stations by CMS: 22Peak Authorized Stations Operated: 22
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
122
Medicaid
36
Private Insurance
16
Charity Care
1
Private Pay Other Public
2
TOTAL
Patients
TOTAL 140
570
107
38140
0
0
020362916
010282217
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
178
030645133
178101 77
178
$1,960,324 $129,334 $901,926 $10,510$0 $1,005,955 $3,997,539
49.0% 3.2% 22.6% 0.3%0.0% 25.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2583
DaVita - Litchfield915 St. Francis WayLitchfieldMontgomery3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare, Inc.Legal Entity Owner:
Property Owner: St. Francis Hospital of the Hospital Sisters Healt
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: X. Gary Chen, M.D.
In-Center Treatments in calendar year: 8,240Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 58
Patients treated as of 12/31/2016: (Ending patients) 57
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 110
Oct 20
Oct 313.5
Oct 410
Oct 513.5
Oct 610
Oct 713.5
22 0 29 23 28 22 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 19Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 15Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 193
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
24Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 73%Use Rate (including Missed Treatments): 75%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 82
81%79%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0.5Other Non-Health: 0
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
70
85.4%
Medicaid
4
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
82
4.9% 4.9% 0.0%0.0% 4.9% 100.0%
Patients
TOTAL 0030
79
0820
0
057
1815
02
101411
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
82
07
1732268245 37
82
$1,558,769 $52,727 $679,511 $0$0 $274,275 $2,565,283
60.8% 2.1% 26.5% 0.0%0.0% 10.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2668
DaVita - Little Village Dialysis2335 W. Cermak RoadChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centes - Illinois, Inc.Legal Entity Owner:
Property Owner: Crystal Realty, Co.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Ogbonnaya Aneziokoro
In-Center Treatments in calendar year: 13,040Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 86
Patients treated as of 12/31/2016: (Ending patients) 91
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 114
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
39 0 45 40 44 40 44
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 39Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 25Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 392
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
52Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 87%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 138
90%95%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
78
59.1%
Medicaid
35
Private Insurance
15
Charity Care
3
Private Pay
0
Other Public
4
TOTAL
132
26.5% 11.4% 2.3%0.0% 3.0% 100.0%
Patients
TOTAL 10
290
108
102360
0
019332111
08
211411
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
138
027543522
13884 54
138
$1,824,219 $137,747 $1,474,524 $73,455$0 $878,678 $4,315,169
42.3% 3.2% 34.2% 1.7%0.0% 20.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2534
DaVita - Logan Square Dialysis2838 N. Kimball Ave.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Kendrew Developments
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kap J. No M.D.
In-Center Treatments in calendar year: 15,843Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 76
Patients treated as of 12/31/2016: (Ending patients) 119
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
43 0 61 47 57 47 63
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 19Transient Patients: 23Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 7Transplant Recipients: 0Patients transferred out: 59Patients voluntarily discontinued: 2Patients lost to follow up: 3Patients deceased: 15
Number of Missed Treatments: 775
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
86Total:
42Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 60%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 183
45%71%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 28Isolation Stations Set up in Oct 1-7: 28
Full-Time Work Week: 40Registered Nurse : 5Dialysis Technician : 13Dietician : 2Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
144
64.9%
Medicaid
23
Private Insurance
31
Charity Care
16
Private Pay
0
Other Public
24
TOTAL
222
10.4% 14.0% 7.2%0.0% 10.8% 100.0%
Patients
TOTAL 50
190
159
131520
0
019483714
011151722
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
183
030635436
183118 65
183
$2,552,584 $179,667 $4,290,118 $36,875$0 $904,571 $7,926,940
32.2% 2.3% 54.1% 0.5%0.0% 11.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2584
DaVita - Macon County1090 West McKinley AvenueDecaturMacon4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare, Inc.Legal Entity Owner:
Property Owner: DVA Renal Healthcare, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Hasnain
In-Center Treatments in calendar year: 10,791Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 77
Patients treated as of 12/31/2016: (Ending patients) 72
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
33 0 36 31 35 28 37
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 13Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 25Patients voluntarily discontinued: 12Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 793
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
48Total:
USE RATE for the FACILITY21,528Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 50%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 125
56%52%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 23Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 6Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 1Other Non-Health: 3
Authorized Stations as of 12/31/2016: 23Certified Stations by CMS: 23Peak Authorized Stations Operated: 23
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
107
87.0%
Medicaid
6
Private Insurance
7
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
123
4.9% 5.7% 1.6%0.0% 2.4% 100.0%
Patients
TOTAL 00
482
75
1124
0
0
09
302414
04
17189
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
125
013474223
12577 48
125
$1,897,676 $16,930 $888,559 $7,375$0 $600,334 $3,403,499
55.8% 0.5% 26.1% 0.2%0.0% 17.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2649
DaVita - Monteclare Dialysis Center7009 West BelmontChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, IncLegal Entity Owner:
Property Owner: Robert Olsen & Gladys Olsen
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Kenneth Kuznetsky
In-Center Treatments in calendar year: 12,672Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 85
Patients treated as of 12/31/2016: (Ending patients) 86
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 195.0
Oct 114
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
37 0 40 37 41 37 41
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 51Transient Patients: 22Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 49Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 20
Number of Missed Treatments: 428
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
72Total:
73Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 85%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 152
89%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
109
76.8%
Medicaid
9
Private Insurance
21
Charity Care
4
Private Pay
0
Other Public
3
TOTAL
142
6.3% 14.8% 2.8%0.0% 2.1% 100.0%
Patients
TOTAL 80
342
51
54980
57
016221411
011402513
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
152
027623924
15263 89
152
$1,978,429 $113,642 $1,572,222 $159,005$0 $619,877 $4,284,169
46.2% 2.7% 36.7% 3.7%0.0% 14.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2654
DaVita - Schaumburg Renal Center1156 South Roselle RoadSchaumburgCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Schaumburg, LLC fka DSI Schaumburg, LLCLegal Entity Owner:
Property Owner: Targo Management Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Izabella Gurau
In-Center Treatments in calendar year: 12,788Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 78
Patients treated as of 12/31/2016: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 112
Oct 20
Oct 315
Oct 412
Oct 515
Oct 612
Oct 715
28 0 54 27 54 26 54
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 44Transient Patients: 54Patients Re-Started: 6Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 72Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 103
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
84Total:
104Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 170
65%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 6Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
118
71.1%
Medicaid
19
Private Insurance
24
Charity Care
2
Private Pay
0
Other Public
5
TOTAL
166
11.4% 14.5% 1.2%0.0% 3.0% 100.0%
Patients
TOTAL 360
192
109
29141
0
4
011422126
08
231920
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
170
019654046
170100 70
170
$2,153,413 $75,376 $1,351,854 $9,735$0 $754,156 $4,334,799
49.7% 1.7% 31.2% 0.2%0.0% 17.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2586
DaVita - Springfield Central932 North Rutledge StreetSpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare Inc.Legal Entity Owner:
Property Owner: Memorial Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ashraf Tamizuddin
In-Center Treatments in calendar year: 11,853Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 82
Patients treated as of 12/31/2016: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 222.0
Oct 111
Oct 20
Oct 315
Oct 411
Oct 515
Oct 611
Oct 715
30 0 47 31 42 30 45
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 36Transient Patients: 24Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 36Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 1,063
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
60Total:
USE RATE for the FACILITY19,656Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 60%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 138
65%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 21Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 5Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 21Certified Stations by CMS: 21Peak Authorized Stations Operated: 21
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
110
80.3%
Medicaid
2
Private Insurance
14
Charity Care
1
Private Pay
0
Other Public
11
TOTAL
137
1.5% 10.2% 0.7%0.0% 8.0% 100.0%
Patients
TOTAL 00
510
86
1137
0
1
09
351420
08
241711
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
138
017593131
13878 60
138
$1,838,858 $28,109 $1,522,723 $590$0 $799,612 $4,189,302
43.9% 0.7% 36.3% 0.0%0.0% 19.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2661
DaVIta - Stony Creek6246 W 95th StOak LawnCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life Link, Inc.Legal Entity Owner:
Property Owner: Shops of Oak Lawn LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: James Rydel
In-Center Treatments in calendar year: 10,154Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 69
Patients treated as of 12/31/2016: (Ending patients) 76
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 115
Oct 215
Oct 315
Oct 415
Oct 515
Oct 615
Oct 715
32 0 35 34 36 33 35
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 36Transient Patients: 17Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 4Transplant Recipients: 0Patients transferred out: 47Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 5
Number of Missed Treatments: 572
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
55Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 77%Use Rate (including Missed Treatments): 82%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 118
82%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
88
75.2%
Medicaid
15
Private Insurance
9
Charity Care
1
Private Pay
2
Other Public
3
TOTAL
117
12.8% 7.7% 0.9%1.7% 2.6% 100.0%
Patients
TOTAL 20
280
82
20980
6
03
201920
06
151916
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
118
09
353836
11862 56
118
$1,737,227 $54,635 $1,138,640 $8,155$8,155 $527,857 $3,466,514
50.1% 1.6% 32.8% 0.2%0.2% 15.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2639
Davita - Sycamore2200 Gateway DriveSycamoreDeKalb1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Dialysis of Northern IL, LLCLegal Entity Owner:
Property Owner: Patricia DeNarde
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Bindu Pavithran, MD
In-Center Treatments in calendar year: 8,156Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 51
Patients treated as of 12/31/2016: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 113
Oct 20
Oct 315
Oct 413
Oct 515
Oct 613
Oct 715
25 0 31 23 29 23 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 18Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 29Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 7
Number of Missed Treatments: 227
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
47Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 73%Use Rate (including Missed Treatments): 75%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 92
71%76%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 30Registered Nurse : 2Dialysis Technician : 4Dietician : 0Social Worker: 0LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
72
78.3%
Medicaid
7
Private Insurance
13
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
92
7.6% 14.1% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
120
75
9830
5
09
191414
079
1010
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
92
0162824249256 36
92
$1,531,410 $43,380 $905,606 $0$0 $0 $2,480,396
61.7% 1.7% 36.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2648
Davita - Whiteside Dialysis2600 North Locust StreetSterlingWhiteside1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers-Ill Inc.Legal Entity Owner:
Property Owner: CGH Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Charlene Murdakes
In-Center Treatments in calendar year: 8,189Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 61
Patients treated as of 12/31/2016: (Ending patients) 50
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 112
Oct 20
Oct 321
Oct 412
Oct 521
Oct 612
Oct 721
14 0 32 19 31 18 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 22Transient Patients: 14Patients Re-Started: 9Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 11Patients voluntarily discontinued: 8Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 416
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
45Total:
USE RATE for the FACILITY14,040Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 72
68%56%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 15Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 30Registered Nurse : 2.8Dialysis Technician : 4.8Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 0.9
Authorized Stations as of 12/31/2016: 15Certified Stations by CMS: 15Peak Authorized Stations Operated: 15
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
51
70.8%
Medicaid
12
Private Insurance
9
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
72
16.7% 12.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 1010
63
7650
7
06
10107
02
13168
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
72
08
2326157233 39
72
$1,636,224 $84,587 $283,084 $0$0 $181,858 $2,185,752
74.9% 3.9% 13.0% 0.0%0.0% 8.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2529
DaVita Emerald Dialysis710 West 43rd StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal CareLegal Entity Owner:
Property Owner: Tony Regas
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Edwin Cook
In-Center Treatments in calendar year: 16,139Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 110
Patients treated as of 12/31/2016: (Ending patients) 111
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 335.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
41 0 61 39 61 36 64
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 25Transient Patients: 26Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 6Patients transferred out: 54Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 9
Number of Missed Treatments: 806
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
71Total:
51Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 72%Use Rate (including Missed Treatments): 75%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 161
76%77%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 24
Full-Time Work Week: 36Registered Nurse : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
109
71.2%
Medicaid
16
Private Insurance
9
Charity Care
6
Private Pay
0
Other Public
19
TOTAL
153
10.5% 5.9% 3.9%0.0% 12.4% 100.0%
Patients
TOTAL 00
1370
23
15145
1
1
02646186
015328
10
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
161
041782616
16196 65
161
$2,527,447 $189,895 $2,214,889 $88,795$0 $1,043,393 $5,975,623
42.3% 3.2% 37.1% 1.5%0.0% 17.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2740
Davita Morris Dialysis Center1551 Creek DriveMorrisGrundy9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Keith Jaeschke
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Z. Teresa Majka-Kravets, MD
In-Center Treatments in calendar year: 5,456Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 29
Patients treated as of 12/31/2016: (Ending patients) 42
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 212.0
Oct 114
Oct 20
Oct 316
Oct 414
Oct 516
Oct 614
Oct 716
22 0 24 20 24 20 22
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 40Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 14Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 207
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
24Total:
53Total:
USE RATE for the FACILITY8,424Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 65%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 80
54%78%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 0Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 4Dietician : 0.4Social Worker: 0.4LPN : 0Other Health : 0.5Other Non-Health: 0
Authorized Stations as of 12/31/2016: 9Certified Stations by CMS: 9Peak Authorized Stations Operated: 9
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
67
83.8%
Medicaid
4
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
80
5.0% 8.8% 0.0%0.0% 2.5% 100.0%
Patients
TOTAL 1071
71
4760
0
06
111416
038
1111
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
80
09
1925278047 33
80
$1,130,161 $61,157 $212,324 $0$0 $144,089 $1,547,731
73.0% 4.0% 13.7% 0.0%0.0% 9.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2660
DaVita Mount Greenwood Dialysis3401 W. 111th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers-Illinois, Inc.Legal Entity Owner:
Property Owner: Columbia Pacific Advisors, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohamad Barakat
In-Center Treatments in calendar year: 13,991Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 102
Patients treated as of 12/31/2016: (Ending patients) 95
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 116
Oct 20
Oct 318
Oct 416
Oct 518
Oct 616
Oct 718
39 0 47 40 48 39 51
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 37Transient Patients: 31Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 33Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 18
Number of Missed Treatments: 808
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
56Total:
69Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 93%Use Rate (including Missed Treatments): 99%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 154
106%99%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 0Registered Nurse : 3Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
114
87.7%
Medicaid
4
Private Insurance
9
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
130
3.1% 6.9% 1.5%0.0% 2.3% 100.0%
Patients
TOTAL 00
1260
28
8146
0
0
015381919
03
241521
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
154
018623440
15491 63
154
$2,321,190 $42,858 $1,520,606 $41,005$0 $896,244 $4,780,898
48.6% 0.9% 31.8% 0.9%0.0% 18.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2548
DaVita Olympia Fields Dialysis Center4557 Lincoln HighwayMattesonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Olympia Fields Dialysis CenterLegal Entity Owner:
Property Owner: Joseph Freed
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Don Hollandsworth
In-Center Treatments in calendar year: 1,214Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 95
Patients treated as of 12/31/2016: (Ending patients) 99
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 231.0
Oct 111
Oct 20
Oct 317
Oct 411
Oct 517
Oct 611
Oct 717
43 0 52 42 51 41 52
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 57Transient Patients: 18Patients Re-Started: 3Post-Transplant Patien 2
Recovered patients: 6Transplant Recipients: 2Patients transferred out: 31Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 1,466
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
80Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 5%Use Rate (including Missed Treatments): 12%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 161
66%69%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 40Dialysis Technician : 40Dietician : 40Social Worker: 40LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
124
78.0%
Medicaid
14
Private Insurance
18
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
159
8.8% 11.3% 1.3%0.0% 1.9% 100.0%
Patients
TOTAL 31
1230
26
8153
0
8
015381917
07
271622
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
161
022653539
16189 72
161
$1,852,090 $285,427 $1,654,345 $87,350$0 $1,310,549 $5,102,411
36.3% 5.6% 32.4% 1.7%0.0% 25.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2718
DaVita Stony Island Dialysis8725 S. Stony Island AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal CareLegal Entity Owner:
Property Owner: Tiebout IL LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nicole Stankus, MD
In-Center Treatments in calendar year: 23,440Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 135
Patients treated as of 12/31/2016: (Ending patients) 135
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 322.0
Oct 116
Oct 20
Oct 319
Oct 416
Oct 519
Oct 616
Oct 719
69 0 90 70 88 71 81
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 88Transient Patients: 4Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 41Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 1,762
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
59Total:
95Total:
USE RATE for the FACILITY29,952Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 78%Use Rate (including Missed Treatments): 84%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 230
70%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 32Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 40Registered Nurse : 9Dialysis Technician : 22Dietician : 2Social Worker: 2LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 32Certified Stations by CMS: 32Peak Authorized Stations Operated: 32
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
166
76.1%
Medicaid
12
Private Insurance
32
Charity Care
2
Private Pay
0
Other Public
8
TOTAL
218
5.5% 14.7% 0.9%0.0% 3.7% 100.0%
Patients
TOTAL 10
22702
5225
0
0
014542220
015383334
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
230
029925554
230110 120
230
$4,289,247 $194,807 $1,988,325 $81,420$0 $1,307,158 $7,779,537
55.1% 2.5% 25.6% 1.0%0.0% 16.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2587
DaVita- Taylorville901 West SpresserTaylorvilleChristian3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVa Renal Healthcare, Inc.Legal Entity Owner:
Property Owner: Richmar LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Pradeep K. Mehta, M.D.
In-Center Treatments in calendar year: 6,539Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 37
Patients treated as of 12/31/2016: (Ending patients) 51
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 114
Oct 20
Oct 314.5
Oct 414
Oct 514.5
Oct 614
Oct 714.5
21 0 25 23 25 22 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 24Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 5Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 155
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
11Total:
25Total:
USE RATE for the FACILITY9,360Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 70%Use Rate (including Missed Treatments): 72%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 57
62%85%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 10Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 3Dietician : 5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 10Certified Stations by CMS: 10Peak Authorized Stations Operated: 10
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
44
77.2%
Medicaid
6
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
57
10.5% 10.5% 0.0%0.0% 1.8% 100.0%
Patients
TOTAL 0010
56
0570
0
048
1013
01867
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
57
05
1616205735 22
57
$1,090,029 $23,344 $398,451 $0$0 $422,695 $1,934,519
56.3% 1.2% 20.6% 0.0%0.0% 21.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2604
DaVita TRC Children's Dialysis2611 North HalstedChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal CareLegal Entity Owner:
Property Owner: Everbury Partners c/o Structured Develpment
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Craig Langman
In-Center Treatments in calendar year: 2,565Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 15
Patients treated as of 12/31/2016: (Ending patients) 17
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 110
Oct 20
Oct 310
Oct 410
Oct 510
Oct 610
Oct 710
8 0 7 6 6 7 6
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 6Patients transferred out: 7Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 14
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
13Total:
15Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 34%Use Rate (including Missed Treatments): 34%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 30
31%35%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 6Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 4.5Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1.5Other Non-Health: 0
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 6
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
6
21.4%
Medicaid
6
Private Insurance
8
Charity Care
2
Private Pay
0
Other Public
8
TOTAL
28
21.4% 28.6% 7.1%0.0% 28.6% 100.0%
Patients
TOTAL 10
110
18
6240
0
128000
55000
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
30
1713
000
3020 10
30
$518,430 $118,077 $1,430,386 $3,540$0 $167,652 $2,234,545
23.2% 5.3% 64.0% 0.2%0.0% 7.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2577
Davita Waukegan3350 W . GRAND AVE STE 100WaukeganLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD RENAL , INC.Legal Entity Owner:
Property Owner: NATIONAL SHOPPING PLAZA
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: SALIMA DIN
In-Center Treatments in calendar year: 22,925Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 125
Patients treated as of 12/31/2016: (Ending patients) 143
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 222.0
Oct 116
Oct 20
Oct 318
Oct 416
Oct 518
Oct 616
Oct 718
56 0 70 56 68 61 67
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 60Transient Patients: 15Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 4Patients transferred out: 42Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 15
Number of Missed Treatments: 387
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
75Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 102%Use Rate (including Missed Treatments): 104%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 136
87%99%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 6Dialysis Technician : 17Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
98
74.2%
Medicaid
16
Private Insurance
13
Charity Care
4
Private Pay
0
Other Public
5
TOTAL
132
12.1% 9.8% 3.0%0.0% 3.8% 100.0%
Patients
TOTAL 30
610
72
57790
0
015341720
03
191414
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
136
018533134
13686 50
136
$3,017,529 $135,789 $2,547,454 $177,000$177,000 $1,388,111 $7,265,883
41.5% 1.9% 35.1% 2.4%2.4% 19.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2544
Davita-South Holland Renal Center16136 South Park AvenueSouth HollandCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Renal, Inc.Legal Entity Owner:
Property Owner: Cornelius Nymeyer
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kenneh Cline, M.D.
In-Center Treatments in calendar year: 16,932Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 118
Patients treated as of 12/31/2016: (Ending patients) 114
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 116
Oct 20
Oct 317
Oct 416
Oct 517
Oct 616
Oct 717
47 0 58 47 56 47 58
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 56Transient Patients: 13Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 60Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 17
Number of Missed Treatments: 1,566
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
82Total:
72Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 90%Use Rate (including Missed Treatments): 99%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 172
98%95%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 8Dialysis Technician : 14Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 4
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
135
78.5%
Medicaid
9
Private Insurance
24
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
172
5.2% 14.0% 0.0%0.0% 2.3% 100.0%
Patients
TOTAL 00
1450
27
8164
0
0
011402325
010261720
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
172
021664045
17299 73
172
$2,871,836 $29,999 $2,691,315 $4,425$4,425 $900,216 $6,497,791
44.2% 0.5% 41.4% 0.1%0.1% 13.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2747
Driftwood Dialysis1808 South West AvenueFreeportStephenson1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Freeport Bay DialysisLegal Entity Owner:
Property Owner: Frontier Real Estate
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Farhan Khan
In-Center Treatments in calendar year: 5,321Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 38
Patients treated as of 12/31/2016: (Ending patients) 38
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 205.0
Oct 16
Oct 20
Oct 313
Oct 46
Oct 513
Oct 66
Oct 713
7 0 29 8 29 8 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 15Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 10Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 394
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
23Total:
USE RATE for the FACILITY9,360Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 57%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 60
63%63%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 10Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2.5Dialysis Technician : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1.3Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 10Certified Stations by CMS: 10Peak Authorized Stations Operated: 10
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
54
90.0%
Medicaid
3
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
60
5.0% 3.3% 0.0%0.0% 1.7% 100.0%
Patients
TOTAL 00
21390
0600
0
03
1677
0259
11
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
60
05
2116186033 27
60
$1,328,947 $61,026 $313,199 $0$0 $99,927 $1,803,099
73.7% 3.4% 17.4% 0.0%0.0% 5.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2628
DSI - Arlington Heights17 West Golf RoadArlington HeightsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Renal, Inc.Legal Entity Owner:
Property Owner: Watermark Property Management, LLC.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: George Hvostik M.D,
In-Center Treatments in calendar year: 8,618Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 64
Patients treated as of 12/31/2016: (Ending patients) 73
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
16 0 38 15 40 14 39
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 46Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 55Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 314
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
65Total:
73Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 51%Use Rate (including Missed Treatments): 53%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 93
59%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 18
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
69
72.6%
Medicaid
11
Private Insurance
10
Charity Care
2
Private Pay
1
Other Public
4
TOTAL
95
11.6% 10.5% 2.1%1.1% 4.2% 100.0%
Patients
TOTAL 14040
74
5871
1
02
231516
02
131012
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
93
04
3625289356 37
93
$1,713,826 $16,430 $1,022,922 $590$590 $310,194 $3,063,962
55.9% 0.5% 33.4% 0.0%0.0% 10.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2650
DSI Buffalo Grove1291 West Dundee RoadBuffalo GroveCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Buffalo Grove, LLC fka DSI Buffalo Grove, LLCLegal Entity Owner:
Property Owner: Amalgamated Bank of Chicago
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fourth Shift is included in the normal scheduled hours of operation during the week of Oct 1 - Oct 7, 2016 but no patients were served on that shift that week.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. George Hvostik MD
In-Center Treatments in calendar year: 9,247Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 67
Patients treated as of 12/31/2016: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 115.5
Oct 20
Oct 318
Oct 415.5
Oct 518
Oct 615.5
Oct 718
18 0 36 14 37 13 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 17Transient Patients: 41Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 56Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 192
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
67Total:
58Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 62%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 166
70%63%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 30Registered Nurse : 4Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
113
68.1%
Medicaid
2
Private Insurance
17
Charity Care
3
Private Pay
3
Other Public
31
TOTAL
166
1.2% 10.2% 1.8%1.8% 18.7% 100.0%
Patients
TOTAL 29170
129
19147
0
0
09
402635
03
131525
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
166
012534160
166110 56
166
$1,676,693 $3,570 $1,087,643 $44,975$44,975 $429,877 $3,242,759
51.7% 0.1% 33.5% 1.4%1.4% 13.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2622
DSI Hazel Crest3470 West 183rd StreetHazel CrestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Renal Inc AKA DSI Renal IncLegal Entity Owner:
Property Owner: Resolution Property Services
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Daniel Yohay
In-Center Treatments in calendar year: 18,274Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 101
Patients treated as of 12/31/2016: (Ending patients) 100
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 116
Oct 20
Oct 321.75
Oct 416
Oct 521.75
Oct 616
Oct 721.75
46 0 52 46 50 38 48
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 51Transient Patients: 20Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 4Transplant Recipients: 1Patients transferred out: 44Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 14
Number of Missed Treatments: 545
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
65Total:
73Total:
USE RATE for the FACILITY17,784Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 103%Use Rate (including Missed Treatments): 106%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 180
89%88%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 19Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 19Certified Stations by CMS: 19Peak Authorized Stations Operated: 19
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
138
76.7%
Medicaid
16
Private Insurance
19
Charity Care
1
Private Pay
1
Other Public
6
TOTAL
180
8.9% 10.6% 0.6%0.6% 3.3% 100.0%
Patients
TOTAL 00
1560
24
8172
0
0
021452319
010251522
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
180
031703841
180108 72
180
$2,379,101 $8,364 $1,775,968 $7,965$7,965 $1,226,021 $5,397,420
44.1% 0.2% 32.9% 0.1%0.1% 22.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2505
DSI Loop Renal Center1101 South Canal StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Renal, Inc.Legal Entity Owner:
Property Owner: McCaffery Interests
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sheldon Hirsch, MD
In-Center Treatments in calendar year: 14,746Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 78
Patients treated as of 12/31/2016: (Ending patients) 111
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 113
Oct 20
Oct 316
Oct 413
Oct 516
Oct 613
Oct 716
48 0 49 50 54 48 52
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 46Transient Patients: 1Patients Re-Started: 3Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 43Patients voluntarily discontinued: 0Patients lost to follow up: 3Patients deceased: 7
Number of Missed Treatments: 2
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
56Total:
52Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 123
46%66%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 28Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 20Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
89
71.8%
Medicaid
23
Private Insurance
10
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
124
18.5% 8.1% 0.0%0.8% 0.8% 100.0%
Patients
TOTAL 110
930
19
13110
0
0
03
34149
07
311114
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
123
010652523
12360 63
123
$2,382,868 $31,135 $2,230,701 $9,735$9,735 $993,514 $5,647,953
42.2% 0.6% 39.5% 0.2%0.2% 17.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2518
DSI Scottsdale Renal Center4651 West 79th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: US Renal CareLegal Entity Owner:
Property Owner: A & R Katz
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Jeannette McLaughlin
In-Center Treatments in calendar year: 18,480Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 132
Patients treated as of 12/31/2016: (Ending patients) 128
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 113
Oct 20
Oct 317
Oct 413
Oct 517
Oct 613
Oct 717
48 0 71 48 68 43 69
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 23Transient Patients: 6Patients Re-Started: 16Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 4Patients transferred out: 25Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 2,578
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
45Total:
USE RATE for the FACILITY33,696Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 55%Use Rate (including Missed Treatments): 62%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 177
61%59%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 36Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 0Registered Nurse : 7Dialysis Technician : 14Dietician : 2Social Worker: 2LPN : 1Other Health : 2Other Non-Health: 0
Authorized Stations as of 12/31/2016: 36Certified Stations by CMS: 36Peak Authorized Stations Operated: 36
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
127
72.6%
Medicaid
14
Private Insurance
20
Charity Care
2
Private Pay
0
Other Public
14
TOTAL
175
8.0% 11.4% 1.1%0.0% 8.0% 100.0%
Patients
TOTAL 110
830
83
29148
0
0
08
323415
06
273025
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
177
014596440
17789 88
177
$3,255,901 $256,381 $3,062,658 $12,006$0 $555,808 $7,130,748
45.7% 3.6% 43.0% 0.2%0.0% 7.8% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2701
Edwardsville Dialysis235 South BuchananEdwardsvilleMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Triple Crown Partners, LLC.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sriraj Kanungo
In-Center Treatments in calendar year: 5,295Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 37
Patients treated as of 12/31/2016: (Ending patients) 33
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 214.0
Oct 19
Oct 20
Oct 314
Oct 49
Oct 514
Oct 69
Oct 714
13 0 20 15 21 12 22
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 11Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 9Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 389
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
25Total:
21Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 71%Use Rate (including Missed Treatments): 76%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 58
77%69%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 3Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
49
84.5%
Medicaid
2
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
58
3.4% 10.3% 0.0%0.0% 1.7% 100.0%
Patients
TOTAL 006
500
0580
2
01
1575
02
12106
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
58
03
2717115828 30
58
$787,547 $0 $607,098 $0$0 $472,308 $1,866,954
42.2% 0.0% 32.5% 0.0%0.0% 25.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2580
Effingham Dialysis904 Medical Park DriveEffinghamEffingham5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare, Inc.Legal Entity Owner:
Property Owner: HSHS Medical Group, Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Bashar Alzahabi
In-Center Treatments in calendar year: 6,413Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 46
Patients treated as of 12/31/2016: (Ending patients) 43
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
16 0 22 16 20 15 22
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 21Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 17Patients voluntarily discontinued: 3Patients lost to follow up: 2Patients deceased: 11
Number of Missed Treatments: 487
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
36Total:
31Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 43%Use Rate (including Missed Treatments): 46%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 76
48%45%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 30Registered Nurse : 3Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
70
92.1%
Medicaid
1
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
76
1.3% 3.9% 0.0%0.0% 2.6% 100.0%
Patients
TOTAL 1000
75
2740
0
02
12207
046
1213
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
76
06
1832207641 35
76
$1,711,158 $23,886 $1,046,697 $0$0 $135,142 $2,916,883
58.7% 0.8% 35.9% 0.0%0.0% 4.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2511
Evanston Renal Center1922 Dempster StreetEvanstonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Renal, Inc.Legal Entity Owner:
Property Owner: Schwab Realty and Development
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: George Kim, MD
In-Center Treatments in calendar year: 12,031Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 74
Patients treated as of 12/31/2016: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 207.0
Oct 113
Oct 20
Oct 315
Oct 413
Oct 515
Oct 613
Oct 715
34 0 41 35 41 35 42
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 43Transient Patients: 21Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 39Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 15
Number of Missed Treatments: 333
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
65Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 71%Use Rate (including Missed Treatments): 73%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 139
69%78%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
91
65.5%
Medicaid
31
Private Insurance
14
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
139
22.3% 10.1% 0.0%2.2% 0.0% 100.0%
Patients
TOTAL 210
690
49
24115
0
0
014292017
07
241216
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
139
021533233
13980 59
139
$1,512,740 $128,751 $1,103,085 $267,750$267,750 $1,013,715 $4,026,042
37.6% 3.2% 27.4% 6.7%6.7% 25.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2568
Fox Valley Dialysis,Ltd.1300 Waterford DriveAuroraKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Renaissance Management Company, LLC (operateLegal Entity Owner:
Property Owner: RBSG&M
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Pardeep Sood
In-Center Treatments in calendar year: 18,516Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 120
Patients treated as of 12/31/2016: (Ending patients) 131
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 318
Oct 412
Oct 518
Oct 612
Oct 718
48 0 71 49 70 47 77
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 60Transient Patients: 19Patients Re-Started: 3Post-Transplant Patien 4
Recovered patients: 6Transplant Recipients: 4Patients transferred out: 50Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 672
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
75Total:
86Total:
USE RATE for the FACILITY27,144Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 71%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 198
69%75%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 27Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 6.23Dialysis Technician : 13.22Dietician : 1.14Social Worker: 0.93LPN : 0.87Other Health : 0.62Other Non-Health: 3.94
Authorized Stations as of 12/31/2016: 29Certified Stations by CMS: 29Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
151
76.3%
Medicaid
28
Private Insurance
19
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
198
14.1% 9.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 70
380
153
79119
0
0
015432622
015342419
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
198
030775041
198106 92
198
$2,795,028 $552,118 $1,715,793 $0$0 $0 $5,062,939
55.2% 10.9% 33.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2524
Fresenius Medical Care Bridgeport825 West 35th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Bridgeport Assosiates
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Maria Sobrero, M.D.
In-Center Treatments in calendar year: 18,790Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 133
Patients treated as of 12/31/2016: (Ending patients) 119
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 114
Oct 20
Oct 317
Oct 414
Oct 517
Oct 613
Oct 717
51 0 64 54 65 48 66
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 40Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 994
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
60Total:
42Total:
USE RATE for the FACILITY25,272Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 74%Use Rate (including Missed Treatments): 78%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 175
82%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 27Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 16Dietician : 1.5Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 27Certified Stations by CMS: 27Peak Authorized Stations Operated: 27
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
118
67.4%
Medicaid
1
Private Insurance
55
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
175
0.6% 31.4% 0.0%0.6% 0.0% 100.0%
Patients
TOTAL 240
980
53
43132
0
0
07
332821
07
352519
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
175
014685340
17589 86
175
$3,296,412 $49,849 $3,755,770 $0$32,235 $122,369 $7,256,635
45.4% 0.7% 51.8% 0.0%0.4% 1.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2658
Fresenius Medical Care Aledo409 NW 9th AvenueAledoMercer10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Quad Cities, LLCLegal Entity Owner:
Property Owner: RRS Investments, LLP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care acquired Quad Cities Aledo, Geneseo, Moline, Rock Island, Rock River – Dixon, and Silvis facilities as of May 1, 2016. Compiled 2016 financial information prior to May 1 was provided by Quad Cities and was combined with compiled 2016 financial information from Fresenius Medical Care to complete the survey. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Travis Figanbaum, M.D.
In-Center Treatments in calendar year: 2,219Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 15
Patients treated as of 12/31/2016: (Ending patients) 13
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 312
Oct 40
Oct 511
Oct 60
Oct 711
0 0 14 0 13 0 13
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 3Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 2Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 55
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
6Total:
4Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 30%Use Rate (including Missed Treatments): 30%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 19
31%27%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
17
89.5%
Medicaid
1
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
19
5.3% 5.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
19
0190
0
00431
00335
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
19
00766
198 11
19
$575,970 $1,401 $88,293 $0$0 $0 $665,664
86.5% 0.2% 13.3% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2630
Fresenius Medical Care Alsip12250 S. Cicero, Ste #105AlsipCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Hickory Properties, INC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sejal Kalawadia, M.D.
In-Center Treatments in calendar year: 11,777Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 77
Patients treated as of 12/31/2016: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 113
Oct 20
Oct 318
Oct 413
Oct 518
Oct 613
Oct 718
37 0 49 37 49 37 49
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 39Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 28Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 433
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
46Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 65%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 117
64%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
75
64.1%
Medicaid
0
Private Insurance
41
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
117
0.0% 35.0% 0.0%0.0% 0.9% 100.0%
Patients
TOTAL 10
810
34
11105
1
1
08
26119
04
282011
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
117
012543120
11754 63
117
$1,431,136 $22,170 $1,942,707 $0$0 $0 $3,396,013
42.1% 0.7% 57.2% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2515
Fresenius Medical Care Aurora455 Mercy LaneAuroraKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: American Realty Capital Properties , INC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Facility runs a 4th shift of patients on Monday, Wednesday, Friday with 6 patients. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Navinchandra Dodhia, M.D.
In-Center Treatments in calendar year: 22,024Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 142
Patients treated as of 12/31/2016: (Ending patients) 152
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 118
Oct 20
Oct 320
Oct 418
Oct 520
Oct 618
Oct 720
72 0 77 74 71 70 76
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 46Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 23Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 599
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
50Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 98%Use Rate (including Missed Treatments): 101%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 192
99%106%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 11Dialysis Technician : 20Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
106
55.2%
Medicaid
1
Private Insurance
74
Charity Care
0
Private Pay
7
Other Public
4
TOTAL
192
0.5% 38.5% 0.0%3.6% 2.1% 100.0%
Patients
TOTAL 70
600
125
82110
0
0
015491828
011302615
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
192
026794443
192110 82
192
$3,098,369 $46,645 $4,962,640 $0$24,164 $85,216 $8,217,034
37.7% 0.6% 60.4% 0.0%0.3% 1.0% 100.0%Net Revenue
1/31/20161/1/2016 to
14-2653
Fresenius Medical Care Austin Community4800 W. Chicago Ave., 2nd Fl.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Westside Health Authority
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Kracker, M.D.
In-Center Treatments in calendar year: 8,661Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 61
Patients treated as of 12/31/2016: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 114
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
25 0 29 28 22 28 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 26Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 21Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 530
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
33Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 90
64%63%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
60
66.7%
Medicaid
1
Private Insurance
29
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
90
1.1% 32.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
780
12
12780
0
01022126
05
15137
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
90
0153725139050 40
90
$1,603,274 $74,148 $1,006,210 $0$94,631 $0 $2,778,263
57.7% 2.7% 36.2% 0.0%3.4% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2533
Fresenius Medical Care Berwyn2601 S. Harlem Avenue, 1st Fl.BerwynCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Blueroad Net Lease, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Andersen, M.D.
In-Center Treatments in calendar year: 22,370Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 149
Patients treated as of 12/31/2016: (Ending patients) 150
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
71 0 71 66 73 66 74
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 32Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 46Patients voluntarily discontinued: 7Patients lost to follow up: 1Patients deceased: 17
Number of Missed Treatments: 334
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
77Total:
77Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 85%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 226
89%89%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 28Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 17Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
114
50.4%
Medicaid
9
Private Insurance
93
Charity Care
0
Private Pay
9
Other Public
1
TOTAL
226
4.0% 41.2% 0.0%4.0% 0.4% 100.0%
Patients
TOTAL 20
250
199
1129123
0
021713517
07
322221
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
226
028
1035738
226144 82
226
$2,971,154 $113,690 $4,830,719 $0$129,243 $0 $8,044,806
36.9% 1.4% 60.0% 0.0%1.6% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2539
Fresenius Medical Care Blue Island12200 Western AvenueBlue IslandCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner:
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Salvatore Ventura, M.D.
In-Center Treatments in calendar year: 17,695Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 125
Patients treated as of 12/31/2016: (Ending patients) 117
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
56 0 56 56 55 57 56
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 30Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 418
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
32Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 150
74%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
81
54.0%
Medicaid
1
Private Insurance
66
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
150
0.7% 44.0% 0.0%0.7% 0.7% 100.0%
Patients
TOTAL 00
1240
25
16133
1
1
010362020
04
212415
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
150
014574435
15086 64
150
$3,018,361 $35,604 $3,509,548 $0$21,881 $57,251 $6,642,645
45.4% 0.5% 52.8% 0.0%0.3% 0.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2605
Fresenius Medical Care Bolingbrook329 Remington BoulevardBolingbrookWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Remington Develoment Partners c/o Physicians Re
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Huma Rohail, M.D.
In-Center Treatments in calendar year: 19,009Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 137
Patients treated as of 12/31/2016: (Ending patients) 121
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
60 0 61 61 66 56 64
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 43Transient Patients: 27Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 6Patients transferred out: 74Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 7
Number of Missed Treatments: 290
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
88Total:
72Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 85%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 209
95%84%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 16Dietician : 2Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
115
55.0%
Medicaid
3
Private Insurance
84
Charity Care
0
Private Pay
5
Other Public
2
TOTAL
209
1.4% 40.2% 0.0%2.4% 1.0% 100.0%
Patients
TOTAL 500
990
60
45164
0
0
025532910
012383012
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
209
037915922
209117 92
209
$3,256,569 $70,104 $4,300,928 $0$43,773 $50,009 $7,721,383
42.2% 0.9% 55.7% 0.0%0.6% 0.6% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2637
Fresenius Medical Care Breese160 N. Main StreetBreeseClinton11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: RAI Care Centers of Illinois I, LLCLegal Entity Owner:
Property Owner: Oakmont Capital Resources
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Koch, M.D.
In-Center Treatments in calendar year: 3,092Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 21
Patients treated as of 12/31/2016: (Ending patients) 20
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 18
Oct 20
Oct 312
Oct 48
Oct 512
Oct 68
Oct 712
6 0 13 5 13 5 12
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 20Transient Patients: 8Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 0Patients transferred out: 13Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 41
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
32Total:
29Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 41%Use Rate (including Missed Treatments): 42%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 49
44%42%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2.5Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
41
83.7%
Medicaid
0
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
49
0.0% 16.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0020
47
0490
0
03
1277
02396
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
49
05
1516134929 20
49
$1,246,640 $0 $478,787 $0$0 $0 $1,725,427
72.3% 0.0% 27.7% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2641
Fresenius Medical Care Burbank4811 W. 77th StreetBurbankCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Burbank Town Center, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Vinitha Raghavan, M.D.
In-Center Treatments in calendar year: 19,355Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 127
Patients treated as of 12/31/2016: (Ending patients) 129
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 118
Oct 219
Oct 319
Oct 418
Oct 518
Oct 618
Oct 718
61 0 60 57 56 60 56
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 49Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 64Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 732
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
78Total:
78Total:
USE RATE for the FACILITY24,336Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 80%Use Rate (including Missed Treatments): 83%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 205
81%83%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 26Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 32Registered Nurse : 7.5Dialysis Technician : 16Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2016: 26Certified Stations by CMS: 26Peak Authorized Stations Operated: 26
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
114
55.6%
Medicaid
8
Private Insurance
81
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
205
3.9% 39.5% 0.0%1.0% 0.0% 100.0%
Patients
TOTAL 30
1200
66
86110
9
16
010202850
013282630
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
205
023485480
205108 97
205
$2,879,883 $186,120 $3,793,202 $0$100,960 $0 $6,960,165
41.4% 2.7% 54.5% 0.0%1.5% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2514
Fresenius Medical Care Carbondale1425 E. Main StreetCarbondaleJackson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Bio-Medical Applications of Illinois, Inc.Legal Entity Owner:
Property Owner: FRE Carbondale, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Randy Cowart, M.D.
In-Center Treatments in calendar year: 11,320Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 82
Patients treated as of 12/31/2016: (Ending patients) 79
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 315
Oct 413
Oct 515
Oct 612
Oct 715
29 0 35 36 38 33 36
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 15Patients Re-Started: 5Post-Transplant Patien 0
Recovered patients: 5Transplant Recipients: 2Patients transferred out: 16Patients voluntarily discontinued: 14Patients lost to follow up: 0Patients deceased: 21
Number of Missed Treatments: 775
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
58Total:
62Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 50%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 143
57%55%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 8Dialysis Technician : 7Dietician : 1Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
106
74.1%
Medicaid
5
Private Insurance
21
Charity Care
0
Private Pay
0
Other Public
11
TOTAL
143
3.5% 14.7% 0.0%0.0% 7.7% 100.0%
Patients
TOTAL 10
410
101
5138
0
0
08
132014
07
372519
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
143
015504533
14355 88
143
$2,691,878 $198,849 $1,667,788 $0$0 $399,870 $4,958,385
54.3% 4.0% 33.6% 0.0%0.0% 8.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2546
Fresenius Medical Care Centre-West Springfield1112 Centre West DriveSpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: RAI Care Centers of Illinois II, LLCLegal Entity Owner:
Property Owner: Indria D. Lakhram, ELH Mgmt. LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Merry Downer, M.D.
In-Center Treatments in calendar year: 10,384Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 73
Patients treated as of 12/31/2016: (Ending patients) 67
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 235.0
Oct 113
Oct 20
Oct 317
Oct 413
Oct 517
Oct 613
Oct 717
28 0 39 28 38 29 36
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 9Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 32Patients voluntarily discontinued: 3Patients lost to follow up: 1Patients deceased: 12
Number of Missed Treatments: 616
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
44Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 73%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 115
76%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
74
64.3%
Medicaid
0
Private Insurance
39
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
115
0.0% 33.9% 0.0%0.0% 1.7% 100.0%
Patients
TOTAL 00
310
84
2113
0
0
03
182019
08
121322
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
115
011303341
11560 55
115
$2,722,219 $3,447 $4,366,115 $0$40,716 $145,175 $7,277,672
37.4% 0.0% 60.0% 0.0%0.6% 2.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2588
Fresenius Medical Care Champaign1405 West Park Street, Suite 100UrbanaChampaign4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Renal Research Institute, LLCLegal Entity Owner:
Property Owner: Tim Max
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Abdel-Moneim Attia, M.D.
In-Center Treatments in calendar year: 16,933Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 111
Patients treated as of 12/31/2016: (Ending patients) 113
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
52 0 57 50 58 47 56
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 41Transient Patients: 16Patients Re-Started: 2Post-Transplant Patien 5
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 37Patients voluntarily discontinued: 9Patients lost to follow up: 0Patients deceased: 24
Number of Missed Treatments: 712
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
74Total:
64Total:
USE RATE for the FACILITY23,400Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 72%Use Rate (including Missed Treatments): 75%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 175
74%75%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 25Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 9.5Dialysis Technician : 13Dietician : 1.5Social Worker: 2LPN : 0Other Health : 0Other Non-Health: 4
Authorized Stations as of 12/31/2016: 25Certified Stations by CMS: 25Peak Authorized Stations Operated: 25
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
127
72.6%
Medicaid
25
Private Insurance
19
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
175
14.3% 10.9% 0.0%0.0% 2.3% 100.0%
Patients
TOTAL 10
880
76
10162
3
10
012422415
016261822
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
175
028684237
17593 82
175
$2,723,619 $247,529 $3,807,155 $0$0 $209,473 $6,987,776
39.0% 3.5% 54.5% 0.0%0.0% 3.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2744
Fresenius Medical Care Chatham8710 S. Holland RoadChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chatham, LLCLegal Entity Owner:
Property Owner: AEI Income & Growth Fund 27, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sreedevi Chittineni, M.D.
In-Center Treatments in calendar year: 11,714Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 82
Patients treated as of 12/31/2016: (Ending patients) 85
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 117
Oct 20
Oct 316
Oct 416
Oct 515
Oct 616
Oct 715
36 0 36 39 35 36 42
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 12Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 41Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 797
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
51Total:
46Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 78%Use Rate (including Missed Treatments): 84%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 128
85%89%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 14Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
85
66.4%
Medicaid
0
Private Insurance
43
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
128
0.0% 33.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
12800
0128
0
0
04
311713
04
241619
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
128
08
553332
12865 63
128
$1,661,612 $0 $1,348,970 $0$16,269 $0 $3,026,851
54.9% 0.0% 44.6% 0.0%0.5% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2506
Fresenius Medical Care Chicago 1806 W. Hubbard StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: KB CHICAGO DIALYSIS, DST
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: George Dunea, M.D.
In-Center Treatments in calendar year: 9,061Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 61
Patients treated as of 12/31/2016: (Ending patients) 61
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 517
Oct 612
Oct 712
24 0 39 22 39 21 39
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 8Transient Patients: 18Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 26Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 513
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
36Total:
26Total:
USE RATE for the FACILITY19,656Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 46%Use Rate (including Missed Treatments): 49%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 79
48%48%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 21Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 7Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 21Certified Stations by CMS: 21Peak Authorized Stations Operated: 21
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
42
53.2%
Medicaid
3
Private Insurance
33
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
79
3.8% 41.8% 0.0%0.0% 1.3% 100.0%
Patients
TOTAL 01
520
23
10672
3
0132591
08
1571
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
79
0214016
27948 31
79
$1,214,219 $90,410 $1,351,870 $0$0 $0 $2,656,499
45.7% 3.4% 50.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2681
Fresenius Medical Care Chicago Westside1340 S. DamenChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Hasting Center Office
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jose Arruda, M.D.
In-Center Treatments in calendar year: 11,694Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 82
Patients treated as of 12/31/2016: (Ending patients) 75
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 112.5
Oct 20
Oct 312.5
Oct 412.5
Oct 512.5
Oct 612.5
Oct 712.5
29 0 36 33 36 33 41
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 11Transient Patients: 2Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 29Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 8
Number of Missed Treatments: 402
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
14Total:
USE RATE for the FACILITY29,016Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 40%Use Rate (including Missed Treatments): 42%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 96
44%40%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 26Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 31Certified Stations by CMS: 31Peak Authorized Stations Operated: 31
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
55
57.3%
Medicaid
1
Private Insurance
40
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
96
1.0% 41.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
500
45
45510
0
01926102
0101694
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
96
0294219
69657 39
96
$1,731,996 $37,352 $3,103,044 $0$123,711 $0 $4,996,103
34.7% 0.7% 62.1% 0.0%2.5% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2754
Fresenius Medical Care Cicero3000 S. Cicero AvenueCiceroCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Cicero, LLCLegal Entity Owner:
Property Owner: MR CICERO PLAZA, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Juan Ruiz, M.D.
In-Center Treatments in calendar year: 8,963Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 60
Patients treated as of 12/31/2016: (Ending patients) 61
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
30 0 29 30 31 28 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 23Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 16Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 130
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
24Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 60%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 83
63%64%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
45
54.2%
Medicaid
0
Private Insurance
33
Charity Care
0
Private Pay
4
Other Public
1
TOTAL
83
0.0% 39.8% 0.0%4.8% 1.2% 100.0%
Patients
TOTAL 1050
77
73100
0
03
3587
04
1466
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
83
07
4914138353 30
83
$493,298 $24,046 $1,400,458 $0$0 $0 $1,917,802
25.7% 1.3% 73.0% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2631
Fresenius Medical Care Congress Parkway3410 West Van BurenChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: CMGS, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Asad Bakir, M.D.
In-Center Treatments in calendar year: 17,872Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 122
Patients treated as of 12/31/2016: (Ending patients) 112
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 315.0
Oct 113.5
Oct 20
Oct 317.5
Oct 413.5
Oct 517.5
Oct 613.5
Oct 717.5
46 0 60 46 53 43 66
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 7Patients transferred out: 33Patients voluntarily discontinued: 0Patients lost to follow up: 3Patients deceased: 7
Number of Missed Treatments: 982
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
40Total:
USE RATE for the FACILITY28,080Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 162
68%62%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 30Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 13Dialysis Technician : 14Dietician : 2Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 30Certified Stations by CMS: 30Peak Authorized Stations Operated: 30
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
98
60.5%
Medicaid
7
Private Insurance
56
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
162
4.3% 34.6% 0.0%0.6% 0.0% 100.0%
Patients
TOTAL 00
1440
18
18144
0
0
021371710
015311318
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
162
036683028
16285 77
162
$3,316,925 $191,422 $2,776,713 $0$55,074 $8,368 $6,348,502
52.2% 3.0% 43.7% 0.0%0.9% 0.1% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2538
Fresenius Medical Care Crestwood4861 Cal Sag RoadCrestwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Brixmor SPE 3, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Akash Ahuja, M.D.
In-Center Treatments in calendar year: 14,959Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 99
Patients treated as of 12/31/2016: (Ending patients) 105
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 381.0
Oct 116
Oct 20
Oct 317
Oct 416
Oct 517
Oct 616
Oct 717
41 0 59 44 55 40 56
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 41Transient Patients: 19Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 34Patients voluntarily discontinued: 6Patients lost to follow up: 1Patients deceased: 14
Number of Missed Treatments: 260
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
58Total:
62Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 68%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 159
69%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
99
62.3%
Medicaid
6
Private Insurance
53
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
159
3.8% 33.3% 0.0%0.0% 0.6% 100.0%
Patients
TOTAL 30
710
85
33126
0
0
09
413319
02
161920
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
159
011575239
159102 57
159
$1,864,685 $67,948 $2,758,430 $0$0 $82,725 $4,773,788
39.1% 1.4% 57.8% 0.0%0.0% 1.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2603
Fresenius Medical Care Decatur East1830 South 44th StreetDecaturMacon4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Lillibridge Healthcare Services, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammed Dawood, M.D.
In-Center Treatments in calendar year: 3Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 52
Patients treated as of 12/31/2016: (Ending patients) 47
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 113
Oct 20
Oct 316
Oct 413
Oct 516
Oct 613
Oct 716
23 0 26 23 27 23 27
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 13Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 42
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
20Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 0%Use Rate (including Missed Treatments): 0%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 73
72%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
63
86.3%
Medicaid
0
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
73
0.0% 11.0% 0.0%0.0% 2.7% 100.0%
Patients
TOTAL 00
110
62
0730
0
03
131510
01
101011
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
73
04
2325217341 32
73
$1,015,871 $0 $908,973 $0$0 $0 $1,924,844
52.8% 0.0% 47.2% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2774
Fresenius Medical Care Des Plaines1625 Oakton PlaceDes PlainesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Des Plaines, LLCLegal Entity Owner:
Property Owner: Washington Center LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Danial Kniaz, M.D.
In-Center Treatments in calendar year: 5,280Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 28
Patients treated as of 12/31/2016: (Ending patients) 42
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 113
Oct 20
Oct 317
Oct 413
Oct 517
Oct 613
Oct 717
12 0 24 11 21 11 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 25Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 32Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 37
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
57Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 47%Use Rate (including Missed Treatments): 47%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 85
39%58%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
55
64.7%
Medicaid
4
Private Insurance
26
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
85
4.7% 30.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 8091
67
16690
0
05
171510
03
111410
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
85
08
2829208547 38
85
$186,529 $6,117 $237,979 $0$0 $10,030 $440,655
42.3% 1.4% 54.0% 0.0%0.0% 2.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2503
Fresenius Medical Care Downers Grove3825 Highland Avenue, Ste 102Downers GroveDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: VTR Downers Grove POB Holdings
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Naresh Julka, M.D.
In-Center Treatments in calendar year: 9,907Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 69
Patients treated as of 12/31/2016: (Ending patients) 70
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 517
Oct 612
Oct 717
25 0 44 25 43 24 44
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 5Patients Re-Started: 3Post-Transplant Patien 3
Recovered patients: 2Transplant Recipients: 4Patients transferred out: 31Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 52
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
42Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 107
72%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 19Peak Authorized Stations Operated: 19
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
76
71.0%
Medicaid
0
Private Insurance
28
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
107
0.0% 26.2% 0.0%0.0% 2.8% 100.0%
Patients
TOTAL 80
120
87
14930
0
05
151825
06
159
14
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
107
011302739
10763 44
107
$1,366,119 $25,951 $2,023,073 $0$45,707 $83,611 $3,544,461
38.5% 0.7% 57.1% 0.0%1.3% 2.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2509
Fresenius Medical Care DuPage West450 E. Roosevelt Rd., Ste. 101West ChicagoDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Midland Ventures Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Gregory Kozeny, M.D.
In-Center Treatments in calendar year: 9,978Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 66
Patients treated as of 12/31/2016: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 112
Oct 20
Oct 318
Oct 412
Oct 518
Oct 612
Oct 718
23 0 42 22 39 25 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 11Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 39Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 178
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
45Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 68%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 103
69%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
58
56.3%
Medicaid
2
Private Insurance
41
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
103
1.9% 39.8% 0.0%1.9% 0.0% 100.0%
Patients
TOTAL 22
151
83
33700
0
09
302012
0866
12
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
103
017362624
10371 32
103
$2,016,743 $184,746 $4,309,929 $0$0 $0 $6,511,418
31.0% 2.8% 66.2% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2595
Fresenius Medical Care DuQuoin825 Sunset AvenueDuQuoinPerry5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Bio-Medical Applications of Illinois, Inc.Legal Entity Owner:
Property Owner: Andrew Chang
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Randy Coward, M.D.
In-Center Treatments in calendar year: 5,790Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 39
Patients treated as of 12/31/2016: (Ending patients) 35
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 255.0
Oct 111
Oct 20
Oct 311
Oct 411
Oct 511
Oct 611
Oct 711
18 0 21 17 21 16 21
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 10Transient Patients: 4Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 7Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 47
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
16Total:
USE RATE for the FACILITY10,296Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 57%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 54
59%53%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 11Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 3Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 11Certified Stations by CMS: 11Peak Authorized Stations Operated: 11
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
41
75.9%
Medicaid
0
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
54
0.0% 14.8% 0.0%0.0% 9.3% 100.0%
Patients
TOTAL 0030
51
0540
0
043
1210
019
105
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
54
05
1222155429 25
54
$1,057,568 $59,227 $525,759 $0$0 $128,273 $1,770,827
59.7% 3.3% 29.7% 0.0%0.0% 7.2% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2562
Fresenius Medical Care East Peoria3300 North MainEast PeoriaTazewell2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Fresenius Medical Care
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Rosborough, M.D.
In-Center Treatments in calendar year: 14,176Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 92
Patients treated as of 12/31/2016: (Ending patients) 102
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 116
Oct 20
Oct 319
Oct 418
Oct 519
Oct 618
Oct 719
40 0 51 40 52 40 53
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 48Transient Patients: 13Patients Re-Started: 3Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 36Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 545
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
65Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 157
64%71%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
109
69.4%
Medicaid
4
Private Insurance
44
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
157
2.5% 28.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
360
120
3154
0
0
011392015
06
262218
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
157
017654233
15785 72
157
$3,664,698 $80,057 $6,042,289 $0$41,599 $0 $9,828,643
37.3% 0.8% 61.5% 0.0%0.4% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2726
Fresenius Medical Care Elgin2130 Point BoulevardElginKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Elgin, LLCLegal Entity Owner:
Property Owner: Stage Management
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Raju Ray, M.D.
In-Center Treatments in calendar year: 11,090Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 67
Patients treated as of 12/31/2016: (Ending patients) 85
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 117
Oct 20
Oct 319
Oct 417
Oct 519
Oct 617
Oct 717
35 0 42 37 41 42 39
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 57Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 26Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 139
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
30Total:
72Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 59%Use Rate (including Missed Treatments): 60%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 116
56%71%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 8.5Dialysis Technician : 7.5Dietician : 2Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
76
65.5%
Medicaid
3
Private Insurance
35
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
116
2.6% 30.2% 0.0%0.9% 0.9% 100.0%
Patients
TOTAL 60
143
93
41750
0
010301619
07
16108
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
116
017462627
11675 41
116
$1,737,692 $0 $3,157,578 $0$0 $0 $4,895,270
35.5% 0.0% 64.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2507
Fresenius Medical Care Elk Grove901 Biesterfield Road, Ste. 400Elk Grove VillageCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Stage Management
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lisa Pillsbury, M.D.
In-Center Treatments in calendar year: 20,395Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 140
Patients treated as of 12/31/2016: (Ending patients) 134
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
61 0 78 60 74 56 73
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 51Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 5
Recovered patients: 0Transplant Recipients: 10Patients transferred out: 35Patients voluntarily discontinued: 7Patients lost to follow up: 1Patients deceased: 17
Number of Missed Treatments: 491
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
70Total:
64Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 78%Use Rate (including Missed Treatments): 80%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 203
83%80%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 28Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 16Dietician : 1.5Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
155
76.4%
Medicaid
1
Private Insurance
42
Charity Care
0
Private Pay
1
Other Public
4
TOTAL
203
0.5% 20.7% 0.0%0.5% 2.0% 100.0%
Patients
TOTAL 171
161
168
31172
0
0
014433232
07
242031
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
203
021675263
203121 82
203
$4,203,602 $73,247 $3,635,095 $0$19,859 $61,416 $7,993,219
52.6% 0.9% 45.5% 0.0%0.2% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2612
Fresenius Medical Care Elmhurst133 E. Brush Hill Road, Ste 410ElmhurstDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Hammes Co.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rukhsana Muneer, M.D.
In-Center Treatments in calendar year: 17,247Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 114
Patients treated as of 12/31/2016: (Ending patients) 111
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 113
Oct 20
Oct 318
Oct 413
Oct 518
Oct 613
Oct 718
39 0 68 38 65 40 65
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 50Transient Patients: 19Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 54Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 17
Number of Missed Treatments: 363
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
74Total:
71Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 185
68%66%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 28Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 10Dialysis Technician : 16Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
118
63.8%
Medicaid
0
Private Insurance
67
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
185
0.0% 36.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 120
450
85
43142
0
43
09
432732
04
331621
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
185
013764353
185111 74
185
$2,880,229 $26,016 $2,428,095 $0$146,924 $56,411 $5,537,675
52.0% 0.5% 43.8% 0.0%2.7% 1.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2621
Fresenius Medical Care Evanston2953 Central Street, 1st FloorEvanstonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Craig Bjorkman
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Neeno Khosla, M.D.
In-Center Treatments in calendar year: 9,609Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 66
Patients treated as of 12/31/2016: (Ending patients) 63
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 114
Oct 20
Oct 316
Oct 414
Oct 516
Oct 614
Oct 716
27 0 35 30 34 28 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 26Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 16Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 153
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
33Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 73%Use Rate (including Missed Treatments): 74%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 99
79%75%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5.5Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
73
73.7%
Medicaid
2
Private Insurance
20
Charity Care
0
Private Pay
2
Other Public
2
TOTAL
99
2.0% 20.2% 0.0%2.0% 2.0% 100.0%
Patients
TOTAL 50
380
53
8910
3
06
132715
04
10168
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
99
0102343239961 38
99
$1,533,133 $53,120 $939,732 $0$0 $33,912 $2,559,897
59.9% 2.1% 36.7% 0.0%0.0% 1.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2545
Fresenius Medical Care Evergreen Park9730 South Western AvenueEvergreen ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Evergreen Plaza
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Due to a condemnation of the facility parking structure, the facility was closed July 22, 2016. Fresenius Medical Care Chicagoland, LLC was granted permit (#16-035) to relocate to 8901 S. Kedzie Avenue also in Evergreen Park. The facility will reopen mid 2017. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Paul Crawford, M.D.
In-Center Treatments in calendar year: 11,980Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 155
Patients treated as of 12/31/2016: (Ending patients) 0
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 10
Oct 20
Oct 30
Oct 40
Oct 50
Oct 60
Oct 70
0 0 0 0 0 0 0
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 19Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 164Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 522
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
174Total:
19Total:
USE RATE for the FACILITY28,080Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 43%Use Rate (including Missed Treatments): 45%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 174
86%0%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 0Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 15Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 30Certified Stations by CMS: 0Peak Authorized Stations Operated: 30
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
107
61.5%
Medicaid
1
Private Insurance
64
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
174
0.6% 36.8% 0.0%0.6% 0.6% 100.0%
Patients
TOTAL 00
1260
48
2172
0
0
09
283520
04
164319
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
174
013447839
17492 82
174
$2,880,219 $18,336 $3,188,734 $0$4,186 $39,590 $6,131,065
47.0% 0.3% 52.0% 0.0%0.1% 0.6% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2579
Fresenius Medical Care Galesburg765 N Kellogg St, Ste 101GalesburgKnox2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Galesburg, LLCLegal Entity Owner:
Property Owner: Galesburg Cottage Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Parthasarathy Srinivasan
In-Center Treatments in calendar year: 10,502Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 74
Patients treated as of 12/31/2016: (Ending patients) 68
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 116
Oct 20
Oct 318
Oct 416
Oct 518
Oct 616
Oct 718
30 0 32 31 32 32 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 41Transient Patients: 15Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 6Transplant Recipients: 3Patients transferred out: 32Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 196
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
59Total:
58Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 80%Use Rate (including Missed Treatments): 82%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 132
88%81%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 8Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 2Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
81
61.4%
Medicaid
4
Private Insurance
41
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
132
3.0% 31.1% 0.0%0.0% 4.5% 100.0%
Patients
TOTAL 20
180
112
9123
0
0
08
292219
06
191118
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
132
014483337
13278 54
132
$1,422,688 $26,328 $1,839,344 $0$19,480 $300,721 $3,608,561
39.4% 0.7% 51.0% 0.0%0.5% 8.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2555
Fresenius Medical Care Garfield5401 South WentworthChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: East Lake Management Company
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Paru Kathpalia, M.D.
In-Center Treatments in calendar year: 14,821Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 102
Patients treated as of 12/31/2016: (Ending patients) 98
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 113
Oct 20
Oct 318
Oct 413
Oct 518
Oct 613
Oct 718
31 0 57 36 58 31 57
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 40Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 40Patients voluntarily discontinued: 0Patients lost to follow up: 3Patients deceased: 11
Number of Missed Treatments: 697
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
53Total:
USE RATE for the FACILITY20,592Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 72%Use Rate (including Missed Treatments): 75%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 155
77%74%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 22Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 22Certified Stations by CMS: 22Peak Authorized Stations Operated: 22
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
99
63.9%
Medicaid
3
Private Insurance
49
Charity Care
0
Private Pay
2
Other Public
2
TOTAL
155
1.9% 31.6% 0.0%1.3% 1.3% 100.0%
Patients
TOTAL 00
15203
3152
0
0
01943247
08
201816
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
155
027634223
15593 62
155
$2,471,781 $187,872 $2,343,216 $0$35,728 $50,530 $5,089,127
48.6% 3.7% 46.0% 0.0%0.7% 1.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2592
Fresenius Medical Care Geneseo600 North College AvenueGeneseoHenry10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Quad Cities, LLCLegal Entity Owner:
Property Owner: RRS Investments, LLP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care acquired Quad Cities Aledo, Geneseo, Moline, Rock Island, Rock River – Dixon, and Silvis facilities as of May 1, 2016. Compiled 2016 financial information prior to May 1 was provided by Quad Cities and was combined with compiled 2016 financial information from Fresenius Medical Care to complete the survey.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Alla, M.D.
In-Center Treatments in calendar year: 3,102Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 20
Patients treated as of 12/31/2016: (Ending patients) 18
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514.5
Oct 60
Oct 714
0 0 19 0 18 0 19
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 2Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 1Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 31
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
4Total:
2Total:
USE RATE for the FACILITY6,552Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 47%Use Rate (including Missed Treatments): 48%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 22
48%43%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 7Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 7Certified Stations by CMS: 7Peak Authorized Stations Operated: 7
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
18
81.8%
Medicaid
1
Private Insurance
2
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
22
4.5% 9.1% 0.0%4.5% 0.0% 100.0%
Patients
TOTAL 0000
22
0220
0
00324
01057
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
22
0137
11229 13
22
$658,129 $2,316 $324,433 $0$42,002 $0 $1,026,880
64.1% 0.2% 31.6% 0.0%4.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2617
Fresenius Medical Care Glendale Heights130 E. Army Trail RoadGlendale HeightsDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Clover Leaf Group, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ernest DeJesus, M.D.
In-Center Treatments in calendar year: 18,477Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 120
Patients treated as of 12/31/2016: (Ending patients) 131
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
53 0 67 53 67 48 69
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 55Transient Patients: 20Patients Re-Started: 1Post-Transplant Patien 4
Recovered patients: 2Transplant Recipients: 4Patients transferred out: 50Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 231
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
69Total:
80Total:
USE RATE for the FACILITY27,144Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 200
69%75%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 29Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 7.5Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 29Certified Stations by CMS: 29Peak Authorized Stations Operated: 29
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
118
59.0%
Medicaid
6
Private Insurance
63
Charity Care
0
Private Pay
12
Other Public
1
TOTAL
200
3.0% 31.5% 0.0%6.0% 0.5% 100.0%
Patients
TOTAL 460
201
133
40160
0
0
011552929
06
221830
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
200
017774759
200124 76
200
$2,588,217 $23,752 $3,412,750 $0$5,981 $52,285 $6,082,985
42.5% 0.4% 56.1% 0.0%0.1% 0.9% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2551
Fresenius Medical Care Glenview4248 Commercial WayGlenviewCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Helios Property Management
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Venkata Behara, M.D.
In-Center Treatments in calendar year: 10,993Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 74
Patients treated as of 12/31/2016: (Ending patients) 72
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 517
Oct 612
Oct 717
30 0 40 29 40 28 41
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 34Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 3Transplant Recipients: 6Patients transferred out: 23Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 135
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
44Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 59%Use Rate (including Missed Treatments): 59%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 112
62%60%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
65
58.0%
Medicaid
3
Private Insurance
42
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
112
2.7% 37.5% 0.0%1.8% 0.0% 100.0%
Patients
TOTAL 20060
86
19930
0
08
281129
03
111012
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
112
011392141
11276 36
112
$1,788,649 $76,414 $2,248,017 $0$26,603 $0 $4,139,683
43.2% 1.8% 54.3% 0.0%0.6% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2601
Fresenius Medical Care Greenwood1111 East 87th Street, Suite 700ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Waveland Property Group
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Malathi Shah, M.D.
In-Center Treatments in calendar year: 15,904Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 127
Patients treated as of 12/31/2016: (Ending patients) 114
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 275.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
44 0 51 48 48 47 48
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 44Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 7Patients transferred out: 38Patients voluntarily discontinued: 3Patients lost to follow up: 2Patients deceased: 18
Number of Missed Treatments: 636
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
55Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 182
76%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 14Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
94
51.6%
Medicaid
2
Private Insurance
79
Charity Care
0
Private Pay
2
Other Public
5
TOTAL
182
1.1% 43.4% 0.0%1.1% 2.7% 100.0%
Patients
TOTAL 10
17900
2180
0
2
013492122
05
381717
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
182
018873839
182105 77
182
$2,593,050 $166,502 $2,536,466 $0$54,861 $145,533 $5,496,412
47.2% 3.0% 46.1% 0.0%1.0% 2.6% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2549
Fresenius Medical Care Gurnee101 GreenleafGurneeLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Lake County, LLCLegal Entity Owner:
Property Owner: Greenleaf Center West/ GRG Properties
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rakhi Khanna, M.D.
In-Center Treatments in calendar year: 12,328Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 79
Patients treated as of 12/31/2016: (Ending patients) 92
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
39 0 38 40 47 40 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 30Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 190
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
51Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 82%Use Rate (including Missed Treatments): 84%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 119
82%96%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 8.5Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
73
61.3%
Medicaid
1
Private Insurance
44
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
119
0.8% 37.0% 0.0%0.0% 0.8% 100.0%
Patients
TOTAL 111
330
74
31880
0
010181914
07
201813
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
119
017383727
11961 58
119
$1,242,244 $74,316 $3,816,722 $0$0 $43,488 $5,176,770
24.0% 1.4% 73.7% 0.0%0.0% 0.8% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2607
Fresenius Medical Care Hazel Crest17524 E Carriage WayHazel CrestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Rockford 550, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Vijaykumar Rao, M.D.
In-Center Treatments in calendar year: 12,397Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 75
Patients treated as of 12/31/2016: (Ending patients) 88
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 265.0
Oct 115
Oct 20
Oct 318
Oct 415
Oct 518
Oct 615
Oct 718
37 0 44 39 46 36 47
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 15Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 29Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 290
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
48Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 83%Use Rate (including Missed Treatments): 85%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 123
78%92%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3.5Dialysis Technician : 9Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
80
65.0%
Medicaid
1
Private Insurance
36
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
123
0.8% 29.3% 0.0%0.0% 4.9% 100.0%
Patients
TOTAL 10
1120
10
6117
0
0
012212212
05
131721
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
123
017343933
12367 56
123
$2,144,485 $81,580 $1,290,148 $0$25,119 $79,192 $3,620,524
59.2% 2.3% 35.6% 0.0%0.7% 2.2% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2782
Fresenius Medical Care Highland Park1657 Old Skokie RoadHighland ParkLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Shepard Warrenville, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nancy Nora, M.D.
In-Center Treatments in calendar year: 8,711Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 65
Patients treated as of 12/31/2016: (Ending patients) 53
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 517
Oct 612
Oct 717
18 0 39 21 38 21 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 52Transient Patients: 17Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 45Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 131
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
61Total:
71Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 47%Use Rate (including Missed Treatments): 47%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 112
54%44%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4.5Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
80
71.4%
Medicaid
0
Private Insurance
32
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
112
0.0% 28.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 2091
100
17950
0
06
141733
035
1222
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
112
09
192955
11270 42
112
$1,425 $0 $1,736 $0$0 $0 $3,161
45.1% 0.0% 54.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2547
Fresenius Medical Care Hoffman Estates3150 West Higgins Road, Suite 190Hoffman EstatesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: 3100 & 2150 Higgins, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Facility runs a 4th shift Monday/Wednesday/Friday with 15 patients.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lo-Ku Chiang, M.D.
In-Center Treatments in calendar year: 15,672Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 106
Patients treated as of 12/31/2016: (Ending patients) 108
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 321
Oct 418
Oct 521
Oct 616.5
Oct 721
36 0 62 38 59 37 59
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 23Transient Patients: 40Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 4Transplant Recipients: 8Patients transferred out: 42Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 290
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
70Total:
66Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 84%Use Rate (including Missed Treatments): 85%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 172
88%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 6.5Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
80
46.5%
Medicaid
3
Private Insurance
78
Charity Care
0
Private Pay
8
Other Public
3
TOTAL
172
1.7% 45.3% 0.0%4.7% 1.7% 100.0%
Patients
TOTAL 140
230
135
45127
0
0
020442411
012182221
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
172
032624632
17299 73
172
$1,644,733 $48,770 $4,210,372 $0$108,380 $0 $6,012,255
27.4% 0.8% 70.0% 0.0%1.8% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2516
Fresenius Medical Care Jackson Park7531 South Stony IslandChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Jackson Park Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Munavvar Izhar, M.D.
In-Center Treatments in calendar year: 14,218Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 99
Patients treated as of 12/31/2016: (Ending patients) 108
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 110
Oct 20
Oct 316
Oct 410
Oct 516
Oct 610
Oct 716
42 0 51 41 50 41 51
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 48Transient Patients: 26Patients Re-Started: 2Post-Transplant Patien 2
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 44Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 13
Number of Missed Treatments: 863
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
62Total:
78Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 137
69%75%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 8Dialysis Technician : 13Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
71
51.8%
Medicaid
4
Private Insurance
59
Charity Care
0
Private Pay
2
Other Public
1
TOTAL
137
2.9% 43.1% 0.0%1.5% 0.7% 100.0%
Patients
TOTAL 00
13302
2133
2
2
01652134
07
171711
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
137
023693015
13785 52
137
$2,148,595 $99,354 $1,567,820 $0$0 $49,316 $3,865,085
55.6% 2.6% 40.6% 0.0%0.0% 1.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2739
Fresenius Medical Care Joliet721 East Jackson StreetJolietWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Plainfield, LLCLegal Entity Owner:
Property Owner: MERIDIAN INVESTMENT PARTNERS, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Shafi, M.D.
In-Center Treatments in calendar year: 10,517Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 68
Patients treated as of 12/31/2016: (Ending patients) 73
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
27 0 40 27 40 26 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 57Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 48Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 452
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
61Total:
66Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 70%Use Rate (including Missed Treatments): 73%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 134
71%76%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
70
52.2%
Medicaid
2
Private Insurance
51
Charity Care
0
Private Pay
7
Other Public
4
TOTAL
134
1.5% 38.1% 0.0%5.2% 3.0% 100.0%
Patients
TOTAL 20
500
82
38960
0
014381916
08
111612
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
134
022493528
13487 47
134
$994,056 $17,425 $1,663,898 $0$17,966 $34,289 $2,727,634
36.4% 0.6% 61.0% 0.0%0.7% 1.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2578
Fresenius Medical Care Kewanee230 W. South StreetKewaneeHenry10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: PTM Development, LLC Pete Mangeri
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sudha Cherukuri, M.D.
In-Center Treatments in calendar year: 4,946Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 33
Patients treated as of 12/31/2016: (Ending patients) 35
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 516.5
Oct 612
Oct 717
14 0 189 15 17 15 18
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 11Transient Patients: 5Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 6Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 209
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
18Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 51
69%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
36
70.6%
Medicaid
0
Private Insurance
11
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
51
0.0% 21.6% 0.0%0.0% 7.8% 100.0%
Patients
TOTAL 0050
46
2490
0
03
1549
01685
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
51
04
2112145131 20
51
$901,257 $49,148 $215,019 $0$0 $43,155 $1,208,579
74.6% 4.1% 17.8% 0.0%0.0% 3.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2798
Fresenius Medical Care Lemont16177 West 127th StreetLemontCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Lemont, LLCLegal Entity Owner:
Property Owner: Meridian Investment Property, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Facility was not in operation in 2015 so there are no revenues reported.
Provides Incenter Noctural Dialysis:
Medical Director Name: Stella Awua-Larbi, M.D.
In-Center Treatments in calendar year: 372Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 0
Patients treated as of 12/31/2016: (Ending patients) 11
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 10
Oct 20
Oct 36
Oct 40
Oct 56
Oct 60
Oct 76
0 0 3 0 3 0 3
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
5Total:
16Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 3%Use Rate (including Missed Treatments): 3%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 16
0%15%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 1Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 1.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
12
75.0%
Medicaid
0
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
16
0.0% 25.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0110
14
1150
0
00425
00122
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
16
00547
1611 5
16
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20151/1/2015 to
14-2766
Fresenius Medical Care Logan Square2721 N. SpauldingChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Logan Square, LLCLegal Entity Owner:
Property Owner: VPRE Real Holdings LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Eduardo Cremer, M.D.
In-Center Treatments in calendar year: 6,917Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 39
Patients treated as of 12/31/2016: (Ending patients) 51
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
19 0 32 15 32 16 28
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 16Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 167
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
34Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 62%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 73
54%71%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
34
46.6%
Medicaid
10
Private Insurance
27
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
73
13.7% 37.0% 0.0%1.4% 1.4% 100.0%
Patients
TOTAL 20
100
61
40330
0
02
22159
04993
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
73
06
3124127348 25
73
$422,665 $46,487 $699,782 $0$0 $0 $1,168,934
36.2% 4.0% 59.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2722
Fresenius Medical Care Lombard1940 Springer DriveLombardDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Lombard, LLCLegal Entity Owner:
Property Owner: Golub Realty Services
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Samir Kumar, M.D.
In-Center Treatments in calendar year: 7,583Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 47
Patients treated as of 12/31/2016: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 115
Oct 20
Oct 312
Oct 415
Oct 512
Oct 615
Oct 712
28 0 22 29 23 26 24
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 24Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 200
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
36Total:
41Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 87
65%76%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4.5Dietician : 0.5Social Worker: 0.5LPN : 0.5Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
56
64.4%
Medicaid
3
Private Insurance
28
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
87
3.4% 32.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 80
101
68
8790
0
02
261519
0256
12
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
87
04
3121318762 25
87
$1,710,410 $0 $1,666,178 $0$20,537 $0 $3,397,125
50.3% 0.0% 49.0% 0.0%0.6% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2591
Fresenius Medical Care Macomb523 East Grant StreetMacombMcDonough2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: McDonough District Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sudha Cherukuri, M.D.
In-Center Treatments in calendar year: 2,702Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 20
Patients treated as of 12/31/2016: (Ending patients) 18
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 111
Oct 20
Oct 313
Oct 412
Oct 511
Oct 611
Oct 712
7 0 10 7 9 7 10
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 9Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 12Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 235
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
15Total:
USE RATE for the FACILITY5,616Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 48%Use Rate (including Missed Treatments): 52%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 32
56%50%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 6Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 2Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 6Certified Stations by CMS: 6Peak Authorized Stations Operated: 6
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
23
71.9%
Medicaid
2
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
32
6.3% 15.6% 0.0%0.0% 6.3% 100.0%
Patients
TOTAL 0050
27
0320
0
00982
01534
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
32
01
1411
63219 13
32
$665,527 $0 $445,020 $0$0 $121,755 $1,232,302
54.0% 0.0% 36.1% 0.0%0.0% 9.9% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2790
Fresenius Medical Care Maple City1225 North Main StreetMonmouthWarren2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Monmouth, LLCLegal Entity Owner:
Property Owner: Rockwell Debt Free Properties
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
The facility was not in operation in 2015 so no Revenues are reported.
Provides Incenter Noctural Dialysis:
Medical Director Name: Parthasarathy Srinivasan, M.D.
In-Center Treatments in calendar year: 1,881Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 8
Patients treated as of 12/31/2016: (Ending patients) 14
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 60
Oct 714
0 0 13 0 13 0 13
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 9Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 46
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
9Total:
12Total:
USE RATE for the FACILITY8,424Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 22%Use Rate (including Missed Treatments): 23%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 17
15%26%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 9Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 1Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 9Certified Stations by CMS: 9Peak Authorized Stations Operated: 9
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
8
47.1%
Medicaid
0
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
17
0.0% 23.5% 0.0%0.0% 29.4% 100.0%
Patients
TOTAL 0020
15
1160
0
00332
00144
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
17
00476
178 9
17
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20151/1/2015 to
14-2566
Fresenius Medical Care Marquette Park6536 S. WesternChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Capri Development 6517, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Satya Ahuja, M.D.
In-Center Treatments in calendar year: 12,314Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 91
Patients treated as of 12/31/2016: (Ending patients) 90
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
39 0 41 39 42 39 39
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 52Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 8Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 13
Number of Missed Treatments: 768
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
30Total:
61Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 82%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 98
95%94%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
41
41.8%
Medicaid
3
Private Insurance
52
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
98
3.1% 53.1% 0.0%1.0% 1.0% 100.0%
Patients
TOTAL 01
680
29
30680
0
01029169
09
1447
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
98
0194320169864 34
98
$1,556,786 $117,924 $1,825,264 $0$45,845 $104,761 $3,650,580
42.6% 3.2% 50.0% 0.0%1.3% 2.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2563
Fresenius Medical Care McLean County1505 Eastland Medical PlazaBloomingtonMcLean4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Normal, LLCLegal Entity Owner:
Property Owner: OSF St. Joseph Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Robert Bruha, M.D.
In-Center Treatments in calendar year: 10,370Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 60
Patients treated as of 12/31/2016: (Ending patients) 86
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
29 0 40 27 40 32 41
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 60Transient Patients: 23Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 44Patients voluntarily discontinued: 5Patients lost to follow up: 7Patients deceased: 0
Number of Missed Treatments: 284
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
58Total:
84Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 55%Use Rate (including Missed Treatments): 57%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 144
50%72%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5.5Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
88
61.1%
Medicaid
5
Private Insurance
49
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
144
3.5% 34.0% 0.0%0.0% 1.4% 100.0%
Patients
TOTAL 21
550
86
12132
0
0
09
20149
011322029
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
144
020523438
14452 92
144
$1,887,022 $72,734 $2,424,721 $0$0 $0 $4,384,477
43.0% 1.7% 55.3% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2554
Fresenius Medical Care Melrose Park1111 Superior Street, Ste 204Melrose ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Resurrection Services
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Constantine Delis, M.D.
In-Center Treatments in calendar year: 11,046Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 68
Patients treated as of 12/31/2016: (Ending patients) 72
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 113
Oct 20
Oct 316
Oct 413
Oct 516
Oct 612.75
Oct 716
32 0 39 33 38 32 40
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 30Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 21Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 157
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
40Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 109
63%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 7.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
58
53.2%
Medicaid
3
Private Insurance
47
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
109
2.8% 43.1% 0.0%0.9% 0.0% 100.0%
Patients
TOTAL 00
480
61
29800
0
09
281412
08
168
14
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
109
017442226
10963 46
109
$867,931 $17,644 $2,213,412 $0$0 $0 $3,098,987
28.0% 0.6% 71.4% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2667
Fresenius Medical Care Merrionette Park11650 S. Kedzie AvenueMerrionette ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Renal Care Group Chicago Southside, LLCLegal Entity Owner:
Property Owner: RSA Companies
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ejikeme Obasi, M.D.
In-Center Treatments in calendar year: 17,483Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 113
Patients treated as of 12/31/2016: (Ending patients) 138
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
56 0 65 56 60 58 67
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 50Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 6Transplant Recipients: 6Patients transferred out: 39Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 709
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
62Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 78%Use Rate (including Missed Treatments): 81%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 163
78%96%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 13Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
100
61.3%
Medicaid
3
Private Insurance
59
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
163
1.8% 36.2% 0.0%0.0% 0.6% 100.0%
Patients
TOTAL 20
1280
22
11152
0
11
05
373019
06
232518
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
163
011605537
16391 72
163
$3,114,925 $81,580 $5,017,728 $0$0 $0 $8,214,233
37.9% 1.0% 61.1% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2713
Fresenius Medical Care Midway6201 West 63rd StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: AR Capital, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Edgar Lerma, M.D.
In-Center Treatments in calendar year: 9,653Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 65
Patients treated as of 12/31/2016: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 275.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
27 0 35 29 34 32 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 30Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 21Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 202
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
30Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 86%Use Rate (including Missed Treatments): 88%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 94
90%89%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
57
60.6%
Medicaid
1
Private Insurance
36
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
94
1.1% 38.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
120
82
39550
0
07
271215
02
1489
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
94
09
4120249461 33
94
$1,332,528 $46,985 $2,597,555 $0$0 $49,533 $4,026,601
33.1% 1.2% 64.5% 0.0%0.0% 1.2% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2526
Fresenius Medical Care Moline400 John Deere RoadMolineRock Island10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Quad Cities, LLCLegal Entity Owner:
Property Owner: RRS Investments, LLP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care acquired the Quad Cities Aledo, Geneseo, Moline, Rock Island, Rock River – Dixon, and Silvis facilities as of May 1, 2016. Compiled 2016 financial information prior to May 1 was provided by Quad Cities and was combined with compiled 2016 financial information from Fresenius Medical Care to complete the survey. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rajesh Alla, M.D.
In-Center Treatments in calendar year: 16,415Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 113
Patients treated as of 12/31/2016: (Ending patients) 100
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 113
Oct 20
Oct 314
Oct 414
Oct 513.5
Oct 613.5
Oct 713
32 0 75 31 74 34 69
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 46Transient Patients: 38Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 68Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 20
Number of Missed Treatments: 870
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
97Total:
85Total:
USE RATE for the FACILITY33,696Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 49%Use Rate (including Missed Treatments): 51%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 204
52%46%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 36Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 9Dietician : 1.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 36Certified Stations by CMS: 36Peak Authorized Stations Operated: 36
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
145
71.1%
Medicaid
4
Private Insurance
43
Charity Care
0
Private Pay
1
Other Public
11
TOTAL
204
2.0% 21.1% 0.0%0.5% 5.4% 100.0%
Patients
TOTAL 30
400
161
16188
0
0
013402934
012261733
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
204
025664667
204116 88
204
$4,142,583 $105,592 $3,398,695 $0$280,550 $346,523 $8,273,943
50.1% 1.3% 41.1% 0.0%3.4% 4.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2731
Fresenius Medical Care Mundelein1400 Townline RoadMundeleinLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Jaffe & Berlin, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Shalini Patel, M.D.
In-Center Treatments in calendar year: 8,068Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 55
Patients treated as of 12/31/2016: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
19 0 36 18 38 19 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 40Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 193
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
52Total:
44Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 62%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 92
65%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
59
64.1%
Medicaid
2
Private Insurance
29
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
92
2.2% 31.5% 0.0%0.0% 2.2% 100.0%
Patients
TOTAL 32
140
73
19730
0
05
161622
02
116
14
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
92
07
2722369259 33
92
$954,260 $0 $1,584,191 $0$0 $0 $2,538,451
37.6% 0.0% 62.4% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2765
Fresenius Medical Care Naperbrook2451 S. Washington St.NapervilleDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Naperbrook, LLCLegal Entity Owner:
Property Owner: BRUSHY CREEK DIALYSIS LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Schlieben, M.D.
In-Center Treatments in calendar year: 12,687Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 79
Patients treated as of 12/31/2016: (Ending patients) 86
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
39 0 46 40 40 41 42
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 21Transient Patients: 36Patients Re-Started: 0Post-Transplant Patien 4
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 42Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 132
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
61Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 85%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 133
82%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 10.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
98
73.7%
Medicaid
0
Private Insurance
35
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
133
0.0% 26.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 200
330
80
9124
0
0
09
342117
05
181316
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
133
014523433
13381 52
133
$1,895,178 $7,176 $1,546,722 $0$0 $5,043 $3,454,119
54.9% 0.2% 44.8% 0.0%0.0% 0.1% 100.0%Net Revenue
12/31/20151/1/2015 to
14-9999
Fresenius Medical Care New City4616 South Bishop StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: 4622 S. Bishop, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
The facility was not open in 2015 so there are no revenues reported. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nic Hristea, M.D.
In-Center Treatments in calendar year: 38Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 0
Patients treated as of 12/31/2016: (Ending patients) 2
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 30
Oct 40
Oct 50
Oct 60
Oct 70
0 0 0 0 0 0 0
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 2Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 0Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
0Total:
2Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 0%Use Rate (including Missed Treatments): 0%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 2
0%2%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 2Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 0Peak Authorized Stations Operated: 2
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
2
100.0%
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
2
0.0% 0.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00200
020
0
00100
00100
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
2
0020021 1
2
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20151/1/2015 to
14-2559
Fresenius Medical Care Niles9371 N. Milwaukee AveNilesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Milbrook Associates LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Harold Bregman, M.D.
In-Center Treatments in calendar year: 15,857Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 103
Patients treated as of 12/31/2016: (Ending patients) 108
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 112
Oct 20
Oct 318
Oct 412
Oct 518
Oct 612
Oct 718
36 0 68 35 68 36 68
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 41Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 42Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 42
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
54Total:
54Total:
USE RATE for the FACILITY29,952Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 53%Use Rate (including Missed Treatments): 53%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 154
54%56%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 32Isolation Stations Set up in Oct 1-7: 4
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 11Dietician : 1.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 32Certified Stations by CMS: 32Peak Authorized Stations Operated: 32
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
99
64.3%
Medicaid
3
Private Insurance
49
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
154
1.9% 31.8% 0.0%1.9% 0.0% 100.0%
Patients
TOTAL 39050
110
21133
0
0
012282435
07
131223
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
154
019413658
15499 55
154
$3,087,496 $120,397 $3,471,978 $0$61,872 $0 $6,741,743
45.8% 1.8% 51.5% 0.0%0.9% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2778
Fresenius Medical Care Normal1531 E. College Ave.NormalMcLean4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Normal, LLCLegal Entity Owner:
Property Owner: 1531 E. College, LLC. c/o Pier & Associates
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kumarpal Shrishrimal, M.D.
In-Center Treatments in calendar year: 6,462Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 43
Patients treated as of 12/31/2016: (Ending patients) 45
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
20 0 20 21 22 21 21
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 20Transient Patients: 35Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 47Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 279
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
55Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 60%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 98
60%63%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
72
73.5%
Medicaid
2
Private Insurance
22
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
98
2.0% 22.4% 0.0%2.0% 0.0% 100.0%
Patients
TOTAL 20
340
62
4940
0
05
18214
06
141416
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
98
0113235209848 50
98
$193,654 $11,924 $253,865 $0$12,285 $0 $471,728
41.1% 2.5% 53.8% 0.0%2.6% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2521
Fresenius Medical Care Norridge4701 North CumberlandNorridgeCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Cumberland Mall, G.P.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Chirag Patel, M.D.
In-Center Treatments in calendar year: 10,971Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 74
Patients treated as of 12/31/2016: (Ending patients) 77
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 111
Oct 20
Oct 316
Oct 411
Oct 516
Oct 611
Oct 716
29 0 44 28 43 29 42
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 36Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 34Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 39
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
44Total:
47Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 73%Use Rate (including Missed Treatments): 74%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 121
77%80%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
81
66.9%
Medicaid
2
Private Insurance
38
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
121
1.7% 31.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 5020
114
15106
0
0
05
231926
02
151516
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
121
07
383442
12173 48
121
$1,770,969 $0 $1,360,694 $0$15,258 $0 $3,146,921
56.3% 0.0% 43.2% 0.0%0.5% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2602
Fresenius Medical Care North Avenue911 W. North AvenueMelrose ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Gottlieb Memorial Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Martin Finn, M.D.
In-Center Treatments in calendar year: 17,094Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 112
Patients treated as of 12/31/2016: (Ending patients) 116
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
56 0 57 54 57 52 56
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 39Transient Patients: 8Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 35Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 5
Number of Missed Treatments: 323
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
44Total:
48Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 76%Use Rate (including Missed Treatments): 78%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 160
78%81%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 9.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
100
62.5%
Medicaid
1
Private Insurance
54
Charity Care
0
Private Pay
5
Other Public
0
TOTAL
160
0.6% 33.8% 0.0%3.1% 0.0% 100.0%
Patients
TOTAL 200
660
74
70900
0
016283211
015231718
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
160
031514929
16087 73
160
$3,314,936 $26,100 $3,279,492 $0$69,788 $0 $6,690,316
49.5% 0.4% 49.0% 0.0%1.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2501
Fresenius Medical Care North Kilpatrick4800 North KilpatrickChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Kilpatrick 1.0, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Madhav Rao, M.D.
In-Center Treatments in calendar year: 20,479Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 139
Patients treated as of 12/31/2016: (Ending patients) 138
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 118
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
71 0 64 74 65 69 65
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 46Transient Patients: 5Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 31Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 15
Number of Missed Treatments: 140
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
54Total:
53Total:
USE RATE for the FACILITY26,208Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 78%Use Rate (including Missed Treatments): 79%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 192
83%82%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 28Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 14.5Dietician : 1.3Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 28Certified Stations by CMS: 28Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
88
45.8%
Medicaid
7
Private Insurance
89
Charity Care
0
Private Pay
7
Other Public
1
TOTAL
192
3.6% 46.4% 0.0%3.6% 0.5% 100.0%
Patients
TOTAL 260
240
142
99930
0
014413224
010252323
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
192
024665547
192111 81
192
$2,852,103 $187,672 $5,715,341 $0$117,740 $110,028 $8,982,884
31.8% 2.1% 63.6% 0.0%1.3% 1.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2531
Fresenius Medical Care Northcenter2620 West Addison StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Bryton Properties LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mark Leischner, M.D.
In-Center Treatments in calendar year: 9,431Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 63
Patients treated as of 12/31/2016: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
27 0 33 30 30 32 30
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 35Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 217
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
41Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 64%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 104
66%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
56
53.8%
Medicaid
4
Private Insurance
42
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
104
3.8% 40.4% 0.0%1.9% 0.0% 100.0%
Patients
TOTAL 60
160
82
40640
0
09
231611
06
17175
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
104
015403316
10459 45
104
$1,271,051 $48,007 $2,457,459 $0$101,190 $0 $3,877,707
32.8% 1.2% 63.4% 0.0%2.6% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2771
Fresenius Medical Care Northfield480 Central Ave.NorthfieldCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Richard N. Abrams
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sandeep Mehta, M.D.
In-Center Treatments in calendar year: 421Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 6
Patients treated as of 12/31/2016: (Ending patients) 1
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 10
Oct 20
Oct 38
Oct 40
Oct 58
Oct 60
Oct 78
0 0 4 0 3 0 4
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 5Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 12Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
14Total:
9Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 4%Use Rate (including Missed Treatments): 4%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 15
8%1%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 1Isolation Stations Set up in Oct 1-7: 12
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 4
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
15
100.0%
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
15
0.0% 0.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 2020
11
2130
0
01233
01023
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
15
02256
159 6
15
$112,511 $0 $92,852 $0$0 $69,633 $274,996
40.9% 0.0% 33.8% 0.0%0.0% 25.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2597
Fresenius Medical Care Northwestern710 North Fairbanks, Suite 4-200ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Real Estate Strategy
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jennifer Tuazon, M.D.
In-Center Treatments in calendar year: 18,818Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 142
Patients treated as of 12/31/2016: (Ending patients) 143
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 117.75
Oct 20
Oct 317.75
Oct 417.75
Oct 517.75
Oct 617.75
Oct 717.75
68 0 78 68 78 68 78
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 104Transient Patients: 53Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 5Transplant Recipients: 6Patients transferred out: 93Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 14
Number of Missed Treatments: 7,047
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
123Total:
160Total:
USE RATE for the FACILITY39,312Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 48%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 263
56%57%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 42Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 19Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 42Certified Stations by CMS: 42Peak Authorized Stations Operated: 42
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
193
73.4%
Medicaid
2
Private Insurance
65
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
263
0.8% 24.7% 0.0%0.4% 0.8% 100.0%
Patients
TOTAL 150
1440
104
36227
0
0
027663520
018382930
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
263
045
1046450
263148 115
263
$4,102,213 $138,250 $3,790,834 $0$38,576 $53,610 $8,123,483
50.5% 1.7% 46.7% 0.0%0.5% 0.7% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2764
Fresenius Medical Care Oak Forest5340A West 159th StreetOak ForestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Oak Forest, LLCLegal Entity Owner:
Property Owner: RJE Investments
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jeannette McLaughlin, M.D.
In-Center Treatments in calendar year: 6,793Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 49
Patients treated as of 12/31/2016: (Ending patients) 49
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 517
Oct 612
Oct 717
22 0 27 22 27 22 27
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 18Transient Patients: 10Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 261
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
14Total:
30Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 60%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 81
68%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
59
72.8%
Medicaid
0
Private Insurance
22
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
81
0.0% 27.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
360
42
8721
2
01015164
066
159
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
81
0162131138145 36
81
$462,253 $0 $529,493 $0$28,872 $0 $1,020,618
45.3% 0.0% 51.9% 0.0%2.8% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2504
Fresenius Medical Care Oak Park733 Madison StreetOak ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care River Forest, LLCLegal Entity Owner:
Property Owner: Three M & L Partnership
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Paul Balter, M.D.
In-Center Treatments in calendar year: 10,058Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 68
Patients treated as of 12/31/2016: (Ending patients) 71
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
31 0 32 32 31 33 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 16Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 4
Number of Missed Treatments: 352
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
31Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 90%Use Rate (including Missed Treatments): 93%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 96
94%99%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 8Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
62
64.6%
Medicaid
1
Private Insurance
33
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
96
1.0% 34.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 03
750
18
4920
0
09
201013
06
14159
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
96
0153425229652 44
96
$1,404,327 $27,001 $1,842,622 $0$0 $0 $3,273,950
42.9% 0.8% 56.3% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2673
Fresenius Medical Care of Antioch311 Depot St., Ste. HAntiochLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Lake County, LLCLegal Entity Owner:
Property Owner: Depot St. Station Development LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Omaima Degani, M.D.
In-Center Treatments in calendar year: 5,275Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 41
Patients treated as of 12/31/2016: (Ending patients) 35
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 314
Oct 412
Oct 514
Oct 612
Oct 714
11 0 23 11 21 14 21
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 6Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 28Patients transferred out: 5Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 0
Number of Missed Treatments: 226
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
8Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 47%Use Rate (including Missed Treatments): 49%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 65
57%49%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
40
61.5%
Medicaid
2
Private Insurance
21
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
65
3.1% 32.3% 0.0%0.0% 3.1% 100.0%
Patients
TOTAL 10
130
51
7580
0
05
1855
04
1495
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
65
09
3214106533 32
65
$1,263,352 $0 $1,620,147 $0$0 $65,378 $2,948,877
42.8% 0.0% 54.9% 0.0%0.0% 2.2% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2710
Fresenius Medical Care of Deerfield405 Lake Cook RoadDeerfieldCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Lake Cook Plaza, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Shalini Patel, M.D.
In-Center Treatments in calendar year: 3,455Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 21
Patients treated as of 12/31/2016: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 316
Oct 40
Oct 516
Oct 60
Oct 716
0 0 26 0 23 0 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 16Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 14Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 45
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
21Total:
22Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 31%Use Rate (including Missed Treatments): 31%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 44
29%32%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
31
70.5%
Medicaid
0
Private Insurance
13
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
44
0.0% 29.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 2040
38
5390
0
0179
13
01634
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
44
02
1312174430 14
44
$1,257,590 $0 $929,468 $0$0 $0 $2,187,058
57.5% 0.0% 42.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2669
Fresenius Medical Care of Lake Bluff101 Waukegan Rd., Ste. 700Lake BluffLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Franklin Partners
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Joshua Trob, M.D.
In-Center Treatments in calendar year: 10,188Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 67
Patients treated as of 12/31/2016: (Ending patients) 67
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 114
Oct 20
Oct 318
Oct 414
Oct 518
Oct 613.75
Oct 718
26 0 42 28 40 24 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 31Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 143
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
42Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 107
70%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
64
59.8%
Medicaid
2
Private Insurance
35
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
107
1.9% 32.7% 0.0%0.0% 5.6% 100.0%
Patients
TOTAL 10
335
67
27800
1
012261510
07
149
14
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
107
019402424
10763 44
107
$2,101,802 $65,667 $1,871,641 $0$0 $210,062 $4,249,172
49.5% 1.5% 44.0% 0.0%0.0% 4.9% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2679
Fresenius Medical Care of Lakeview4008 N. Broadway, St. 1200ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Thorek Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Haresh Muni, M.D.
In-Center Treatments in calendar year: 7,799Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 50
Patients treated as of 12/31/2016: (Ending patients) 52
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 111
Oct 20
Oct 316
Oct 411
Oct 516
Oct 611
Oct 716
22 0 31 20 32 20 30
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 8Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 16Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 212
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
38Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 60%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 80
60%62%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
53
66.3%
Medicaid
4
Private Insurance
19
Charity Care
0
Private Pay
1
Other Public
3
TOTAL
80
5.0% 23.8% 0.0%1.3% 3.8% 100.0%
Patients
TOTAL 80
360
30
16640
6
06
23166
03
11105
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
80
09
3426118051 29
80
$1,189,192 $24,151 $1,366,914 $0$0 $53,374 $2,633,631
45.2% 0.9% 51.9% 0.0%0.0% 2.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2672
Fresenius Medical Care of McHenry4312 W. Elm St.McHenryMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Lake County, LLCLegal Entity Owner:
Property Owner: Bob Dellutri/Heidner Properites, Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Karol Rosner, M.D.
In-Center Treatments in calendar year: 5,356Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 35
Patients treated as of 12/31/2016: (Ending patients) 35
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 90.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
17 0 19 15 19 14 19
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 12Patients transferred out: 16Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 250
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
26Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 41%Use Rate (including Missed Treatments): 43%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 62
42%42%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
44
71.0%
Medicaid
0
Private Insurance
15
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
62
0.0% 24.2% 0.0%0.0% 4.8% 100.0%
Patients
TOTAL 0020
60
8540
0
04
11157
03985
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
62
07
2023126237 25
62
$1,616,118 $107,432 $1,714,480 $0$52,134 $46,795 $3,536,959
45.7% 3.0% 48.5% 0.0%1.5% 1.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2705
Fresenius Medical Care of Metropolis20 Hospital DrMetropolisMassac5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Metropolis Dialysis Services, LLCLegal Entity Owner:
Property Owner: Massac Memorial Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jonathan Wilkerson, M.D.
In-Center Treatments in calendar year: 3,005Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 31
Patients treated as of 12/31/2016: (Ending patients) 28
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 110
Oct 20
Oct 311
Oct 410
Oct 511
Oct 610
Oct 711
10 0 16 9 15 9 15
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 19Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 11Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 183
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
19Total:
22Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 40%Use Rate (including Missed Treatments): 43%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 42
65%58%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0.5Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
28
66.7%
Medicaid
4
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
42
9.5% 14.3% 0.0%0.0% 9.5% 100.0%
Patients
TOTAL 00
120
30
0420
0
06
1266
01443
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
42
07
1610
94230 12
42
$351,363 $41,507 $563,659 $0$0 $45,236 $1,001,765
35.1% 4.1% 56.3% 0.0%0.0% 4.5% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2689
Fresenius Medical Care of Mokena8910 West 192nd StreetMokenaWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Value Industrial
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Facility runs a 4th shift on M/W/F that consists of 5 Nocturnal dialysis patients. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Abraham Thomas, M.D.
In-Center Treatments in calendar year: 7,888Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 53
Patients treated as of 12/31/2016: (Ending patients) 59
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 113
Oct 20
Oct 322
Oct 413
Oct 522
Oct 613
Oct 722
17 0 37 15 38 16 36
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 34Transient Patients: 16Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 25Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 456
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
45Total:
51Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 70%Use Rate (including Missed Treatments): 74%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 101
74%82%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
69
68.3%
Medicaid
0
Private Insurance
25
Charity Care
0
Private Pay
5
Other Public
2
TOTAL
101
0.0% 24.8% 0.0%5.0% 2.0% 100.0%
Patients
TOTAL 20
220
77
8930
0
08
201517
02
131511
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
101
010333028
10160 41
101
$1,241,433 $0 $1,579,635 $0$0 $45,722 $2,866,790
43.3% 0.0% 55.1% 0.0%0.0% 1.6% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2678
Fresenius Medical Care of Naperville North514 West 5th AvenueNapervilleDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Mustang Construction, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kevin Pandya, M.D.
In-Center Treatments in calendar year: 10,707Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 69
Patients treated as of 12/31/2016: (Ending patients) 69
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 113
Oct 20
Oct 317
Oct 413
Oct 517.5
Oct 613.5
Oct 718
29 0 46 26 44 26 44
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 30Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 56Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 225
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
73Total:
65Total:
USE RATE for the FACILITY19,656Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 54%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 136
55%55%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 21Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4.5Dialysis Technician : 7Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 21Certified Stations by CMS: 21Peak Authorized Stations Operated: 21
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
94
69.1%
Medicaid
2
Private Insurance
34
Charity Care
0
Private Pay
6
Other Public
0
TOTAL
136
1.5% 25.0% 0.0%4.4% 0.0% 100.0%
Patients
TOTAL 210
390
76
13123
0
0
013221722
05
171525
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
136
018393247
13674 62
136
$1,750,509 $0 $2,113,924 $0$23,450 $39,659 $3,927,542
44.6% 0.0% 53.8% 0.0%0.6% 1.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2677
Fresenius Medical Care of Oswego1051 Station DriveOswegoKendall9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Oswego Junction, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Atif Fakhruddin, M.D.
In-Center Treatments in calendar year: 9,098Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 60
Patients treated as of 12/31/2016: (Ending patients) 65
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
30 0 31 30 32 30 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 43Transient Patients: 12Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 4Patients transferred out: 42Patients voluntarily discontinued: 1Patients lost to follow up: 2Patients deceased: 2
Number of Missed Treatments: 216
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
56Total:
USE RATE for the FACILITY10,296Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 88%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 117
91%98%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 11Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 11Certified Stations by CMS: 11Peak Authorized Stations Operated: 11
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
80
68.4%
Medicaid
3
Private Insurance
32
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
117
2.6% 27.4% 0.0%0.0% 1.7% 100.0%
Patients
TOTAL 70
180
92
14103
0
0
012211310
012161815
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
117
024373125
11756 61
117
$1,067,470 $40,549 $1,488,905 $0$6,581 $35,082 $2,638,587
40.5% 1.5% 56.4% 0.0%0.2% 1.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2707
Fresenius Medical Care of Plainfield2320 Michas DrivePlainfieldWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Plainfield, LLCLegal Entity Owner:
Property Owner: ZENITH HOLDINGS, LIMITED
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Morufu Alausa, M.D.
In-Center Treatments in calendar year: 11,879Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 84
Patients treated as of 12/31/2016: (Ending patients) 79
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
36 0 38 35 39 36 36
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 43Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 7Transplant Recipients: 4Patients transferred out: 45Patients voluntarily discontinued: 3Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 269
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
58Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 79%Use Rate (including Missed Treatments): 81%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 134
88%82%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 8Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
86
64.2%
Medicaid
2
Private Insurance
44
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
134
1.5% 32.8% 0.0%0.0% 1.5% 100.0%
Patients
TOTAL 20
322
98
22112
0
0
03
502212
04
161611
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
134
07
663823
13487 47
134
$1,904,651 $47,533 $2,679,645 $0$0 $0 $4,631,829
41.1% 1.0% 57.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2690
Fresenius Medical Care of Roseland136 West 111th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Roseland Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nimeet Brahmbhatt, M.D.
In-Center Treatments in calendar year: 9,277Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 70
Patients treated as of 12/31/2016: (Ending patients) 68
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
26 0 31 30 32 33 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 26Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 24Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 6
Number of Missed Treatments: 826
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
34Total:
39Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 83%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 107
97%94%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
58
54.2%
Medicaid
2
Private Insurance
47
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
107
1.9% 43.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
10601
0107
0
0
0192797
03
228
12
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
107
022491719
10762 45
107
$1,068,072 $80,605 $1,588,292 $0$0 $148,947 $2,885,916
37.0% 2.8% 55.0% 0.0%0.0% 5.2% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2700
Fresenius Medical Care of Sandwich1310 North Main StreetSandwichDeKalb1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Sandwich, LLCLegal Entity Owner:
Property Owner: Sandwich Development Partners
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Atif Fakhruddin, M.D.
In-Center Treatments in calendar year: 5,261Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 33
Patients treated as of 12/31/2016: (Ending patients) 37
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
15 0 17 18 16 18 18
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 18Transient Patients: 15Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 20Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 120
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
35Total:
USE RATE for the FACILITY9,360Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 57%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 64
55%62%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 10Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0.5Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 10Certified Stations by CMS: 10Peak Authorized Stations Operated: 10
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
44
68.8%
Medicaid
2
Private Insurance
16
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
64
3.1% 25.0% 0.0%3.1% 0.0% 100.0%
Patients
TOTAL 10
100
52
9541
1
03
1887
03
1357
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
64
06
3113146436 28
64
$777,346 $25,936 $840,042 $0$0 $0 $1,643,324
47.3% 1.6% 51.1% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2695
Fresenius Medical Care of Streator2356 North Bloomington StreetStreatorLaSalle2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Sandor Development Co.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Rosborough, M.D.
In-Center Treatments in calendar year: 3,211Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 22
Patients treated as of 12/31/2016: (Ending patients) 22
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 17
Oct 20
Oct 310
Oct 47
Oct 510
Oct 67
Oct 710
7 0 15 7 16 6 16
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 21Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 15Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 59
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
21Total:
25Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 43%Use Rate (including Missed Treatments): 44%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 40
46%46%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2.5Dialysis Technician : 2.5Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
35
87.5%
Medicaid
0
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
40
0.0% 7.5% 0.0%0.0% 5.0% 100.0%
Patients
TOTAL 0040
36
2380
0
01
1276
01526
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
40
02
179
124026 14
40
$482,550 $18,210 $399,143 $0$0 $0 $899,903
53.6% 2.0% 44.4% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2692
Fresenius Medical Care of Uptown47000 North Marine Drive, Ste 200ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership: Renal Care Group Chicago Uptown, LLC
Ownership Type: Limited Liability Company
Legal Entity Operator: Renal Care Group Chicago Uptown, LLCLegal Entity Owner:
Property Owner: Wellness Associates LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Neil Soifer, M.D.
In-Center Treatments in calendar year: 10,458Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 68
Patients treated as of 12/31/2016: (Ending patients) 77
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
34 0 35 34 35 32 36
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 11Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 14Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 347
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
16Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 80%Use Rate (including Missed Treatments): 82%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 84
81%92%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 11Dietician : 1Social Worker: 2LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
58
69.0%
Medicaid
0
Private Insurance
24
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
84
0.0% 28.6% 0.0%1.2% 1.2% 100.0%
Patients
TOTAL 70
371311
135813
16
07
176
13
05
151110
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
84
0123217238443 41
84
$1,859,938 $210,711 $1,719,329 $0$0 $6,317 $3,796,295
49.0% 5.6% 45.3% 0.0%0.0% 0.2% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2702
Fresenius Medical Care of West Chicago1859 North Neltnor BoulevardWest ChicagoDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: West Chicago Management LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jeffrey Kropp, M.D.
In-Center Treatments in calendar year: 7,356Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 43
Patients treated as of 12/31/2016: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 318
Oct 412
Oct 517.75
Oct 612.25
Oct 718
20 0 34 18 32 17 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 19Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 6
Number of Missed Treatments: 82
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
34Total:
46Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 65%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 82
60%76%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 7.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
59
72.0%
Medicaid
0
Private Insurance
20
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
82
0.0% 24.4% 0.0%0.0% 3.7% 100.0%
Patients
TOTAL 12070
63
12700
0
05
161316
0397
13
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
82
08
2520298250 32
82
$1,063,529 $22,923 $525,913 $0$40,182 $0 $1,652,547
64.4% 1.4% 31.8% 0.0%2.4% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2550
Fresenius Medical Care Orland Park9160 W. 159th St.Orland ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: MGT/Marketing Services
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lourdes Terrado, M.D.
In-Center Treatments in calendar year: 11,709Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 79
Patients treated as of 12/31/2016: (Ending patients) 72
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 117.5
Oct 20
Oct 317.5
Oct 417.5
Oct 517.5
Oct 617.5
Oct 717.5
35 0 40 32 37 37 37
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 25Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 26Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 62
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
34Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 70%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 106
73%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4.5Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
81
76.4%
Medicaid
1
Private Insurance
22
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
106
0.9% 20.8% 0.0%0.9% 0.9% 100.0%
Patients
TOTAL 60
120
88
4102
0
0
07
162120
05
111313
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
106
012273433
10664 42
106
$2,711,839 $0 $3,036,989 $0$42,161 $0 $5,790,989
46.8% 0.0% 52.4% 0.0%0.7% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2576
Fresenius Medical Care Ottawa1601 Mercury Circle Drive, Ste 3OttawaLaSalle2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: OSF Healthcare System
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Amit Jamnadas, M.D.
In-Center Treatments in calendar year: 7,412Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 47
Patients treated as of 12/31/2016: (Ending patients) 47
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
23 0 28 19 29 20 28
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 14Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 5Transplant Recipients: 2Patients transferred out: 33Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 58
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
49Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 98
65%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
72
73.5%
Medicaid
9
Private Insurance
17
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
98
9.2% 17.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
76
22760
22
08
281211
07
101111
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
98
0153823229859 39
98
$590,969 $67,256 $846,821 $0$0 $95,907 $1,600,953
36.9% 4.2% 52.9% 0.0%0.0% 6.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2723
Fresenius Medical Care Palatine691 E. Dundee RoadPalatineCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Palatine, LLCLegal Entity Owner:
Property Owner: Ramco Gershenson, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Manish Tanna, M.D.
In-Center Treatments in calendar year: 10,408Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 63
Patients treated as of 12/31/2016: (Ending patients) 77
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 318
Oct 417
Oct 517.5
Oct 617
Oct 718
32 0 38 35 39 37 38
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 40Transient Patients: 7Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 5Patients transferred out: 25Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 57
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
50Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 79%Use Rate (including Missed Treatments): 80%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 113
75%92%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
66
58.4%
Medicaid
8
Private Insurance
39
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
113
7.1% 34.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 120
110
90
16970
0
08
232015
02
131319
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
113
010363334
11366 47
113
$1,424,861 $43,831 $3,271,150 $0$69,930 $13,054 $4,822,826
29.5% 0.9% 67.8% 0.0%1.4% 0.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2571
Fresenius Medical Care Pekin3521 Veterans DrivePekinTazewell2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: East Court Shopping Center, LP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Gordon James, M.D.
In-Center Treatments in calendar year: 6,027Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 36
Patients treated as of 12/31/2016: (Ending patients) 45
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 115
Oct 20
Oct 317
Oct 415
Oct 517.5
Oct 613
Oct 718
16 0 24 15 22 13 24
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 23Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 14Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 186
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
31Total:
USE RATE for the FACILITY9,360Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 66
60%75%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 10Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 10Certified Stations by CMS: 10Peak Authorized Stations Operated: 10
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
41
62.1%
Medicaid
0
Private Insurance
20
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
66
0.0% 30.3% 0.0%3.0% 4.5% 100.0%
Patients
TOTAL 1010
64
0660
0
04
167
11
0574
12
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
66
09
2311236638 28
66
$740,972 $0 $1,109,278 $0$0 $79,203 $1,929,453
38.4% 0.0% 57.5% 0.0%0.0% 4.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2574
Fresenius Medical Care Peoria Downtown410 W Romeo B. Garrett Ave.PeoriaPeoria2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: PNLC, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Tim Pflederer, M.D.
In-Center Treatments in calendar year: 18,837Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 134
Patients treated as of 12/31/2016: (Ending patients) 131
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 115
Oct 20
Oct 318
Oct 415
Oct 518
Oct 615
Oct 718
52 0 60 50 53 55 61
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 53Transient Patients: 20Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 42Patients voluntarily discontinued: 9Patients lost to follow up: 0Patients deceased: 22
Number of Missed Treatments: 1,422
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
78Total:
75Total:
USE RATE for the FACILITY29,952Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 68%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 209
70%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 32Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 19Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 32Certified Stations by CMS: 32Peak Authorized Stations Operated: 32
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
127
60.8%
Medicaid
5
Private Insurance
72
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
209
2.4% 34.4% 0.0%1.0% 1.4% 100.0%
Patients
TOTAL 11
1230
84
5204
0
0
018442114
013482625
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
209
031924739
20997 112
209
$2,468,612 $12,753 $3,073,789 $0$0 $100,707 $5,655,861
43.6% 0.2% 54.3% 0.0%0.0% 1.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2613
Fresenius Medical Care Peoria North10405 N. Juliet CourtPeoriaPeoria2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: K&S Coleman Revocable Trust
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Samer Sader, M.D.
In-Center Treatments in calendar year: 12,451Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 79
Patients treated as of 12/31/2016: (Ending patients) 86
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 313
Oct 412
Oct 516
Oct 612
Oct 716
32 0 48 36 45 35 47
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 43Transient Patients: 16Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 32Patients voluntarily discontinued: 3Patients lost to follow up: 2Patients deceased: 13
Number of Missed Treatments: 336
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
54Total:
61Total:
USE RATE for the FACILITY19,656Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 65%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 140
63%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 21Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 21Certified Stations by CMS: 21Peak Authorized Stations Operated: 21
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
86
61.4%
Medicaid
2
Private Insurance
52
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
140
1.4% 37.1% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
420
97
3137
0
0
08
361418
05
231323
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
140
013592741
14076 64
140
$2,005,293 $0 $3,077,088 $0$32,276 $0 $5,114,657
39.2% 0.0% 60.2% 0.0%0.6% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2596
Fresenius Medical Care Plainfield North24024 W. Riverwalk CourtPlainfieldWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Plainfield North, LLCLegal Entity Owner:
Property Owner: MERIDIAN INVESTMENT PARTNERS, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Aaron Gurfinchel, M.D.
In-Center Treatments in calendar year: 1,797Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 14
Patients treated as of 12/31/2016: (Ending patients) 13
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 10
Oct 20
Oct 312
Oct 40
Oct 512
Oct 60
Oct 712
0 0 10 0 10 0 10
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 19Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 16Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 40
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
20Total:
USE RATE for the FACILITY9,360Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 19%Use Rate (including Missed Treatments): 20%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 34
23%22%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 10Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 10Certified Stations by CMS: 10Peak Authorized Stations Operated: 10
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
24
70.6%
Medicaid
0
Private Insurance
10
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
34
0.0% 29.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 1030
30
3310
0
01687
00237
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
34
018
11143422 12
34
$297,537 $0 $322,489 $0$0 $9,919 $629,945
47.2% 0.0% 51.2% 0.0%0.0% 1.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2502
Fresenius Medical Care Polk557 West PolkChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: 571 W. Polk Street LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Marco Pagani, M.D.
In-Center Treatments in calendar year: 9,456Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 69
Patients treated as of 12/31/2016: (Ending patients) 63
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 317
Oct 412
Oct 517
Oct 612
Oct 717
20 0 44 20 44 20 44
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 29Transient Patients: 21Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 43Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 195
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
52Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 42%Use Rate (including Missed Treatments): 43%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 110
48%44%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
63
57.3%
Medicaid
7
Private Insurance
38
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
110
6.4% 34.5% 0.0%1.8% 0.0% 100.0%
Patients
TOTAL 50
640
41
26840
0
01333125
09
2279
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
110
022551914
11063 47
110
$3,064,448 $110,551 $4,180,815 $0$0 $0 $7,355,814
41.7% 1.5% 56.8% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2611
Fresenius Medical Care Pontiac804 West Madison StreetPontiacLivingston4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: FTB, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kumarpal Shrishrimal, M.D.
In-Center Treatments in calendar year: 4,800Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 31
Patients treated as of 12/31/2016: (Ending patients) 29
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 312
Oct 418
Oct 515
Oct 612
Oct 713
14 0 15 17 13 12 16
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 12Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 9Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 164
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
15Total:
13Total:
USE RATE for the FACILITY8,424Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 57%Use Rate (including Missed Treatments): 59%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 44
57%54%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 9Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 3.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 9Certified Stations by CMS: 9Peak Authorized Stations Operated: 9
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
35
79.5%
Medicaid
0
Private Insurance
6
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
44
0.0% 13.6% 0.0%2.3% 4.5% 100.0%
Patients
TOTAL 0000
40
1430
4
03
10104
01763
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
44
04
1716
74427 17
44
$815,657 $31,866 $582,915 $0$0 $51,805 $1,482,243
55.0% 2.1% 39.3% 0.0%0.0% 3.5% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2569
Fresenius Medical Care Prairie1717 South Wabash AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Loop Auto Parks, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sheldon Hirsch, M.D.
In-Center Treatments in calendar year: 15,913Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 109
Patients treated as of 12/31/2016: (Ending patients) 109
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 317
Oct 413
Oct 517.5
Oct 611.5
Oct 718
40 0 61 44 63 43 60
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 16Transient Patients: 26Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 7Patients transferred out: 37Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 233
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
43Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 71%Use Rate (including Missed Treatments): 72%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 152
76%76%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
85
55.9%
Medicaid
0
Private Insurance
66
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
152
0.0% 43.4% 0.0%0.0% 0.7% 100.0%
Patients
TOTAL 70
14302
4148
0
0
08
272120
013222318
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
152
021494438
15276 76
152
$2,442,580 $25,117 $3,050,189 $0$0 $169,735 $5,687,621
42.9% 0.4% 53.6% 0.0%0.0% 3.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2589
Fresenius Medical Care Randolph County102 Memorial DriveChesterRandolph5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Bio-Medical Applications of Illinois, Inc.Legal Entity Owner:
Property Owner: Randolph Hospital District d/b/a Memorial Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Kamran, M.D.
In-Center Treatments in calendar year: 3,125Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 23
Patients treated as of 12/31/2016: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 285.0
Oct 17
Oct 20
Oct 310
Oct 47
Oct 59.5
Oct 66.5
Oct 79
5 0 14 5 11 7 12
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 9Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 7Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 158
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
14Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 42%Use Rate (including Missed Treatments): 44%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 38
48%48%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 1.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
25
65.8%
Medicaid
0
Private Insurance
13
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
38
0.0% 34.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0040
31
3350
3
03754
01387
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
38
04
1013113819 19
38
$404,973 $21,610 $538,743 $0$0 $13,853 $979,179
41.4% 2.2% 55.0% 0.0%0.0% 1.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2558
Fresenius Medical Care Regency Park124 Regency Park Drive, Suite 1O'FallonSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: RAI Care Centers of Illinois I, LLCLegal Entity Owner:
Property Owner: Savvi Investment
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Koch, M.D.
In-Center Treatments in calendar year: 15,378Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 104
Patients treated as of 12/31/2016: (Ending patients) 106
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 113
Oct 20
Oct 313
Oct 413
Oct 513
Oct 613
Oct 713
49 0 52 54 49 46 51
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 48Transient Patients: 16Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 30Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 29
Number of Missed Treatments: 694
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
66Total:
65Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 82%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 167
87%88%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 7Dietician : 2Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
112
67.1%
Medicaid
0
Private Insurance
51
Charity Care
0
Private Pay
2
Other Public
2
TOTAL
167
0.0% 30.5% 0.0%1.2% 1.2% 100.0%
Patients
TOTAL 00
951
71
4163
0
0
07
392320
07
282122
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
167
014674442
16789 78
167
$3,090,818 $0 $3,196,888 $0$0 $93,333 $6,381,039
48.4% 0.0% 50.1% 0.0%0.0% 1.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2735
Fresenius Medical Care River Forest103 Forest AvenueRiver ForestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care River Forest, LLCLegal Entity Owner:
Property Owner: Elliott Bay Healthcare Realty, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: George Naratdam, M.D.
In-Center Treatments in calendar year: 12,534Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 86
Patients treated as of 12/31/2016: (Ending patients) 83
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
30 0 52 29 51 29 48
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 15Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 37Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 322
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
47Total:
USE RATE for the FACILITY20,592Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 62%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 133
65%63%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 22Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 22Certified Stations by CMS: 22Peak Authorized Stations Operated: 22
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
103
77.4%
Medicaid
0
Private Insurance
26
Charity Care
0
Private Pay
2
Other Public
2
TOTAL
133
0.0% 19.5% 0.0%1.5% 1.5% 100.0%
Patients
TOTAL 31
970
32
8125
0
0
015311512
04
251318
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
133
019562830
13373 60
133
$3,003,609 $43,532 $3,184,807 $0$47,218 $119,097 $6,398,263
46.9% 0.7% 49.8% 0.0%0.7% 1.9% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2703
Fresenius Medical Care Rock Island2623 17th StreetRock IslandRock Island10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Quad Cities, LLCLegal Entity Owner:
Property Owner: RRS Investments, LLP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care acquired the Quad Cities Aledo, Geneseo, Moline, Rock Island, Rock River – Dixon, and Silvis facilities as of May 1, 2016. Compiled 2016 financial information prior to May 1 was provided by Quad Cities and was combined with compiled 2016 financial information from Fresenius Medical Care to complete the survey. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Travis Figanbaum, M.D.
In-Center Treatments in calendar year: 4,954Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 35
Patients treated as of 12/31/2016: (Ending patients) 33
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 60
Oct 713
0 0 33 0 35 0 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 8Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 219
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
15Total:
USE RATE for the FACILITY17,784Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 28%Use Rate (including Missed Treatments): 29%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 50
31%29%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 19Certified Stations by CMS: 19Peak Authorized Stations Operated: 19
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
31
62.0%
Medicaid
1
Private Insurance
17
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
50
2.0% 34.0% 0.0%2.0% 0.0% 100.0%
Patients
TOTAL 10
230
26
1490
0
01697
0069
12
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
50
01
1218195023 27
50
$924,501 $8,119 $594,318 $0$27,725 $0 $1,554,663
59.5% 0.5% 38.2% 0.0%1.8% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2645
Fresenius Medical Care Rock River - Dixon101 West Second StreetDixonLee1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Quad Cities, LLCLegal Entity Owner:
Property Owner: Katherine Shaw Bethea Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care acquired the Quad Cities Aledo, Geneseo, Moline, Rock Island, Rock River – Dixon, and Silvis facilities as of May 1, 2016. Compiled 2016 financial information prior to May 1 was provided by Quad Cities and was combined with compiled 2016 financial information from Fresenius Medical Care to complete the survey. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Alla, M.D.
In-Center Treatments in calendar year: 2,773Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 20
Patients treated as of 12/31/2016: (Ending patients) 19
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 315
Oct 40
Oct 514
Oct 60
Oct 715
0 0 17 0 18 0 16
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 1Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 1Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 43
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
2Total:
1Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 37%Use Rate (including Missed Treatments): 38%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 21
42%40%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
18
85.7%
Medicaid
2
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
21
9.5% 4.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
21
2190
0
00
1242
00210
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
21
00
1452
2118 3
21
$654,975 $64,287 $35,546 $0$0 $0 $754,808
86.8% 8.5% 4.7% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2522
Fresenius Medical Care Rogers Park2277 W. Howard St.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: 2277 Howard L.L.C.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Arnold Berns, M.D.
In-Center Treatments in calendar year: 12,668Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 84
Patients treated as of 12/31/2016: (Ending patients) 78
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 111
Oct 20
Oct 316
Oct 411
Oct 516
Oct 611
Oct 716
36 0 48 36 48 36 48
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 21Transient Patients: 10Patients Re-Started: 8Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 40Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 294
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
40Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 124
70%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4.5Dialysis Technician : 10Dietician : 1Social Worker: 0.6LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
75
60.5%
Medicaid
2
Private Insurance
43
Charity Care
0
Private Pay
2
Other Public
2
TOTAL
124
1.6% 34.7% 0.0%1.6% 1.6% 100.0%
Patients
TOTAL 161
360
71
25990
0
018272016
013136
11
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
124
031402627
12481 43
124
$1,728,341 $101,796 $2,247,740 $0$19,028 $82,557 $4,179,462
41.4% 2.4% 53.8% 0.0%0.5% 2.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2525
Fresenius Medical Care Rolling Meadows4180 Winnetka AvenueRolling MeadowsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: RMS Properties LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Azza Suleiman, M.D.
In-Center Treatments in calendar year: 14,871Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 97
Patients treated as of 12/31/2016: (Ending patients) 102
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
0 0 0 0 0 0 0
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 49Transient Patients: 8Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 32Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 175
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
60Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 153
67%71%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
106
69.3%
Medicaid
1
Private Insurance
43
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
153
0.7% 28.1% 0.0%2.0% 0.0% 100.0%
Patients
TOTAL 8060
139
26127
0
0
010281439
05
171327
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
153
015452766
15391 62
153
$2,389,746 $30,906 $3,484,351 $0$75,320 $0 $5,980,323
40.0% 0.5% 58.3% 0.0%1.3% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2670
Fresenius Medical Care Ross Dialysis Englewood6333 South Green StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Ross Dialysis Englewood, LLCLegal Entity Owner:
Property Owner: AIN Investments, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: April Kennedy, M.D.
In-Center Treatments in calendar year: 11,980Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 89
Patients treated as of 12/31/2016: (Ending patients) 82
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 275.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
37 0 35 38 39 35 35
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 13Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 43Patients voluntarily discontinued: 3Patients lost to follow up: 1Patients deceased: 14
Number of Missed Treatments: 2,184
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
64Total:
56Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 80%Use Rate (including Missed Treatments): 95%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 145
93%85%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
90
62.1%
Medicaid
0
Private Insurance
52
Charity Care
0
Private Pay
2
Other Public
1
TOTAL
145
0.0% 35.9% 0.0%1.4% 0.7% 100.0%
Patients
TOTAL 00
14300
2143
0
2
01345208
08
231810
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
145
021683818
14586 59
145
$2,107,617 $126,592 $1,066,894 $0$31,585 $56,253 $3,388,941
62.2% 3.7% 31.5% 0.0%0.9% 1.7% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2616
Fresenius Medical Care Round Lake401 Nippersink RoadRound LakeLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Lake County, LLCLegal Entity Owner:
Property Owner: Rockford 550, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nino Alapishvili, M.D.
In-Center Treatments in calendar year: 11,384Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 79
Patients treated as of 12/31/2016: (Ending patients) 79
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
37 0 37 34 32 35 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 38Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 44Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 128
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
58Total:
53Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 76%Use Rate (including Missed Treatments): 77%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 116
82%82%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 10Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
69
59.5%
Medicaid
5
Private Insurance
39
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
116
4.3% 33.6% 0.0%0.0% 2.6% 100.0%
Patients
TOTAL 10060
100
40760
0
09
351814
07
121110
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
116
016472924
11676 40
116
$1,685,429 $77,462 $2,398,565 $0$27,283 $40,580 $4,229,319
39.9% 1.8% 56.7% 0.0%0.6% 1.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2573
Fresenius Medical Care Saline County275 Small Street, Ste 200HarrisburgSaline5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Bio-Medical Applications of Illinois, Inc.Legal Entity Owner:
Property Owner: Lewis Lane, LLC c/o Burley Shay Investments
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Randy Cowart, M.D.
In-Center Treatments in calendar year: 7,247Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 44
Patients treated as of 12/31/2016: (Ending patients) 51
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 111.5
Oct 20
Oct 311.5
Oct 411.5
Oct 511.5
Oct 611.5
Oct 711.5
24 0 26 20 28 20 30
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 25Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 11Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 17
Number of Missed Treatments: 430
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
35Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 48%Use Rate (including Missed Treatments): 51%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 79
46%53%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
60
75.9%
Medicaid
9
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
79
11.4% 5.1% 0.0%0.0% 7.6% 100.0%
Patients
TOTAL 0060
73
0790
0
03
171113
02
1779
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
79
05
3418227944 35
79
$2,279,915 $40,963 $74,101 $0$0 $421,922 $2,816,901
80.9% 1.5% 2.6% 0.0%0.0% 15.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2675
Fresenius Medical Care Silvis880 Crosstown AvenueSilvisRock Island10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Quad Cities, LLCLegal Entity Owner:
Property Owner: RRS Investments, LLP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care acquired the Quad Cities Aledo, Geneseo, Moline, Rock Island, Rock River – Dixon, and Silvis facilities as of May 1, 2016. Compiled 2016 financial information prior to May 1 was provided by Quad Cities and was combined with compiled 2016 financial information from Fresenius Medical Care to complete the survey. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Alla, M.D.
In-Center Treatments in calendar year: 9,445Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 65
Patients treated as of 12/31/2016: (Ending patients) 66
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 230.0
Oct 113
Oct 20
Oct 313.5
Oct 413
Oct 513.5
Oct 613
Oct 714
25 0 34 25 31 27 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 24Transient Patients: 2Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 8Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 19
Number of Missed Treatments: 347
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
28Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 58%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 93
60%61%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 2Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
79
84.9%
Medicaid
1
Private Insurance
11
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
93
1.1% 11.8% 0.0%2.2% 0.0% 100.0%
Patients
TOTAL 00
100
82
9840
1
02
131516
05
145
23
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
93
07
2720399346 47
93
$1,490,218 $13,315 $1,774,517 $0$105,768 $0 $3,383,818
44.0% 0.4% 52.4% 0.0%3.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2618
Fresenius Medical Care Skokie9801 Woods DriveSkokieCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Old Orchard Woods Management
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Christopher Najafi, M.D.
In-Center Treatments in calendar year: 8,611Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 58
Patients treated as of 12/31/2016: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
25 0 34 23 34 22 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 30Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 17
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
40Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 98
69%76%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 4.5Dialysis Technician : 6Dietician : 1Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
64
65.3%
Medicaid
3
Private Insurance
26
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
98
3.1% 26.5% 0.0%2.0% 3.1% 100.0%
Patients
TOTAL 310
130
54
7910
0
029
1125
04
139
25
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
98
06
2220509847 51
98
$2,363,471 $79,272 $2,016,051 $0$0 $87,642 $4,546,436
52.0% 1.7% 44.3% 0.0%0.0% 1.9% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2519
Fresenius Medical Care South Chicago9200 South Chicago AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Rockford 550, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kareen Simpson, M.D.
In-Center Treatments in calendar year: 29,956Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 169
Patients treated as of 12/31/2016: (Ending patients) 207
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
88 0 99 93 95 87 99
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 89Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 5Patients transferred out: 33Patients voluntarily discontinued: 3Patients lost to follow up: 1Patients deceased: 15
Number of Missed Treatments: 1,705
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
95Total:
USE RATE for the FACILITY33,696Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 89%Use Rate (including Missed Treatments): 94%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 264
78%96%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 36Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 19Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 4
Authorized Stations as of 12/31/2016: 36Certified Stations by CMS: 36Peak Authorized Stations Operated: 36
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
149
56.4%
Medicaid
4
Private Insurance
109
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
264
1.5% 41.3% 0.0%0.4% 0.4% 100.0%
Patients
TOTAL 00
2120
52
50214
0
0
021322398
04
122153
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
264
0254444
151264174 90
264
$3,397,518 $81,902 $3,953,046 $0$73,233 $131,792 $7,637,491
44.5% 1.1% 51.8% 0.0%1.0% 1.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2756
Fresenius Medical Care South Deering10559 S. Torrence Ave.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: Fresenius Medical Care South Deering, LLCLegal Entity Owner:
Property Owner: Torrence Complex, LP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Richard Hong, M.D.
In-Center Treatments in calendar year: 9,467Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 42
Patients treated as of 12/31/2016: (Ending patients) 78
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 113
Oct 20
Oct 318
Oct 413
Oct 518
Oct 613
Oct 718
38 0 44 38 44 38 44
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 132Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 67Patients voluntarily discontinued: 1Patients lost to follow up: 5Patients deceased: 12
Number of Missed Treatments: 485
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
87Total:
135Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 51%Use Rate (including Missed Treatments): 53%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 159
35%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 5.5Dialysis Technician : 10Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
114
71.7%
Medicaid
0
Private Insurance
43
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
159
0.0% 27.0% 0.0%1.3% 0.0% 100.0%
Patients
TOTAL 00
1370
22
18141
0
0
06
421819
04
291823
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
159
010713642
15985 74
159
$931,857 $24,254 $927,866 $0$32,614 $0 $1,916,591
48.6% 1.3% 48.4% 0.0%1.7% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2542
Fresenius Medical Care South Holland17225 South Paxton AvenueSouth HollandCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Physicians Capital investments, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ramesh Soundararajan, M.D.
In-Center Treatments in calendar year: 14,094Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 93
Patients treated as of 12/31/2016: (Ending patients) 101
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
44 0 49 45 51 46 49
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 36Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 29Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 305
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
46Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 64%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 136
65%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 19Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 10Dialysis Technician : 12.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
65
47.8%
Medicaid
0
Private Insurance
70
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
136
0.0% 51.5% 0.0%0.0% 0.7% 100.0%
Patients
TOTAL 30
12904
16120
0
0
03
46206
07
231912
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
136
010693918
13675 61
136
$1,881,941 $0 $4,729,395 $0$18,844 $55,621 $6,685,801
28.1% 0.0% 70.7% 0.0%0.3% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2572
Fresenius Medical Care South Shore2420 East 79th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: Realty Income Illinois Properties
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Clark McClurkin, M.D.
In-Center Treatments in calendar year: 6,018Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 67
Patients treated as of 12/31/2016: (Ending patients) 47
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 10
Oct 20
Oct 318
Oct 40
Oct 518
Oct 60
Oct 718
0 0 41 0 40 0 43
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 62Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 80Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 591
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
89Total:
67Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 40%Use Rate (including Missed Treatments): 44%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 95
70%49%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 8Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
57
60.0%
Medicaid
0
Private Insurance
36
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
95
0.0% 37.9% 0.0%2.1% 0.0% 100.0%
Patients
TOTAL 00
9302
2930
0
06
32159
05
1396
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
95
0114524159562 33
95
$1,616,118 $107,432 $1,714,480 $0$52,134 $46,795 $3,536,959
45.7% 3.0% 48.5% 0.0%1.5% 1.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2517
Fresenius Medical Care South Suburban2609 Lincoln HighwayOlympia FieldsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: SSKG, Inc.Legal Entity Owner:
Property Owner: GAHC3 Mount Olympia MOB
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lourdes Terrado, M.D.
In-Center Treatments in calendar year: 3Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 133
Patients treated as of 12/31/2016: (Ending patients) 131
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
58 0 66 55 64 54 68
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 22Transient Patients: 21Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 31Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 614
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
45Total:
USE RATE for the FACILITY25,272Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 0%Use Rate (including Missed Treatments): 2%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 178
82%81%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 27Isolation Stations Set up in Oct 1-7: 3
Full-Time Work Week: 32Registered Nurse : 8Dialysis Technician : 15Dietician : 1Social Worker: 2LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 27Certified Stations by CMS: 27Peak Authorized Stations Operated: 27
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
110
61.8%
Medicaid
1
Private Insurance
63
Charity Care
0
Private Pay
3
Other Public
1
TOTAL
178
0.6% 35.4% 0.0%1.7% 0.6% 100.0%
Patients
TOTAL 21
1540
20
12165
1
1
015412819
010242021
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
178
025654840
178103 75
178
$3,440,434 $123,544 $4,308,699 $0$31,640 $58,071 $7,962,388
43.2% 1.6% 54.1% 0.0%0.4% 0.7% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2508
Fresenius Medical Care Southside3134 W. 76TH STREETChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Elliot Bay Healthcare Realty
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ashutosh Gupta, M.D.
In-Center Treatments in calendar year: 27,248Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 194
Patients treated as of 12/31/2016: (Ending patients) 197
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 1,145.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
86 0 90 86 86 88 87
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 77Transient Patients: 15Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 7Patients transferred out: 54Patients voluntarily discontinued: 1Patients lost to follow up: 2Patients deceased: 25
Number of Missed Treatments: 300
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
89Total:
92Total:
USE RATE for the FACILITY36,504Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 75%Use Rate (including Missed Treatments): 75%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 286
83%84%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 39Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 18Dietician : 1.5Social Worker: 1.5LPN : 1Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 39Certified Stations by CMS: 39Peak Authorized Stations Operated: 39
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
175
61.2%
Medicaid
4
Private Insurance
96
Charity Care
0
Private Pay
8
Other Public
3
TOTAL
286
1.4% 33.6% 0.0%2.8% 1.0% 100.0%
Patients
TOTAL 00
2310
55
46240
0
0
023802521
019474427
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
286
042
1276948
286149 137
286
$4,147,957 $175,501 $4,967,085 $0$254,147 $111,690 $9,656,380
43.0% 1.8% 51.4% 0.0%2.6% 1.2% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2535
Fresenius Medical Care Southwestern Illinois7 Professional DriveAltonMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Bio-Medical Applications of Illinois, Inc.Legal Entity Owner:
Property Owner: Jim Cunning, Manager, Herman Trust
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Erik Daniels, M.D.
In-Center Treatments in calendar year: 11,631Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 73
Patients treated as of 12/31/2016: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
31 0 33 30 34 31 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 46Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 22Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 249
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
53Total:
USE RATE for the FACILITY17,784Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 65%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 126
64%74%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 19Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 1.5Dialysis Technician : 6.5Dietician : 0.75Social Worker: 0.75LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 19Certified Stations by CMS: 19Peak Authorized Stations Operated: 19
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
90
71.4%
Medicaid
1
Private Insurance
35
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
126
0.8% 27.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
280
98
2124
0
0
09
231821
07
141717
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
126
016373538
12671 55
126
$2,398,755 $105,523 $1,170,698 $0$0 $57,654 $3,732,630
64.3% 2.8% 31.4% 0.0%0.0% 1.5% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2565
Fresenius Medical Care Spoon River340 S. Avenue BCantonFulton2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Graham Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Anthony Horinek, M.D.
In-Center Treatments in calendar year: 5,807Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 41
Patients treated as of 12/31/2016: (Ending patients) 38
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 316
Oct 414
Oct 515
Oct 613
Oct 716
16 0 22 15 22 15 22
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 21Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 18Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 111
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
26Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 52%Use Rate (including Missed Treatments): 53%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 63
57%53%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 9Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
46
73.0%
Medicaid
6
Private Insurance
9
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
63
9.5% 14.3% 0.0%0.0% 3.2% 100.0%
Patients
TOTAL 0010
61
0630
1
037
1014
0357
14
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
63
06
1217286334 29
63
$1,414,749 $40,173 $399,667 $0$0 $0 $1,854,589
76.3% 2.2% 21.6% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2564
Fresenius Medical Care Spring Valley12 Wolfer Industrial ParkSpring ValleyBureau2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc.Legal Entity Owner:
Property Owner: Richwoods Enterprises, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Usman Khan, M.D.
In-Center Treatments in calendar year: 10,012Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 70
Patients treated as of 12/31/2016: (Ending patients) 69
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 114.5
Oct 20
Oct 318
Oct 417
Oct 518
Oct 616.5
Oct 718
28 0 36 30 36 31 36
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 23Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 16Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 14
Number of Missed Treatments: 371
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
32Total:
USE RATE for the FACILITY15,912Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 65%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 100
69%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 17Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 17Certified Stations by CMS: 17Peak Authorized Stations Operated: 17
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
80
80.0%
Medicaid
6
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
100
6.0% 8.0% 0.0%0.0% 6.0% 100.0%
Patients
TOTAL 0030
97
15850
0
06
191316
03
148
21
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
100
09
332137
10054 46
100
$2,314,139 $24,149 $743,445 $0$0 $109,672 $3,191,405
72.5% 0.8% 23.3% 0.0%0.0% 3.4% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2725
Fresenius Medical Care Steger219 East 34th StreetStegerCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: Manco Construction
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Daniel Yohay, M.D.
In-Center Treatments in calendar year: 9,839Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 70
Patients treated as of 12/31/2016: (Ending patients) 70
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
33 0 28 33 31 30 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 20Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 496
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
39Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 96
65%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
69
71.9%
Medicaid
1
Private Insurance
18
Charity Care
0
Private Pay
3
Other Public
5
TOTAL
96
1.0% 18.8% 0.0%3.1% 5.2% 100.0%
Patients
TOTAL 10
580
37
4920
0
04
22198
05
18137
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
96
09
4032159653 43
96
$1,834,284 $54,199 $1,160,372 $0$9,127 $93,762 $3,151,744
58.2% 1.7% 36.8% 0.0%0.3% 3.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2802
Fresenius Medical Care Summit7320 West Archer AvenueSummitCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Summit, LLCLegal Entity Owner:
Property Owner: Net3 (Summit), LLC (N)
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
The facility was not operating in 2015 so there are no revenues to report. Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Andersen, M.D.
In-Center Treatments in calendar year: 249Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 12
Patients treated as of 12/31/2016: (Ending patients) 12
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 10
Oct 20
Oct 38
Oct 40
Oct 58
Oct 60
Oct 78
0 0 2 0 2 0 2
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 2Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 0Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
0Total:
12Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 2%Use Rate (including Missed Treatments): 2%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 12
17%17%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
7
58.3%
Medicaid
0
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
12
0.0% 41.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0010
11
1110
0
00612
00111
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
12
00723
129 3
12
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20151/1/2015 to
14-2789
Fresenius Medical Care Waterloo624 Voris-Jost DriveWaterlooMonroe11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care of Illinois, LLCLegal Entity Owner:
Property Owner: GAHC3 Southern Illinois MOB Portfolio LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Koch, M.D.
In-Center Treatments in calendar year: 1,652Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 8
Patients treated as of 12/31/2016: (Ending patients) 12
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 10
Oct 20
Oct 310
Oct 40
Oct 510
Oct 60
Oct 710
0 0 11 0 11 0 10
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 13Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 8Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 2
Number of Missed Treatments: 11
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
14Total:
17Total:
USE RATE for the FACILITY5,616Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 29%Use Rate (including Missed Treatments): 30%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 25
22%33%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 6Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2016: 6Certified Stations by CMS: 6Peak Authorized Stations Operated: 6
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
11
44.0%
Medicaid
0
Private Insurance
14
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
25
0.0% 56.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 1130
20
0250
0
00266
03143
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
25
033
109
2514 11
25
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20151/1/2015 to
14-2727
Fresenius Medical Care Waukegan Harbor110 North West StreetWaukeganLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Lake County, LLCLegal Entity Owner:
Property Owner: AR Capital, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rakhi Khanna, M.D.
In-Center Treatments in calendar year: 16,985Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 113
Patients treated as of 12/31/2016: (Ending patients) 114
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 117
Oct 20
Oct 318
Oct 417
Oct 518
Oct 617
Oct 718
52 0 58 54 56 52 54
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 34Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 29Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 343
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
48Total:
USE RATE for the FACILITY19,656Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 86%Use Rate (including Missed Treatments): 88%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 157
90%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 21Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 21Certified Stations by CMS: 21Peak Authorized Stations Operated: 21
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
88
56.1%
Medicaid
4
Private Insurance
61
Charity Care
0
Private Pay
1
Other Public
3
TOTAL
157
2.5% 38.9% 0.0%0.6% 1.9% 100.0%
Patients
TOTAL 20
730
82
55102
0
0
016451714
07
281614
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
157
023733328
15792 65
157
$1,984,903 $107,220 $4,349,249 $0$53,276 $243,274 $6,737,922
29.5% 1.6% 64.5% 0.0%0.8% 3.6% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2729
Fresenius Medical Care West Batavia2580 W. Fabyan ParkwayBataviaKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Batavia, LLCLegal Entity Owner:
Property Owner: MedProperties Group
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Navinchandra Dodhia, M.D.
In-Center Treatments in calendar year: 6,006Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 38
Patients treated as of 12/31/2016: (Ending patients) 47
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 113
Oct 20
Oct 313
Oct 413
Oct 513
Oct 613
Oct 713
19 0 21 19 20 17 23
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 37Transient Patients: 1Patients Re-Started: 3Post-Transplant Patien 2
Recovered patients: 2Transplant Recipients: 36Patients transferred out: 3Patients voluntarily discontinued: 0Patients lost to follow up: 10Patients deceased: 0
Number of Missed Treatments: 104
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
51Total:
43Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 53%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 91
53%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
41
45.1%
Medicaid
4
Private Insurance
39
Charity Care
0
Private Pay
5
Other Public
2
TOTAL
91
4.4% 42.9% 0.0%5.5% 2.2% 100.0%
Patients
TOTAL 20
150
74
28630
0
06
181312
05
146
17
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
91
0113219299149 42
91
$516,145 $11,547 $1,948,742 $0$0 $107,186 $2,583,620
20.0% 0.4% 75.4% 0.0%0.0% 4.1% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2523
Fresenius Medical Care West Belmont4943 West BelmontChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care Chicagoland, LLCLegal Entity Owner:
Property Owner: 4935 W Belmont, Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Neetha Dhananjaya, M.D.
In-Center Treatments in calendar year: 12,093Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 79
Patients treated as of 12/31/2016: (Ending patients) 83
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
37 0 45 39 47 36 43
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 35Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 30Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 5
Number of Missed Treatments: 284
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
42Total:
USE RATE for the FACILITY15,912Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 76%Use Rate (including Missed Treatments): 78%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 121
77%81%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 17Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 17Certified Stations by CMS: 17Peak Authorized Stations Operated: 17
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
49
40.5%
Medicaid
6
Private Insurance
63
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
121
5.0% 52.1% 0.0%2.5% 0.0% 100.0%
Patients
TOTAL 4090
108
89320
0
015261615
07
181410
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
121
022443025
12172 49
121
$1,423,709 $144,475 $3,323,426 $0$48,348 $0 $4,939,958
28.8% 2.9% 67.3% 0.0%1.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2536
Fresenius Medical Care West Metro1044 North MozartChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Norweigan American Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Remegio Vilbar, M.D.
In-Center Treatments in calendar year: 24,750Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 173
Patients treated as of 12/31/2016: (Ending patients) 167
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 370.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
74 0 84 77 83 75 85
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 26Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 21Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 19
Number of Missed Treatments: 1,112
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
40Total:
USE RATE for the FACILITY29,952Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 83%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 213
90%87%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 32Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 11.5Dialysis Technician : 18Dietician : 2Social Worker: 2LPN : 2Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 32Certified Stations by CMS: 32Peak Authorized Stations Operated: 32
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
129
60.6%
Medicaid
3
Private Insurance
80
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
213
1.4% 37.6% 0.0%0.5% 0.0% 100.0%
Patients
TOTAL 50
580
150
149622
0
017792117
07
252324
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
213
024
1044441
213134 79
213
$4,514,425 $284,988 $7,703,696 $0$9,624 $65,295 $12,578,028
35.9% 2.3% 61.2% 0.0%0.1% 0.5% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2530
Fresenius Medical Care West Suburban518 N. Austin Blvd., 5th FloorOak ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: West Suburban Hospital Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Arthur Morris, M.D.
In-Center Treatments in calendar year:
Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 247
Patients treated as of 12/31/2016: (Ending patients) 241
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
103 0 119 108 122 99 125
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 62Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 9Patients transferred out: 85Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 1,429
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
112Total:
105Total:
USE RATE for the FACILITY43,056Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity):Use Rate (including Missed Treatments):Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 343
89%87%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 46Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 12Dialysis Technician : 27Dietician : 2Social Worker: 2LPN : 1Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 46Certified Stations by CMS: 46Peak Authorized Stations Operated: 46
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
200
58.3%
Medicaid
4
Private Insurance
129
Charity Care
0
Private Pay
4
Other Public
6
TOTAL
343
1.2% 37.6% 0.0%1.2% 1.7% 100.0%
Patients
TOTAL 20
2980
43
11332
0
0
032773933
015564645
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
343
047
1338578
343181 162
343
$5,072,820 $134,208 $6,201,190 $0$49,827 $248,322 $11,706,367
43.3% 1.1% 53.0% 0.0%0.4% 2.1% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2730
Fresenius Medical Care West Willow1444 West WillowChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care West Willow, LLCLegal Entity Owner:
Property Owner: Elston Industrial Loft LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Salem, M.D.
In-Center Treatments in calendar year: 5,196Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 37
Patients treated as of 12/31/2016: (Ending patients) 36
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
16 0 21 16 16 17 17
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 18Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 21Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 2
Number of Missed Treatments: 250
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
26Total:
25Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 46%Use Rate (including Missed Treatments): 48%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 62
51%50%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
37
59.7%
Medicaid
0
Private Insurance
25
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
62
0.0% 40.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 30
310
28
10520
0
07
1689
01777
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
62
08
2315166240 22
62
$862,880 $20,573 $927,577 $0$0 $0 $1,811,030
47.6% 1.1% 51.2% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2520
Fresenius Medical Care Westchester2400 Wolf Road, Ste 101AWestchesterCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership: Limited Company
Ownership Type: Other For Profit (specify
Legal Entity Operator: DuPage Dialysis, LTDLegal Entity Owner:
Property Owner: TANDEM REAL ESTATE, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Leonard Potempa, M.D.
In-Center Treatments in calendar year: 12,727Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 89
Patients treated as of 12/31/2016: (Ending patients) 78
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 114
Oct 20
Oct 318
Oct 414
Oct 518
Oct 614
Oct 718
28 0 45 27 45 25 46
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 41Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 47Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 18
Number of Missed Treatments: 285
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
70Total:
57Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 70%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 137
74%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 22Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 22Peak Authorized Stations Operated: 22
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
87
63.5%
Medicaid
2
Private Insurance
38
Charity Care
0
Private Pay
5
Other Public
5
TOTAL
137
1.5% 27.7% 0.0%3.6% 3.6% 100.0%
Patients
TOTAL 50
450
87
8129
0
0
07
351822
03
211318
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
137
010563140
13782 55
137
$2,072,950 $26,142 $2,841,621 $0$62,087 $64,746 $5,067,546
40.9% 0.5% 56.1% 0.0%1.2% 1.3% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2627
Fresenius Medical Care Williamson County900 Skyline Drive, Ste 200MarionWilliamson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Bio-Medical Applications of Illinois, Inc.Legal Entity Owner:
Property Owner: Zeller Properties
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Kamran, M.D.
In-Center Treatments in calendar year: 6,791Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 53
Patients treated as of 12/31/2016: (Ending patients) 49
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 110
Oct 20
Oct 310
Oct 410
Oct 510
Oct 610
Oct 710
19 0 26 15 22 16 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 29Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 20Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 19
Number of Missed Treatments: 313
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
39Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 52%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 83
63%58%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
64
77.1%
Medicaid
4
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
7
TOTAL
83
4.8% 9.6% 0.0%0.0% 8.4% 100.0%
Patients
TOTAL 3170
72
1820
0
06
131212
039
199
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
83
09
2231218343 40
83
$1,806,383 $28,315 $869,072 $0$18,361 $109,762 $2,831,893
63.8% 1.0% 30.7% 0.0%0.6% 3.9% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2632
Fresenius Medical Care Willowbrook6300 Kingery Highway, Ste 408WillowbrookDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: WSKC Dialysis Services, Inc.Legal Entity Owner:
Property Owner: Regency Centers LP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Fresenius Medical Care does not hold long term debt on any Illinois dialysis location balance sheet. Fresenius Medical Care does not, as a for profit corporation, provide charity care under the Board's definition of same; however, it treats all patients regardless of ability to pay and thus does provide uncompensated care. Many of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburses at rates more similar to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance.
Provides Incenter Noctural Dialysis:
Medical Director Name: May Chow, M.D.
In-Center Treatments in calendar year: 11,673Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 82
Patients treated as of 12/31/2016: (Ending patients) 73
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 117
Oct 20
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
34 0 45 24 46 30 45
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 26Transient Patients: 41Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 3Transplant Recipients: 7Patients transferred out: 55Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 277
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
81Total:
70Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 62%Use Rate (including Missed Treatments): 64%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 142
68%61%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 9Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
98
69.0%
Medicaid
0
Private Insurance
42
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
142
0.0% 29.6% 0.0%1.4% 0.0% 100.0%
Patients
TOTAL 150
290
98
12130
0
0
07
251622
02
251827
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
142
09
503449
14270 72
142
$2,238,257 $51,192 $1,799,262 $0$89,083 $0 $4,177,794
53.6% 1.2% 43.1% 0.0%2.1% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2777
Garfield Kidney Center3250 West FranklinChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Total Renal Care Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ogbonnaya Aneziokoro
In-Center Treatments in calendar year: 14,382Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 100
Patients treated as of 12/31/2016: (Ending patients) 103
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 115
Oct 20
Oct 318
Oct 415
Oct 518
Oct 615
Oct 718
46 0 48 43 51 41 49
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 38Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 36Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 9
Number of Missed Treatments: 900
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
53Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 96%Use Rate (including Missed Treatments): 102%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 152
104%107%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
96
64.4%
Medicaid
34
Private Insurance
16
Charity Care
3
Private Pay
0
Other Public
3
TOTAL
149
22.8% 10.7% 2.0%0.0% 2.0% 100.0%
Patients
TOTAL 21
1040
44
42110
0
1
01956156
06
27149
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
152
025832915
15296 56
152
$2,327,622 $111,641 $1,750,300 $24,780$24,780 $774,515 $4,988,858
46.7% 2.2% 35.1% 0.5%0.5% 15.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2728
Grand Crossing Dialysis7319 South Cottage Grove AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, IncLegal Entity Owner:
Property Owner: Mao Mei
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammed Salem, MD
In-Center Treatments in calendar year: 8,867Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 67
Patients treated as of 12/31/2016: (Ending patients) 75
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 114
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
29 0 26 29 24 27 26
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 46Transient Patients: 20Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 23Patients voluntarily discontinued: 0Patients lost to follow up: 16Patients deceased: 7
Number of Missed Treatments: 1,225
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
48Total:
67Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 79%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 103
93%104%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 1Dialysis Technician : 5Dietician : 0Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
70
68.6%
Medicaid
18
Private Insurance
10
Charity Care
1
Private Pay
1
Other Public
3
TOTAL
102
17.6% 9.8% 1.0%1.0% 2.9% 100.0%
Patients
TOTAL 00
10300
0103
0
0
012351410
08
1095
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
103
020452315
10371 32
103
$1,385,666 $71,365 $1,010,227 $780$780 $670,511 $3,138,548
44.1% 2.3% 32.2% 0.0%0.0% 21.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2537
Granite City Dialysis9 American VillageGranite CityMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers-Illinois, INCLegal Entity Owner:
Property Owner: Daniel's Realty Group, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kenneth Gerdes
In-Center Treatments in calendar year: 13,121Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 90
Patients treated as of 12/31/2016: (Ending patients) 100
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 206.0
Oct 111
Oct 20
Oct 314
Oct 411
Oct 514
Oct 611
Oct 714
32 0 51 33 51 35 48
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 41Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 24Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 1,217
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
49Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 70%Use Rate (including Missed Treatments): 77%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 133
75%83%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 20Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 30Registered Nurse : 5Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 20
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
89
66.9%
Medicaid
26
Private Insurance
13
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
133
19.5% 9.8% 0.0%0.0% 3.8% 100.0%
Patients
TOTAL 20
480
83
6127
0
0
08
331613
06
222411
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
133
014554024
13370 63
133
$2,196,495 $65,088 $910,787 $0$0 $1,012,944 $4,185,315
52.5% 1.6% 21.8% 0.0%0.0% 24.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2633
Illini Renal Dialysis507 E. University AvenueChampaignChampaign4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare, IncLegal Entity Owner:
Property Owner: Barr Real Estate
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Abdel-Moneim M. Attia
In-Center Treatments in calendar year: 7,783Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 51
Patients treated as of 12/31/2016: (Ending patients) 66
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 112
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
26 0 25 24 27 25 27
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 36Transient Patients: 28Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 32Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 3
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
45Total:
68Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 112
71%92%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
89
80.2%
Medicaid
8
Private Insurance
7
Charity Care
1
Private Pay
3
Other Public
4
TOTAL
111
7.2% 6.3% 0.9%2.7% 3.6% 100.0%
Patients
TOTAL 30
470
51
9101
2
11
09
24218
08
191211
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
112
017433319
11262 50
112
$1,704,775 $47,864 $885,411 $3,540$3,540 $695,772 $3,337,362
51.1% 1.4% 26.5% 0.1%0.1% 20.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2581
Jacksonville Dialysis1515 West WalnutJacksonvilleMorgan3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare IncLegal Entity Owner:
Property Owner: DVA Renal Healthcare Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lawrence Smith, MD
In-Center Treatments in calendar year: 7,056Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 49
Patients treated as of 12/31/2016: (Ending patients) 50
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
23 0 24 26 22 23 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 22Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 11Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 504
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
28Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 54%Use Rate (including Missed Treatments): 58%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 76
58%60%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
67
88.2%
Medicaid
2
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
76
2.6% 7.9% 0.0%0.0% 1.3% 100.0%
Patients
TOTAL 0070
69
0760
0
0489
19
01
14129
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
76
05
2221287640 36
76
$1,418,438 $30,856 $189,933 $0$0 $270,785 $1,910,011
74.3% 1.6% 9.9% 0.0%0.0% 14.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2636
JCH Dialysis Center917 S. State StreetJerseyvilleJersey3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Raul Walters Properties, Inc.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Meher S. Mallick, MD
In-Center Treatments in calendar year: 6,148Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 42
Patients treated as of 12/31/2016: (Ending patients) 47
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 111
Oct 20
Oct 314
Oct 411
Oct 514
Oct 613.5
Oct 714
18 0 18 21 17 20 20
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 23Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 350
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
14Total:
25Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 82%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 62
88%98%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 7Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 4Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
50
80.6%
Medicaid
4
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
62
6.5% 4.8% 0.0%0.0% 8.1% 100.0%
Patients
TOTAL 0000
62
0620
0
01
13117
01
10109
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
62
02
2321166232 30
62
$1,232,453 $58,059 $110,087 $0$0 $319,357 $1,719,955
71.7% 3.4% 6.4% 0.0%0.0% 18.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2313
John H. Stroger Hospital of Cook County1969 W. Ogden AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: County
Legal Entity Operator: JOHN H STROGER HOSPITAL OF COOK COUNTLegal Entity Owner:
Property Owner: Cook County
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Comment on page 12- NET REVENUES DURING FISCAL YEAR- Section C- Managed Care Revenue amount was entered in ' Other Public ' category as it did not fit into other Revenue Categories
Provides Incenter Noctural Dialysis:
Medical Director Name: KALYANI PERUMAL
In-Center Treatments in calendar year: 3,095Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 29
Patients treated as of 12/31/2016: (Ending patients) 18
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 117
Oct 217
Oct 317
Oct 417
Oct 517
Oct 617
Oct 717
6 0 9 7 8 5 8
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 17Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 27Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 114
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
18Total:
USE RATE for the FACILITY8,424Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 37%Use Rate (including Missed Treatments): 38%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 47
54%33%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 8Dialysis Technician : 0Dietician : 1Social Worker: 1LPN : 2Other Health : 2Other Non-Health: 0
Authorized Stations as of 12/31/2016: 9Certified Stations by CMS: 9Peak Authorized Stations Operated: 9
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
11
25.0%
Medicaid
28
Private Insurance
2
Charity Care
3
Private Pay
3
Other Public
0
TOTAL
44
63.6% 4.5% 6.8%6.8% 0.0% 100.0%
Patients
TOTAL 01
240
17
22250
5
0131700
06
1001
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
47
01927
01
4730 17
47
$196,300,000 $375,700,000 $47,500,000 $265,700,000$5,700,000 $0 $625,200,000
31.4% 60.1% 7.6% 42.5%0.9% 0.0% 100.0%Net Revenue
11/30/201512/1/2014 to
14-2685
Kankakee County Dialysis581 William Latham DriveBourbonnaisKankakee9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers - Illinois, Inc.Legal Entity Owner:
Property Owner: Faz Properties LLC.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Nashib Hashmi
In-Center Treatments in calendar year: 7,986Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 48
Patients treated as of 12/31/2016: (Ending patients) 52
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 514
Oct 612
Oct 716
25 0 34 25 28 23 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 16Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 0Patients transferred out: 17Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 3
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
30Total:
45Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 71%Use Rate (including Missed Treatments): 71%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 92
67%72%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
61
67.0%
Medicaid
3
Private Insurance
17
Charity Care
1
Private Pay
1
Other Public
9
TOTAL
91
3.3% 18.7% 1.1%1.1% 9.9% 100.0%
Patients
TOTAL 00
280
64
9830
0
04
26137
04
111314
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
92
08
3726219250 42
92
$1,189,047 $41,925 $308,194 $46,610$46,610 $733,951 $2,319,727
51.3% 1.8% 13.3% 2.0%2.0% 31.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2717
Kenwood Dialysis43rd & South Cottage GroveChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, IncLegal Entity Owner:
Property Owner: Glazier, King, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Bharathi Reddy
In-Center Treatments in calendar year: 17,316Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 135
Patients treated as of 12/31/2016: (Ending patients) 125
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 320
Oct 412
Oct 520
Oct 612
Oct 720
43 0 66 44 63 44 66
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 48Transient Patients: 18Patients Re-Started: 4Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 8Patients transferred out: 24Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 1,758
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
70Total:
USE RATE for the FACILITY29,952Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 64%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 190
70%65%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 32Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 15Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 32Certified Stations by CMS: 32Peak Authorized Stations Operated: 32
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
148
78.7%
Medicaid
26
Private Insurance
10
Charity Care
2
Private Pay
2
Other Public
2
TOTAL
188
13.8% 5.3% 1.1%1.1% 1.1% 100.0%
Patients
TOTAL 00
18801
1189
0
1
014402713
011372919
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
190
025775632
19094 96
190
$3,275,006 $47,763 $1,251,642 $60,770$60,770 $1,169,273 $5,804,454
56.4% 0.8% 21.6% 1.0%1.0% 20.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2666
Lake Villa Dialysis37809 North IL Route 59Lake VillaLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: RENAL TREATMENT CENTERS-ILLINOIS, INC.Legal Entity Owner:
Property Owner: OMAR DALLOUL
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: OMAR DALLOUL
In-Center Treatments in calendar year: 6,829Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 49
Patients treated as of 12/31/2016: (Ending patients) 53
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 219.0
Oct 19
Oct 20
Oct 314
Oct 49
Oct 514
Oct 69
Oct 714
15 0 32 16 30 16 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 25Transient Patients: 30Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 48Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 150
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
51Total:
57Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 62%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 76
68%74%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 1.75Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
57
78.1%
Medicaid
3
Private Insurance
9
Charity Care
3
Private Pay
1
Other Public
3
TOTAL
73
4.1% 12.3% 4.1%1.4% 4.1% 100.0%
Patients
TOTAL 2060
46
22540
22
18
16177
12
1095
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
76
2102626127649 27
76
$1,009,256 $34,187 $978,919 $24,190$24,190 $473,937 $2,520,489
40.0% 1.4% 38.8% 1.0%1.0% 18.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2768
Lawndale Dialysis3934 W. 24th StChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Cowell Dialysis LLCLegal Entity Owner:
Property Owner: SDO Development LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ogbonnaya Aneziokoro
In-Center Treatments in calendar year: 12,714Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 70
Patients treated as of 12/31/2016: (Ending patients) 98
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 114
Oct 20
Oct 316
Oct 414
Oct 516
Oct 614
Oct 716
37 0 46 41 47 39 46
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 56Transient Patients: 17Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 41Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 789
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
52Total:
74Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 85%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 144
73%102%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 15Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
75
52.1%
Medicaid
46
Private Insurance
12
Charity Care
10
Private Pay
10
Other Public
1
TOTAL
144
31.9% 8.3% 6.9%6.9% 0.7% 100.0%
Patients
TOTAL 41
5006
73629
83
014431311
01424187
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
144
028673118
14481 63
144
$1,325,887 $308,873 $1,700,848 $199,125$199,125 $1,016,227 $4,550,960
29.1% 6.8% 37.4% 4.4%4.4% 22.3% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2582
Lincoln Dialysis2100 West 5th StreetLincolnLogan3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare,INCLegal Entity Owner:
Property Owner: Sheley Corporation LLP
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Allen Krall
In-Center Treatments in calendar year: 5,080Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 31
Patients treated as of 12/31/2016: (Ending patients) 32
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 211.0
Oct 16.5
Oct 20
Oct 311.5
Oct 46.5
Oct 511.5
Oct 66.5
Oct 711.5
12 0 28 11 25 9 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 18Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 3Patients voluntarily discontinued: 3Patients lost to follow up: 2Patients deceased: 11
Number of Missed Treatments: 170
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
20Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 39%Use Rate (including Missed Treatments): 40%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 45
37%38%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 3Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
29
59.2%
Medicaid
14
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
49
28.6% 8.2% 0.0%0.0% 4.1% 100.0%
Patients
TOTAL 0110
42
0441
1
01
1158
01829
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
45
02
197
174525 20
45
$1,057,170 $13,457 $513,773 $0$0 $293,464 $1,877,865
56.3% 0.7% 27.4% 0.0%0.0% 15.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2329
Loyola Center for Dialysis on Roosevelt1201 West Roosevelt RoadMaywoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Not for Profit Corp
Legal Entity Operator: Loyola University Medical CenterLegal Entity Owner:
Property Owner: Loyola University Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Vinod Bansal, MD
In-Center Treatments in calendar year: 29,910Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 167
Patients treated as of 12/31/2016: (Ending patients) 174
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
58 0 76 62 71 61 69
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 66Transient Patients: 0Patients Re-Started: 2Post-Transplant Patien 5
Recovered patients: 1Transplant Recipients: 17Patients transferred out: 28Patients voluntarily discontinued: 1Patients lost to follow up: 3Patients deceased: 17
Number of Missed Treatments: 837
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
67Total:
73Total:
USE RATE for the FACILITY29,016Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 103%Use Rate (including Missed Treatments): 106%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 188
90%94%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 30Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 10Dialysis Technician : 16.5Dietician : 2Social Worker: 2LPN : 0Other Health : 1Other Non-Health: 3
Authorized Stations as of 12/31/2016: 31Certified Stations by CMS: 31Peak Authorized Stations Operated: 30
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
123
65.4%
Medicaid
15
Private Insurance
43
Charity Care
0
Private Pay
6
Other Public
1
TOTAL
188
8.0% 22.9% 0.0%3.2% 0.5% 100.0%
Patients
TOTAL 60
1020
80
44144
0
0
12440269
012292720
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
188
136695329
188100 88
188
$353,428,945 $189,037,253 $542,720,193 $0$13,774,927 $2,105,359 $1,101,066,677
32.1% 17.2% 49.3% 0.0%1.3% 0.2% 100.0%Net Revenue
6/30/20167/1/2015 to
14-2806
Machesney Park Dialysis7170 North Perryville RoadMachesney ParkWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal CareLegal Entity Owner:
Property Owner: First Rockford Group
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Michael Robertson
In-Center Treatments in calendar year: 676Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 0
Patients treated as of 12/31/2016: (Ending patients) 31
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 221.0
Oct 10
Oct 20
Oct 36
Oct 40
Oct 56
Oct 60
Oct 76
0 0 2 0 2 0 2
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 31Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 0Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 19
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
1Total:
36Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 6%Use Rate (including Missed Treatments): 6%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 36
0%43%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 3Registered Nurse : 1Dialysis Technician : 1Dietician : 0Social Worker: 0LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
31
88.6%
Medicaid
0
Private Insurance
3
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
35
0.0% 8.6% 2.9%0.0% 2.9% 100.0%
Patients
TOTAL 0041
28
3330
3
03963
00474
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
36
03
1313
73621 15
36
$139,340 $0 $61,079 $1,475$1,475 $31,397 $233,291
59.7% 0.0% 26.2% 0.6%0.6% 13.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2671
Manteno Dialysis Centre1 East DivisionMantenoKankakee9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: Kankakee Valley Dialysis Network dba Manteno DiaLegal Entity Owner:
Property Owner: Jerry Curwick
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Paritosh Tiwari, MD
In-Center Treatments in calendar year: 6,234Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 49
Patients treated as of 12/31/2016: (Ending patients) 42
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 215.0
Oct 19.5
Oct 20
Oct 312.5
Oct 49.5
Oct 512.5
Oct 69.5
Oct 712.5
12 0 25 11 24 11 26
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 16Transient Patients: 2Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 9Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 160
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
25Total:
19Total:
USE RATE for the FACILITY14,040Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 44%Use Rate (including Missed Treatments): 46%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 63
54%47%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 15Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 0Registered Nurse : 3.8Dialysis Technician : 2.7Dietician : 0.4Social Worker: 0.8LPN : 1.8Other Health : 0Other Non-Health: 0.6
Authorized Stations as of 12/31/2016: 15Certified Stations by CMS: 15Peak Authorized Stations Operated: 15
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
54
85.7%
Medicaid
3
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
63
4.8% 9.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
110
52
2610
0
01
166
15
004
1011
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
63
01
2016266338 25
63
$1,372,485 $65,326 $557,243 $0$0 $0 $1,995,053
68.8% 3.3% 27.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2570
Marion Dialysis324 South 4th StreetMarionWilliamson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life Link, Inc.Legal Entity Owner:
Property Owner: Steven Zelman
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kevin Chen
In-Center Treatments in calendar year: 6,369Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 49
Patients treated as of 12/31/2016: (Ending patients) 45
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 338.0
Oct 110
Oct 20
Oct 321
Oct 410
Oct 521
Oct 610
Oct 721
13 0 25 12 21 9 21
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 20Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 9Patients voluntarily discontinued: 9Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 691
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
30Total:
30Total:
USE RATE for the FACILITY12,168Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 52%Use Rate (including Missed Treatments): 58%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 84
63%58%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 13Isolation Stations Set up in Oct 1-7: 13
Full-Time Work Week: 38Registered Nurse : 5Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 13Certified Stations by CMS: 13Peak Authorized Stations Operated: 13
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
61
70.9%
Medicaid
5
Private Insurance
6
Charity Care
2
Private Pay
2
Other Public
12
TOTAL
86
5.8% 7.0% 2.3%2.3% 14.0% 100.0%
Patients
TOTAL 0070
77
0840
0
03
151515
04
12137
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
84
07
2728228448 36
84
$1,248,812 $54,817 $620,232 $12,095$12,095 $699,629 $2,635,585
47.4% 2.1% 23.5% 0.5%0.5% 26.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2634
Maryville Dialysis- Renal Treatment Ctrs2102 Vadalabene Dr, Suite #1MaryvilleMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers-Illinois, IncLegal Entity Owner:
Property Owner: Maryville Medical Park Fund, Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Henry Purcell
In-Center Treatments in calendar year: 9,533Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 63
Patients treated as of 12/31/2016: (Ending patients) 72
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 114
Oct 20
Oct 315
Oct 414
Oct 515
Oct 614
Oct 715
29 0 37 30 31 31 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 43Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 5Transplant Recipients: 1Patients transferred out: 19Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 375
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
52Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 73%Use Rate (including Missed Treatments): 76%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 102
75%86%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 5Dialysis Technician : 8Dietician : 0.75Social Worker: 0.75LPN : 0Other Health : 3Other Non-Health: 0
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
88
86.3%
Medicaid
4
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
102
3.9% 7.8% 0.0%0.0% 2.0% 100.0%
Patients
TOTAL 00
190
83
1101
0
0
08
181316
03
161315
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
102
011342631
10255 47
102
$1,900,280 $4,952 $578,847 $0$0 $412,182 $2,896,261
65.6% 0.2% 20.0% 0.0%0.0% 14.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2585
Mattoon Dialysis6051 Development DriveCharlestonColes4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare, Inc.Legal Entity Owner:
Property Owner: J&P Associates
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Chen
In-Center Treatments in calendar year: 8,886Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 53
Patients treated as of 12/31/2016: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 217.0
Oct 111
Oct 20
Oct 313
Oct 411
Oct 513
Oct 611
Oct 713
30 0 35 29 29 30 33
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 32Transient Patients: 4Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 1Patients transferred out: 11Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 400
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
26Total:
39Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 59%Use Rate (including Missed Treatments): 62%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 103
55%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 1Other Non-Health: 1.5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
86
80.4%
Medicaid
7
Private Insurance
10
Charity Care
2
Private Pay
2
Other Public
2
TOTAL
107
6.5% 9.3% 1.9%1.9% 1.9% 100.0%
Patients
TOTAL 1020
99
3991
1
04
1893
04
30278
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
103
08
483611
10334 69
103
$2,060,597 $72,431 $1,752,772 $3,835$3,835 $408,164 $4,297,799
47.9% 1.7% 40.8% 0.1%0.1% 9.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2315
Memorial Medical Center701 North First StreetSpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Not for Profit Corp
Legal Entity Operator: Memorial Medical CenterLegal Entity Owner:
Property Owner: Memorial Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lawrence J. Smith, MD
In-Center Treatments in calendar year: 15Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 0
Patients treated as of 12/31/2016: (Ending patients) 0
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 114
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
0 0 1 0 1 0 1
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 1Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 1Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
1Total:
1Total:
USE RATE for the FACILITY5,616Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 0%Use Rate (including Missed Treatments): 0%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 1
0%0%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 1Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 36Registered Nurse : 11.9Dialysis Technician : 0Dietician : 1Social Worker: 1LPN : 0.9Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 6Certified Stations by CMS: 6Peak Authorized Stations Operated: 1
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
0
0.0%
Medicaid
1
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
1
100.0% 0.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00001
010
0
00010
00000
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
1
0001011 0
1
$0 $8,390 $0 $0$0 $0 $8,390
0.0% 100.0% 0.0% 0.0%0.0% 0.0% 100.0%Net Revenue
9/30/201610/1/2015 to
14-2527
Metro East Dialysis5105 West Main StreetBellevilleSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life Linc, Inc.Legal Entity Owner:
Property Owner: Columbia Pacific Advisors
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rashid Dalal
In-Center Treatments in calendar year: 24,882Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 184
Patients treated as of 12/31/2016: (Ending patients) 173
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 222.0
Oct 112
Oct 26
Oct 317
Oct 418
Oct 517
Oct 618
Oct 717
61 14 71 56 67 60 68
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 56Transient Patients: 74Patients Re-Started: 3Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 97Patients voluntarily discontinued: 10Patients lost to follow up: 0Patients deceased: 20
Number of Missed Treatments: 2,823
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
130Total:
134Total:
USE RATE for the FACILITY33,696Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 74%Use Rate (including Missed Treatments): 82%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 309
85%80%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 36Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 12Dialysis Technician : 22Dietician : 1Social Worker: 2LPN : 0Other Health : 1Other Non-Health: 3
Authorized Stations as of 12/31/2016: 36Certified Stations by CMS: 36Peak Authorized Stations Operated: 36
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
240
78.2%
Medicaid
29
Private Insurance
27
Charity Care
2
Private Pay
0
Other Public
11
TOTAL
307
9.4% 8.8% 0.7%0.0% 3.6% 100.0%
Patients
TOTAL 00
2460
63
0309
0
0
026683225
022644230
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
309
048
1327455
309151 158
309
$4,504,277 $15,482 $3,152,887 $6,785$0 $2,045,559 $9,718,206
46.3% 0.2% 32.4% 0.1%0.0% 21.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2302
Mt. Sinai Hospital Med Ctr1500 S. California AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Not for Profit Corp
Legal Entity Operator: Mt. Sinai Hospital and Medical CenterLegal Entity Owner:
Property Owner: Mt. Sinai Hospital and Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Our facility is hospital based. The hospital system currently has no methodology for allocating long-term debt to specific departments (page 12 question B). Our facility did operate a 4th shift on days Monday through Saturday (page 3 questions D). Significant change to Charity compared to last year attributed to the Affordable Care Act (page 12 question D).
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohammad Ahmed
In-Center Treatments in calendar year: 12,304Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 86
Patients treated as of 12/31/2016: (Ending patients) 88
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 214.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
37 0 41 37 42 35 40
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 24Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 12Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 809
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
24Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 82%Use Rate (including Missed Treatments): 88%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 88
90%92%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 11Isolation Stations Set up in Oct 1-7: 11
Full-Time Work Week: 40Registered Nurse : 12Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 1Other Health : 5Other Non-Health: 0
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 11
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
53
62.4%
Medicaid
30
Private Insurance
2
Charity Care
3
Private Pay
0
Other Public
0
TOTAL
85
35.3% 2.4% 3.5%0.0% 0.0% 100.0%
Patients
TOTAL 00
5101
36520
36
08
2496
08
2094
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
88
0164418108847 41
88
$864,041 $489,444 $204,291 $5,399$0 $0 $1,557,776
55.5% 31.4% 13.1% 0.3%0.0% 0.0% 100.0%Net Revenue
6/30/20167/1/2015 to
14-2541
Mt. Vernon Dialysis4102 North Water Tower PlaceMount VernonJefferson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life Link, INCLegal Entity Owner:
Property Owner: Steven Zelman,MD
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Steven Zelman, MD
In-Center Treatments in calendar year: 9,139Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 60
Patients treated as of 12/31/2016: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 211.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
32 0 28 31 29 31 29
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 9Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 362
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
33Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 63%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 97
63%67%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 8Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
82
83.7%
Medicaid
1
Private Insurance
9
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
98
1.0% 9.2% 0.0%0.0% 6.1% 100.0%
Patients
TOTAL 00
120
85
0970
0
07
191321
029
1214
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
97
09
2825359760 37
97
$2,023,342 $29,206 $1,506,703 $0$0 $368,495 $3,927,746
51.5% 0.7% 38.4% 0.0%0.0% 9.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2600
Nephron Dialysis Center, Ltd.5140 N. California Ave., Suite 510ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Nephron Dialysis Center, Ltd.Legal Entity Owner:
Property Owner: Swedish Covenant Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Hamid Humayun MD
In-Center Treatments in calendar year: 13,481Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 77
Patients treated as of 12/31/2016: (Ending patients) 88
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 13
Oct 20
Oct 33
Oct 43
Oct 53
Oct 63
Oct 73
46 0 44 46 43 44 47
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 41Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 16Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 859
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
44Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 90%Use Rate (including Missed Treatments): 96%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 115
80%92%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 30Registered Nurse : 3Dialysis Technician : 8.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 5
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
97
84.3%
Medicaid
9
Private Insurance
9
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
115
7.8% 7.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 410
160
58
21940
0
02
262421
00
101517
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
115
02
363938
11573 42
115
$2,408,251 $151,611 $918,941 $0$3,373 $0 $3,482,176
69.2% 4.4% 26.4% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2779
NxStage Oak Brook, LLC1600 16th StreetOak BrookCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: NxStage Kidney Care, LLCLegal Entity Owner:
Property Owner: TCB- Oaks LLC C/O Newport Capital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. William Whittier
In-Center Treatments in calendar year: 3,037Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 10
Patients treated as of 12/31/2016: (Ending patients) 14
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 18
Oct 20
Oct 38
Oct 48
Oct 58
Oct 68
Oct 78
12 0 12 12 12 12 12
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 24Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 6Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 98
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
12Total:
27Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 41%Use Rate (including Missed Treatments): 42%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 24
21%29%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3.8Dialysis Technician : 2Dietician : 0.3Social Worker: 0.2LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
15
62.5%
Medicaid
4
Private Insurance
4
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
24
16.7% 16.7% 0.0%4.2% 0.0% 100.0%
Patients
TOTAL 2060
12
4200
4
01571
01630
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
24
02
1110
12414 10
24
$474 $36,168 $248,368 $0$13,879 $0 $298,889
0.2% 12.1% 83.1% 0.0%4.6% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2644
Oak Park Kidney Centers, LLC610 South Maple AvenueOak ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Oak Park kidney Center LLCLegal Entity Owner:
Property Owner: Rush University Medical center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Hamid Humayun
In-Center Treatments in calendar year: 11,682Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 72
Patients treated as of 12/31/2016: (Ending patients) 71
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 1,740.0
Oct 113.5
Oct 20
Oct 313.5
Oct 413.5
Oct 513.5
Oct 613.5
Oct 713.5
35 0 35 33 36 31 30
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 2Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 18Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 16
Number of Missed Treatments: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
36Total:
USE RATE for the FACILITY16,848Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 111
67%66%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3.5Dialysis Technician : 7.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 18Certified Stations by CMS: 18Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
80
72.1%
Medicaid
20
Private Insurance
11
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
111
18.0% 9.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 20
930
16
5106
0
0
07
29198
05
151414
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
111
012443322
11163 48
111
$1,680,000 $141,317 $738,566 $0$0 $0 $2,559,883
65.6% 5.5% 28.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2674
Olney Dialysis Unit Olney117 North BooneOlneyRichland5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Life Link, Inc.Legal Entity Owner:
Property Owner: Andy Shuetz
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Rafael Lao
In-Center Treatments in calendar year: 4,234Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 25
Patients treated as of 12/31/2016: (Ending patients) 27
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 199.0
Oct 110
Oct 20
Oct 312
Oct 410
Oct 512
Oct 610
Oct 712
13 0 19 14 18 12 20
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 11Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 241
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
11Total:
13Total:
USE RATE for the FACILITY6,552Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 65%Use Rate (including Missed Treatments): 68%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 38
60%64%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 7Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 3Dietician : 0.3Social Worker: 0.3LPN : 0Other Health : 0Other Non-Health: 0.3
Authorized Stations as of 12/31/2016: 7Certified Stations by CMS: 7Peak Authorized Stations Operated: 7
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
34
89.5%
Medicaid
0
Private Insurance
1
Charity Care
1
Private Pay
1
Other Public
2
TOTAL
38
0.0% 2.6% 2.6%2.6% 5.3% 100.0%
Patients
TOTAL 0010
37
0380
0
02585
04374
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
38
068
159
3820 18
38
$1,193,599 $0 $73,488 $2,360$2,360 $81,257 $1,350,704
88.4% 0.0% 5.4% 0.2%0.2% 6.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2732
Palos Park Dialysis13155 South LaGrange RoadOrland ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: GX Orland Park 2, LLC.
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Sonja Marcic
In-Center Treatments in calendar year: 7,125Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 43
Patients treated as of 12/31/2016: (Ending patients) 49
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 112.0
Oct 19.5
Oct 20
Oct 313
Oct 49.5
Oct 513
Oct 69.5
Oct 713
16 0 26 18 24 20 26
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 81Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 46Patients voluntarily discontinued: 6Patients lost to follow up: 2Patients deceased: 12
Number of Missed Treatments: 171
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
72Total:
110Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 63%Use Rate (including Missed Treatments): 65%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 115
60%68%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
77
67.5%
Medicaid
1
Private Insurance
14
Charity Care
1
Private Pay
0
Other Public
22
TOTAL
114
0.9% 12.3% 0.9%0.0% 19.3% 100.0%
Patients
TOTAL 90
280
78
5110
0
0
03
131632
02
121621
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
115
05
253253
11564 51
115
$1,296,306 $16,931 $576,987 $8,850$8,850 $471,488 $2,370,562
54.7% 0.7% 24.3% 0.4%0.4% 19.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2335
Presence Resurrection Medical Center Dialysis7435 West TalcottChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Church-Related
Legal Entity Operator: Presence Resurrection Medical CenterLegal Entity Owner:
Property Owner: Presence Resurrection Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Daiva K Vilaitis
In-Center Treatments in calendar year: 7,058Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 49
Patients treated as of 12/31/2016: (Ending patients) 40
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 180.0
Oct 112
Oct 20
Oct 312.5
Oct 412
Oct 512.5
Oct 612
Oct 712.5
23 0 23 24 22 21 23
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 22Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 20Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 3
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
26Total:
USE RATE for the FACILITY13,104Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 54%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 71
58%48%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 3.5Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 14Certified Stations by CMS: 14Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
61
93.8%
Medicaid
0
Private Insurance
4
Charity Care
6
Private Pay
0
Other Public
0
TOTAL
65
0.0% 6.2% 9.2%0.0% 0.0% 100.0%
Patients
TOTAL 7011
57
3662
5
019
1414
0076
20
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
71
01
1620347138 33
71
$1,339,173 $0 $411,578 $8,667$0 $0 $1,750,751
76.5% 0.0% 23.5% 0.5%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2318
Provena St. Mary's Hospital455 West Court StreetKankakeeKankakee9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Not for Profit Corp
Legal Entity Operator: Presence St. Mary's HospitalLegal Entity Owner:
Property Owner: Presence St. Mary's Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Miguel Hizon
In-Center Treatments in calendar year: 12,119Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 78
Patients treated as of 12/31/2016: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
34 0 48 35 47 34 47
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 36Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 16Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 21
Number of Missed Treatments: 516
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
47Total:
USE RATE for the FACILITY22,464Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 54%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 128
54%58%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 26Registered Nurse : 10Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 24Certified Stations by CMS: 24Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
107
84.3%
Medicaid
8
Private Insurance
10
Charity Care
1
Private Pay
0
Other Public
2
TOTAL
127
6.3% 7.9% 0.8%0.0% 1.6% 100.0%
Patients
TOTAL 20
600
66
4124
0
0
05
391211
05
191918
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
128
010583129
12867 61
128
$3,299,331 $211,184 $831,892 $0$0 $85,939 $4,428,346
74.5% 4.8% 18.8% 0.0%0.0% 1.9% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2643
Quality Renal Care910 Greenlee Street, Suite BMarengoMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care Inc.Legal Entity Owner:
Property Owner: Luciano Zecchin
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Aamir Memon
In-Center Treatments in calendar year: 3,384Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 27
Patients treated as of 12/31/2016: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 10
Oct 20
Oct 315
Oct 40
Oct 515
Oct 60
Oct 715
0 0 25 0 21 0 22
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 10Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 12Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 196
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
19Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 30%Use Rate (including Missed Treatments): 32%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 46
38%32%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 0Registered Nurse : 1Dialysis Technician : 3Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 13Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
35
79.5%
Medicaid
2
Private Insurance
4
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
44
4.5% 9.1% 4.5%0.0% 6.8% 100.0%
Patients
TOTAL 1010
44
11350
0
017
128
04572
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
46
05
1219104628 18
46
$726,313 $10,590 $83,481 $79,650$79,650 $80,604 $980,639
74.1% 1.1% 8.5% 8.1%8.1% 8.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2598
Quality Renal Care-Dundee2203 Randall RoadDundeeKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal CareLegal Entity Owner:
Property Owner: Dr. Nasir J. Ahmad
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Nasir J. Ahmad
In-Center Treatments in calendar year: 10,284Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 67
Patients treated as of 12/31/2016: (Ending patients) 77
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 117.25
Oct 20
Oct 317
Oct 417.25
Oct 517
Oct 617.25
Oct 717
36 0 31 34 33 35 36
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 45Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 35Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 264
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
54Total:
USE RATE for the FACILITY12,168Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 85%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 54
86%99%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 13Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 13Certified Stations by CMS: 13Peak Authorized Stations Operated: 13
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
42
79.2%
Medicaid
3
Private Insurance
8
Charity Care
1
Private Pay
0
Other Public
0
TOTAL
53
5.7% 15.1% 1.9%0.0% 0.0% 100.0%
Patients
TOTAL 2070
32
13410
13
05
12135
01477
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
54
06
1620125435 19
54
$1,683,483 $2,235 $2,603,900 $26,845$26,845 $433,526 $4,749,989
35.4% 0.0% 54.8% 0.6%0.6% 9.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2772
Red Bud Dialysis1500 E. Market St.Red BudRandolph5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, INC.Legal Entity Owner:
Property Owner: Market Street HealthCare Red Bud, LLC, a Tenness
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Meher Mallick
In-Center Treatments in calendar year: 2,496Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 14
Patients treated as of 12/31/2016: (Ending patients) 16
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 60
Oct 714
0 0 19 0 16 0 20
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 6Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 136
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
7Total:
8Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 33%Use Rate (including Missed Treatments): 35%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 23
29%33%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 0Dietician : 0Social Worker: 0LPN : 1Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
20
87.0%
Medicaid
1
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
23
4.3% 8.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0020
21
0230
0
00475
00124
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
23
00599
2316 7
23
$492,767 $48,447 $153,958 $0$0 $30,450 $725,622
67.9% 6.7% 21.2% 0.0%0.0% 4.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2742
Renal Center West Joliet1051 Essington RoadJolietWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, IncLegal Entity Owner:
Property Owner: Midwest Community Real Estate Corp
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Preeti Nagarkatte, MD
In-Center Treatments in calendar year: 18,118Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 131
Patients treated as of 12/31/2016: (Ending patients) 127
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 115
Oct 20
Oct 315
Oct 415
Oct 515
Oct 615
Oct 715
55 0 70 56 67 56 66
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 78Transient Patients: 27Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 74Patients voluntarily discontinued: 6Patients lost to follow up: 1Patients deceased: 22
Number of Missed Treatments: 1,425
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
109Total:
105Total:
USE RATE for the FACILITY27,144Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 72%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 236
75%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 28Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 7.48Dialysis Technician : 11.95Dietician : 0.94Social Worker: 1.05LPN : 0Other Health : 0Other Non-Health: 1.55
Authorized Stations as of 12/31/2016: 29Certified Stations by CMS: 29Peak Authorized Stations Operated: 28
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
200
85.5%
Medicaid
2
Private Insurance
19
Charity Care
2
Private Pay
1
Other Public
12
TOTAL
234
0.9% 8.1% 0.9%0.4% 5.1% 100.0%
Patients
TOTAL 30
682
153
33199
4
10
018483452
010192926
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
236
028676378
236152 84
236
$3,269,553 $23,808 $2,072,177 $4,315$4,315 $1,003,489 $6,373,342
51.3% 0.4% 32.5% 0.1%0.1% 15.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2714
Robinson Dialysis1121 North Allen StreetRobinsonCrawford5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Robinson Davita DialysisLegal Entity Owner:
Property Owner: Crawford Hospital District
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Rafael Lao
In-Center Treatments in calendar year: 4,973Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 34
Patients treated as of 12/31/2016: (Ending patients) 31
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 328.0
Oct 112
Oct 20
Oct 314
Oct 412
Oct 514
Oct 612
Oct 714
15 0 15 16 16 15 16
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 15Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 2Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 23
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
14Total:
22Total:
USE RATE for the FACILITY8,424Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 59%Use Rate (including Missed Treatments): 59%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 56
63%57%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 9Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 30Registered Nurse : 2Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 2Other Non-Health: 2
Authorized Stations as of 12/31/2016: 9Certified Stations by CMS: 9Peak Authorized Stations Operated: 9
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
48
85.7%
Medicaid
0
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
56
0.0% 12.5% 0.0%0.0% 1.8% 100.0%
Patients
TOTAL 0030
52
1550
1
00
118
15
01669
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
56
01
1714245634 22
56
$1,059,477 $5,253 $143,963 $0$0 $133,924 $1,342,617
78.9% 0.4% 10.7% 0.0%0.0% 10.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2647
Rockford Dialysis3339 North Rockton AvenueRockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers - Illinois, Inc.Legal Entity Owner:
Property Owner: Stenstrom Real Estate - Renal Treatment Centers o
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Krishna Sankaran, MD
In-Center Treatments in calendar year: 15,307Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 118
Patients treated as of 12/31/2016: (Ending patients) 109
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 248.0
Oct 115
Oct 20
Oct 316
Oct 415
Oct 516
Oct 615
Oct 716
38 0 52 37 52 40 50
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 16Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 8Transplant Recipients: 2Patients transferred out: 49Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 17
Number of Missed Treatments: 1,634
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
83Total:
47Total:
USE RATE for the FACILITY20,592Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 74%Use Rate (including Missed Treatments): 82%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 185
89%83%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 22Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 7Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 22Certified Stations by CMS: 22Peak Authorized Stations Operated: 22
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
74
40.2%
Medicaid
16
Private Insurance
5
Charity Care
1
Private Pay
5
Other Public
84
TOTAL
184
8.7% 2.7% 0.5%2.7% 45.7% 100.0%
Patients
TOTAL 00
962
73
1715414
14
014551821
04
381916
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
185
018933737
185108 77
185
$2,861,967 $126,538 $1,750,626 $19,765$19,765 $930,872 $5,689,769
50.3% 2.2% 30.8% 0.3%0.3% 16.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2665
Roxbury Dialysis622 Roxbury RoadRockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Dialysis of Northern IL, LLCLegal Entity Owner:
Property Owner: Stenstrom Real Estate
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: James Stim, MD
In-Center Treatments in calendar year: 14,414Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 102
Patients treated as of 12/31/2016: (Ending patients) 89
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 226.0
Oct 116
Oct 20
Oct 323
Oct 416
Oct 523
Oct 616
Oct 723
40 0 52 39 52 39 51
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 49Transient Patients: 17Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 59Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 487
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
80Total:
66Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 96%Use Rate (including Missed Treatments): 99%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 164
106%93%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 7.2Dialysis Technician : 9.5Dietician : 1.1Social Worker: 1.5LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
132
80.5%
Medicaid
10
Private Insurance
19
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
164
6.1% 11.6% 0.0%0.6% 1.2% 100.0%
Patients
TOTAL 50
302
125
20140
4
2
012412223
010192017
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
164
022604240
16498 66
164
$3,364,413 $53,464 $2,245,335 $295$295 $858,279 $6,521,786
51.6% 0.8% 34.4% 0.0%0.0% 13.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2312
Rush University Dialysis1653 West Congress ParkwayChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Not for Profit Corp
Legal Entity Operator: Rush University Medical CenterLegal Entity Owner:
Property Owner: Rush University Medical Center
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Part 2 Financial and Capital expenditures is not entered here because this is bit a freestanding dialysis center. It is part of the pediatrics program of Rush University Medical Center. Comprehensive RUMC financial and capital expenditures information will be provided by March 31, in the Annual Hospital Questionnaire.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Sara Jandeska
In-Center Treatments in calendar year: 916Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 7
Patients treated as of 12/31/2016: (Ending patients) 4
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 10
Oct 20
Oct 310
Oct 40
Oct 510
Oct 60
Oct 710
0 0 4 0 4 0 4
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 3Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 2Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
6Total:
3Total:
USE RATE for the FACILITY4,680Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 20%Use Rate (including Missed Treatments): 20%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 10
23%13%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 5Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2.4Dialysis Technician : 0.7Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.2
Authorized Stations as of 12/31/2016: 5Certified Stations by CMS: 5Peak Authorized Stations Operated: 5
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
2
20.0%
Medicaid
6
Private Insurance
0
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
10
60.0% 0.0% 0.0%10.0% 10.0% 100.0%
Patients
TOTAL 00800
190
2
43000
03000
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
10
46000
107 3
10
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
6/30/20167/1/2015 to
14-2620
Rushville Dialysis112 Sullivan DriveRushvilleSchuyler3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Healthcare, Inc.Legal Entity Owner:
Property Owner: Stan Silverio
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Allan Krall
In-Center Treatments in calendar year: 2,996Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 21
Patients treated as of 12/31/2016: (Ending patients) 16
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 198.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 64
Oct 714
0 0 19 0 18 1 18
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 10Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 8Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 157
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
12Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 40%Use Rate (including Missed Treatments): 42%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 33
44%33%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 2Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
26
78.8%
Medicaid
2
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
33
6.1% 12.1% 0.0%0.0% 3.0% 100.0%
Patients
TOTAL 0010
32
3300
0
04932
00366
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
33
04
1298
3318 15
33
$588,910 $16,223 $452,652 $0$0 $113,879 $1,171,664
50.3% 1.4% 38.6% 0.0%0.0% 9.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2758
SAH Dialysis Center @ 26th Street3059 W. 26th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Church-Related
Legal Entity Operator: Saint Anthony HospitalLegal Entity Owner:
Property Owner: Chicago Title Land Trust#22630
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Izabella Gurau
In-Center Treatments in calendar year: 5,085Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 29
Patients treated as of 12/31/2016: (Ending patients) 41
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 110
Oct 20
Oct 311
Oct 410
Oct 511
Oct 610
Oct 711
16 0 28 11 28 12 28
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 6Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 195
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
8Total:
14Total:
USE RATE for the FACILITY14,040Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 36%Use Rate (including Missed Treatments): 38%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 55
32%46%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2.25Dialysis Technician : 3.75Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 0.25
Authorized Stations as of 12/31/2016: 15Certified Stations by CMS: 15Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
22
40.0%
Medicaid
19
Private Insurance
11
Charity Care
0
Private Pay
2
Other Public
1
TOTAL
55
34.5% 20.0% 0.0%3.6% 1.8% 100.0%
Patients
TOTAL 0040
41
4140
0
06
1552
04832
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
45
01023
84
4528 17
45
$1,777,779 $124,497 $74,515 $0$8,466 $2,106 $1,987,363
89.5% 6.3% 3.7% 0.0%0.4% 0.1% 100.0%Net Revenue
6/30/20167/1/2015 to
14-2746
Satellite Dialysis of Glenview2601 Compass RoadGlenviewCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Not for Profit Corp
Legal Entity Operator: Satellite Health CareLegal Entity Owner:
Property Owner: Scott Norton
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
I just spoke to Mike Mitchell from the Health department and explained him how the 2016 audited financials weren’t available at this time. He suggested that in the comment section we put a note which reads as follow: Fiscal ended 12/31/2016 and will supply Financial Information as soon it will be available. Harita Bajaj Financial Reporting and Taxation Mgr. Satellite Healthcare Inc./300 Santana Row, Suite 300/San Jose, CA 95128 Tel: (650)404-3681 (Direct) / Fax: (650)625-6081/[email protected] www.satellitehealth.com .
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr.Sprague,S
In-Center Treatments in calendar year: 7,984Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 55
Patients treated as of 12/31/2016: (Ending patients) 53
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 111
Oct 20
Oct 315
Oct 411
Oct 515
Oct 611
Oct 715
19 0 36 19 35 17 35
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 37Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 4Patients transferred out: 23Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 52
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
40Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 53%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 83
57%55%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 15Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 36Registered Nurse : 3Dialysis Technician : 3Dietician : 0.75Social Worker: 0.75LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
70
86.4%
Medicaid
7
Private Insurance
3
Charity Care
2
Private Pay
0
Other Public
1
TOTAL
81
8.6% 3.7% 2.5%0.0% 1.2% 100.0%
Patients
TOTAL 13060
63
6761
1
02
161423
0268
12
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
83
04
2222358355 28
83
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20151/1/2015 to
14-2561
Sauget Dialysis2061 Goose Lake RoadEast St LouisSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers- Illinois, LLCLegal Entity Owner:
Property Owner: Rick Sauget
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rashid Dalal
In-Center Treatments in calendar year: 10,910Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 87
Patients treated as of 12/31/2016: (Ending patients) 77
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 217.0
Oct 115
Oct 20
Oct 316
Oct 415
Oct 516
Oct 615
Oct 716
34 0 35 35 33 30 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 21Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 21Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 1,907
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
31Total:
USE RATE for the FACILITY14,976Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 73%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 118
91%80%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 16Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 5Dialysis Technician : 14Dietician : 1Social Worker: 0LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 16Certified Stations by CMS: 16Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
87
74.4%
Medicaid
16
Private Insurance
6
Charity Care
1
Private Pay
1
Other Public
7
TOTAL
117
13.7% 5.1% 0.9%0.9% 6.0% 100.0%
Patients
TOTAL 00
1010
17
1117
0
0
09
341210
08
241011
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
118
017582221
11865 53
118
$1,936,100 $19,878 $1,102,067 $6,785$6,785 $633,601 $3,698,431
52.3% 0.5% 29.8% 0.2%0.2% 17.1% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2624
Shelbyville Community Dialysis410 Heinlein DriveShelbyvilleShelby4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Renal Therapies, LLCLegal Entity Owner:
Property Owner:
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mahamood Quereshi
In-Center Treatments in calendar year: 2,645Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 16
Patients treated as of 12/31/2016: (Ending patients) 20
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 10
Oct 20
Oct 311
Oct 48.5
Oct 511
Oct 68.5
Oct 711
0 0 18 0 18 0 18
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 6Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 0Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 0
Number of Missed Treatments: 47
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
3Total:
7Total:
USE RATE for the FACILITY8,424Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 31%Use Rate (including Missed Treatments): 32%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 23
30%37%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 9Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 9Certified Stations by CMS: 9Peak Authorized Stations Operated: 9
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
18
78.3%
Medicaid
0
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
23
0.0% 21.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
23
0230
0
00513
02255
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
23
02768
239 14
23
$494,498 $0 $203,616 $0$0 $0 $698,115
70.8% 0.0% 29.2% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2753
Shiloh Dialysis1095 North Green Mount RoadShilohSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Vare, Inc.Legal Entity Owner:
Property Owner: Threlkeld Family Investment, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Rashid Dalal
In-Center Treatments in calendar year: 8,748Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 58
Patients treated as of 12/31/2016: (Ending patients) 65
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 112
Oct 20
Oct 316
Oct 412
Oct 516
Oct 612
Oct 716
24 0 34 23 32 23 35
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 58Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 38Patients voluntarily discontinued: 5Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 918
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
87Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 78%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 131
81%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 14Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 6Dietician : 0Social Worker: 0LPN : 1Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 14Peak Authorized Stations Operated: 14
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
102
79.1%
Medicaid
10
Private Insurance
8
Charity Care
2
Private Pay
2
Other Public
7
TOTAL
129
7.8% 6.2% 1.6%1.6% 5.4% 100.0%
Patients
TOTAL 10
960
34
3128
0
0
011391213
04
211813
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
131
015603026
13175 56
131
$1,601,175 $25,842 $1,080,102 $0$1,770 $313,042 $3,021,932
53.0% 0.9% 35.7% 0.0%0.1% 10.4% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2741
Silver Cross Renal Center1860 Silver Cross BoulevardNew LenoxWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, IncLegal Entity Owner:
Property Owner: NexCore Properties
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Naila Ahmed
In-Center Treatments in calendar year: 13,561Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 91
Patients treated as of 12/31/2016: (Ending patients) 98
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
42 0 45 41 40 37 43
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 61Transient Patients: 31Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 13Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 17
Number of Missed Treatments: 344
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
95Total:
USE RATE for the FACILITY17,784Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 76%Use Rate (including Missed Treatments): 78%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 151
80%86%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 19Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 5Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 19Certified Stations by CMS: 19Peak Authorized Stations Operated: 19
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
127
84.1%
Medicaid
8
Private Insurance
16
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
151
5.3% 10.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
360
113
11140
0
1
07
252631
08
141723
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
151
015394354
15189 62
151
$2,805,615 $3,625 $1,224,008 $0$0 $532,624 $4,565,872
61.4% 0.1% 26.8% 0.0%0.0% 11.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2733
Springfield South2930 South 6th StreetSpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care Inc.Legal Entity Owner:
Property Owner: Bill Furling
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lawrence Smith, MD
In-Center Treatments in calendar year: 5,838Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 41
Patients treated as of 12/31/2016: (Ending patients) 45
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 112
Oct 20
Oct 314
Oct 412
Oct 514
Oct 612
Oct 714
7 0 28 8 29 10 28
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 22Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 23Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 411
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
29Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 52%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 69
57%63%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
50
73.5%
Medicaid
6
Private Insurance
9
Charity Care
1
Private Pay
1
Other Public
2
TOTAL
68
8.8% 13.2% 1.5%1.5% 2.9% 100.0%
Patients
TOTAL 10
240
43
0680
0
04
15129
03
1096
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
68
07
2521156840 28
68
$1,580,828 $20,724 $1,318,802 $4,720$4,720 $731,666 $3,656,741
43.2% 0.6% 36.1% 0.1%0.1% 20.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2615
Stonecrest Dialysis1302 East State StreetRockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care IncLegal Entity Owner:
Property Owner: Lillibridge Healthcare Services, Inc
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Joanna Niemiec
In-Center Treatments in calendar year: 9,618Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 62
Patients treated as of 12/31/2016: (Ending patients) 72
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 116
Oct 20
Oct 316
Oct 416
Oct 516
Oct 616
Oct 716
31 0 32 29 32 30 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 38Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 30Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 438
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
53Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 86%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 113
86%100%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 2.5Dialysis Technician : 5.5Dietician : 0.8Social Worker: 0.7LPN : 0Other Health : 1Other Non-Health: 1.3
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
88
77.9%
Medicaid
17
Private Insurance
4
Charity Care
1
Private Pay
1
Other Public
3
TOTAL
113
15.0% 3.5% 0.9%0.9% 2.7% 100.0%
Patients
TOTAL 50
510
43
12992
14
09
24149
06
231216
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
113
015472625
11356 57
113
$1,720,496 $70,410 $443,226 $3,245$3,245 $560,114 $2,797,490
61.5% 2.5% 15.8% 0.1%0.1% 20.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2553
Sun Health2121 Oneida StreetJolietWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Sun Health Inc./Bhuvan Chawla M.D.Legal Entity Owner:
Property Owner: Triumph Joliet, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Let it be noted that Monday 03/20/2017 was my first email notification that this questionnaire was due. I did not receive any other emails, therefore I am submitting this questionnaire ASAP which is today,Tuesday 03/21/2017.
Provides Incenter Noctural Dialysis:
Medical Director Name: Bhuvan Chawla M.D.
In-Center Treatments in calendar year: 8,400Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 62
Patients treated as of 12/31/2016: (Ending patients) 54
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 265.0
Oct 111
Oct 20
Oct 315.5
Oct 411
Oct 515.5
Oct 611
Oct 715.5
20 0 35 18 31 19 34
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 14Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 11Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 24
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
25Total:
17Total:
USE RATE for the FACILITY15,912Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 53%Use Rate (including Missed Treatments): 53%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 77
61%53%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 15Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 30Registered Nurse : 5Dialysis Technician : 6Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2016: 17Certified Stations by CMS: 17Peak Authorized Stations Operated: 16
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
66
85.7%
Medicaid
5
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
77
6.5% 7.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
220
40
10643
15
03
141412
009
1114
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
77
03
2325267743 34
77
$2,028,057 $7,473 $2,525,827 $0$0 $0 $4,561,357
44.5% 0.2% 55.4% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20151/1/2015 to
14-2767
Tazewell County Dialysis1021 Court St.PekinTazewell2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Pekin Dialysis, LLCLegal Entity Owner:
Property Owner: GP Real Estate Holding LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Ashan Usman
In-Center Treatments in calendar year: 2,749Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 18
Patients treated as of 12/31/2016: (Ending patients) 21
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 213.0
Oct 10
Oct 20
Oct 312
Oct 40
Oct 512
Oct 60
Oct 712
0 0 17 0 19 0 20
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 28Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 8Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 3
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
19Total:
35Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 37%Use Rate (including Missed Treatments): 37%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 48
38%44%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 2Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
38
80.9%
Medicaid
3
Private Insurance
2
Charity Care
0
Private Pay
1
Other Public
3
TOTAL
47
6.4% 4.3% 0.0%2.1% 6.4% 100.0%
Patients
TOTAL 00
100
38
0480
0
02666
06895
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
48
08
1415114820 28
48
$645,477 $10,992 $516,925 $0$2,655 $169,285 $1,345,335
48.0% 0.8% 38.4% 0.0%0.2% 12.6% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2763
Timber Creek Dialysis1001 S. Annie Glidden RoadDeKalbDeKalb1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Dialysis of Norhtern Illinois, LLCLegal Entity Owner:
Property Owner: Donald E. Meyers Jr
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Bindu Pavithran
In-Center Treatments in calendar year: 3,849Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 26
Patients treated as of 12/31/2016: (Ending patients) 27
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 219.0
Oct 10
Oct 20
Oct 315
Oct 40
Oct 515
Oct 60
Oct 715
0 0 25 0 26 0 28
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 23Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 20Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 95
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
30Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 34%Use Rate (including Missed Treatments): 35%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 57
36%38%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 36Registered Nurse : 1.5Dialysis Technician : 2.5Dietician : 0.3Social Worker: 0.3LPN : 0Other Health : 0.5Other Non-Health: 0.75
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
47
70.1%
Medicaid
5
Private Insurance
5
Charity Care
4
Private Pay
4
Other Public
6
TOTAL
67
7.5% 7.5% 6.0%6.0% 9.0% 100.0%
Patients
TOTAL 00
160
39
10452
2
06
1277
06586
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
57
0121715135732 25
57
$849,626 $59,151 $154,483 $885$885 $56,139 $1,120,283
75.8% 5.3% 13.8% 0.1%0.1% 5.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2810
Tinley Park Dialysis16767 South 80th AvenueTinley ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Kidney Center South LLCLegal Entity Owner:
Property Owner: Tinley Park Healthcare LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Naila Ahmed
In-Center Treatments in calendar year: 38Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 0
Patients treated as of 12/31/2016: (Ending patients) 1
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 10
Oct 20
Oct 35
Oct 40
Oct 50
Oct 60
Oct 75
0 0 1 0 0 0 1
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 1Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 0Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 1
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
0Total:
1Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 0%Use Rate (including Missed Treatments): 0%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 1
0%1%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 0Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 1Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 1
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
1
100.0%
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
1
0.0% 0.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00001
010
0
00001
00000
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
1
0000111 0
1
$11,138 $0 $0 $0$0 $0 $11,138
100.0% 0.0% 0.0% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2614
Tri-Cities Dialysis, LLC306 Randall RoadGenevaKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Renaissance Management Company, LLC (operateLegal Entity Owner:
Property Owner: Delnor Community Healthcare Foundation
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Harry Rubinstein
In-Center Treatments in calendar year: 9,240Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 61
Patients treated as of 12/31/2016: (Ending patients) 70
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 112
Oct 20
Oct 318
Oct 412
Oct 518
Oct 612
Oct 718
20 0 40 21 40 21 41
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 53Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 8Transplant Recipients: 0Patients transferred out: 27Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 215
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
52Total:
61Total:
USE RATE for the FACILITY18,720Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 49%Use Rate (including Missed Treatments): 51%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 118
51%58%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 18Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 3.79Dialysis Technician : 6.8Dietician : 0.63Social Worker: 0.5LPN : 0.07Other Health : 0.17Other Non-Health: 1.01
Authorized Stations as of 12/31/2016: 20Certified Stations by CMS: 20Peak Authorized Stations Operated: 18
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
103
87.3%
Medicaid
4
Private Insurance
10
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
118
3.4% 8.5% 0.0%0.0% 0.8% 100.0%
Patients
TOTAL 20
100
106
7111
0
0
06
141929
01
101029
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
118
07
242958
11868 50
118
$1,746,095 $19,576 $851,212 $0$0 $0 $2,616,883
66.7% 0.7% 32.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2316
University of Illinois Hospital Dialysis1859 West TaylorChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership: State
Ownership Type: Other Governmental (speci
Legal Entity Operator: The Board of Trustees of the University of IllinoiLegal Entity Owner:
Property Owner: The Board of Trustees of the University of Illinoi
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Jose A. Arruda
In-Center Treatments in calendar year: 19,711Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 138
Patients treated as of 12/31/2016: (Ending patients) 141
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 118
Oct 20
Oct 318
Oct 418
Oct 518
Oct 618
Oct 718
58 0 64 58 63 61 63
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 7
Recovered patients: 0Transplant Recipients: 7Patients transferred out: 15Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 2,102
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
31Total:
34Total:
USE RATE for the FACILITY24,336Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 81%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 173
88%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 24Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 9.4Dialysis Technician : 22Dietician : 2Social Worker: 1LPN : 1Other Health : 18Other Non-Health: 7.5
Authorized Stations as of 12/31/2016: 26Certified Stations by CMS: 26Peak Authorized Stations Operated: 24
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
120
70.2%
Medicaid
24
Private Insurance
26
Charity Care
2
Private Pay
1
Other Public
0
TOTAL
171
14.0% 15.2% 1.2%0.6% 0.0% 100.0%
Patients
TOTAL 10
1070
65
62111
0
0
02640146
023331912
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
173
049733318
17386 87
173
$29,733,236 $5,315,592 $5,525,739 $443,831$162,522 $0 $40,737,089
73.0% 13.0% 13.6% 1.1%0.4% 0.0% 100.0%Net Revenue
6/30/20167/1/2015 to
14-2749
USRC Bolingbrook Dialysis396 Remington BlvdBolingbrookWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: USRC Bolingbrook, LLCLegal Entity Owner:
Property Owner: PHT Bolingbrook MOB,LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammed Ahmed
In-Center Treatments in calendar year: 7,916Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 49
Patients treated as of 12/31/2016: (Ending patients) 54
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 195.0
Oct 110
Oct 20
Oct 312
Oct 410
Oct 512
Oct 610
Oct 712
27 0 26 26 16 24 25
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 27Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 10Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 488
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
28Total:
USE RATE for the FACILITY12,168Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 65%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 72
63%69%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 4.1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2016: 13Certified Stations by CMS: 13Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
33
47.1%
Medicaid
23
Private Insurance
14
Charity Care
1
Private Pay
0
Other Public
0
TOTAL
70
32.9% 20.0% 1.4%0.0% 0.0% 100.0%
Patients
TOTAL 90
170
39
8577
7
06
14158
0285
14
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
72
08
2220227243 29
72
$1,227,192 $299,176 $704,761 $9,524$0 $0 $2,231,129
55.0% 13.4% 31.6% 0.4%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2750
USRC Oak Brook Dialysis1201-B Butterfield RdDowners GroveDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: USRC Oakbrook,LLCLegal Entity Owner:
Property Owner: Cedar Street Commercial
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Anis Rauf
In-Center Treatments in calendar year: 6,818Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 50
Patients treated as of 12/31/2016: (Ending patients) 46
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 195.0
Oct 110
Oct 20
Oct 314
Oct 410
Oct 514
Oct 610
Oct 714
17 0 30 15 29 12 31
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 33Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 35Patients voluntarily discontinued: 5Patients lost to follow up: 1Patients deceased: 3
Number of Missed Treatments: 516
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
48Total:
44Total:
USE RATE for the FACILITY12,168Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 60%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 80
64%59%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2.65Dialysis Technician : 4.1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.9
Authorized Stations as of 12/31/2016: 13Certified Stations by CMS: 13Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
62
78.5%
Medicaid
5
Private Insurance
9
Charity Care
1
Private Pay
1
Other Public
2
TOTAL
79
6.3% 11.4% 1.3%1.3% 2.5% 100.0%
Patients
TOTAL 40
170
47
26612
12
05
14208
027
1410
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
80
07
2134188047 33
80
$1,222,106 $37,376 $475,327 $0$2,100 $252,784 $1,989,693
61.4% 1.9% 23.9% 0.0%0.1% 12.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2738
USRC Streamwood Dialysis149 East Irving Park RoadStreamwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: USRenalcare Streamwood LLCLegal Entity Owner:
Property Owner: Inland Commercail Property
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Gordan Lang
In-Center Treatments in calendar year: 5,368Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 41
Patients treated as of 12/31/2016: (Ending patients) 35
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 195.0
Oct 110
Oct 20
Oct 310
Oct 410
Oct 510
Oct 610
Oct 710
14 0 19 14 18 12 19
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 20Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 16Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 195
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
21Total:
USE RATE for the FACILITY12,168Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 44%Use Rate (including Missed Treatments): 46%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 53
53%45%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 13Certified Stations by CMS: 13Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
40
76.9%
Medicaid
1
Private Insurance
7
Charity Care
1
Private Pay
0
Other Public
4
TOTAL
52
1.9% 13.5% 1.9%0.0% 7.7% 100.0%
Patients
TOTAL 6032
30
33812
12
018
109
024
136
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
53
03
1223155328 25
53
$913,943 $65,484 $519,477 $2,039$0 $217,109 $1,716,013
53.3% 3.8% 30.3% 0.1%0.0% 12.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2755
USRC Villa Park Dialysis200 E. North AvenueVilla ParkDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: USRC Villa ParkLegal Entity Owner:
Property Owner: Royal Plaza Management
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Michael Cohan
In-Center Treatments in calendar year: 9,120Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 58
Patients treated as of 12/31/2016: (Ending patients) 57
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 112
Oct 20
Oct 312
Oct 412
Oct 512
Oct 612
Oct 712
28 0 31 28 27 26 27
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 34Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 23Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 13
Number of Missed Treatments: 600
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
40Total:
USE RATE for the FACILITY12,168Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 75%Use Rate (including Missed Treatments): 80%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 89
74%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3.5Dialysis Technician : 6.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 13Certified Stations by CMS: 13Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
66
74.2%
Medicaid
1
Private Insurance
19
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
89
1.1% 21.3% 0.0%1.1% 2.2% 100.0%
Patients
TOTAL 20
171
51
46718
18
09
131419
01
101112
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
89
0102325318955 34
89
$1,608,883 $11,208 $2,437,834 $0$0 $135,563 $4,193,488
38.4% 0.3% 58.1% 0.0%0.0% 3.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2693
Vandalia Dialysis301 Mattes RoadVandaliaFayette5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Total Renal Care Inc.Legal Entity Owner:
Property Owner: Old Capital Retail
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Bashar Alzahabi
In-Center Treatments in calendar year: 3,635Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 28
Patients treated as of 12/31/2016: (Ending patients) 22
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 220.0
Oct 17
Oct 20
Oct 310
Oct 47
Oct 510
Oct 67
Oct 710
8 0 14 8 13 6 14
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 8Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 12Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 194
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
12Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 49%Use Rate (including Missed Treatments): 51%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 41
58%46%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 0Registered Nurse : 2Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
38
92.7%
Medicaid
0
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
41
0.0% 4.9% 0.0%0.0% 2.4% 100.0%
Patients
TOTAL 0030
38
0410
0
01957
02566
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
41
03
1411134122 19
41
$855,344 $0 $239,411 $0$0 $159,439 $1,254,194
68.2% 0.0% 19.1% 0.0%0.0% 12.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2688
Wayne County Dialysis Center303 NW 11th StreetFairfieldWayne5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Fairfield Memorial Hospital
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Steven Zelman
In-Center Treatments in calendar year: 4,247Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 27
Patients treated as of 12/31/2016: (Ending patients) 26
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 213.0
Oct 110
Oct 20
Oct 311
Oct 410
Oct 511
Oct 611
Oct 711
13 0 15 12 14 13 13
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 9Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 4Transplant Recipients: 0Patients transferred out: 7Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 89
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
14Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 57%Use Rate (including Missed Treatments): 58%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 44
56%54%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 2Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
35
79.5%
Medicaid
1
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
44
2.3% 6.8% 0.0%0.0% 11.4% 100.0%
Patients
TOTAL 0000
44
0440
0
039
109
01534
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
44
04
1413134431 13
44
$872,021 $6,273 $323,592 $0$0 $209,216 $1,411,103
61.8% 0.4% 22.9% 0.0%0.0% 14.8% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2719
West Lawn Dialysis7000 South Pulaski RoadChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Glendale 2004 LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Michael Arvan
In-Center Treatments in calendar year: 9,707Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 67
Patients treated as of 12/31/2016: (Ending patients) 69
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 115
Oct 20
Oct 317
Oct 415
Oct 517
Oct 615
Oct 717
28 0 32 32 33 29 32
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 30Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 27Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 6
Number of Missed Treatments: 713
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
40Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 86%Use Rate (including Missed Treatments): 93%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 77
93%96%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
49
71.0%
Medicaid
11
Private Insurance
8
Charity Care
4
Private Pay
0
Other Public
1
TOTAL
69
15.9% 11.6% 5.8%0.0% 1.4% 100.0%
Patients
TOTAL 10
210
46
41270
0
05
10115
03
15127
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
68
08
2523126831 37
68
$1,538,689 $60,491 $1,585,005 $64,310$0 $333,100 $3,517,284
43.7% 1.7% 45.1% 1.8%0.0% 9.5% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2783
West Side Dialysis1600 W 13th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, Inc.Legal Entity Owner:
Property Owner: Inland Western Chicago Ashland, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Don Hollandsworth
In-Center Treatments in calendar year: 3,140Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 18
Patients treated as of 12/31/2016: (Ending patients) 27
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 221.0
Oct 10
Oct 20
Oct 314
Oct 40
Oct 514
Oct 60
Oct 714
0 0 20 0 19 0 20
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 20Transient Patients: 39Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 48Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 343
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
51Total:
60Total:
USE RATE for the FACILITY11,232Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 28%Use Rate (including Missed Treatments): 31%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 38
25%38%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 3Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2016: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 12
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
23
65.7%
Medicaid
8
Private Insurance
4
Charity Care
3
Private Pay
0
Other Public
0
TOTAL
35
22.9% 11.4% 8.6%0.0% 0.0% 100.0%
Patients
TOTAL 30
2807
7310
0
04
1212
05833
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
38
09
2045
3819 19
38
$448,050 $106,142 $531,295 $6,785$6,785 $131,380 $1,223,652
36.6% 8.7% 43.4% 0.6%0.6% 10.7% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2721
Woodlawn Dialysis5060 S. State StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care, IncLegal Entity Owner:
Property Owner: South Central Medical Center Building Trust
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mary Hammes
In-Center Treatments in calendar year: 17,627Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 121
Patients treated as of 12/31/2016: (Ending patients) 134
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 114
Oct 20
Oct 314
Oct 414
Oct 514
Oct 614
Oct 714
56 0 68 56 68 56 68
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 42Transient Patients: 21Patients Re-Started: 7Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 5Patients transferred out: 37Patients voluntarily discontinued: 1Patients lost to follow up: 2Patients deceased: 9
Number of Missed Treatments: 1,516
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
54Total:
71Total:
USE RATE for the FACILITY29,952Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 59%Use Rate (including Missed Treatments): 64%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 193
63%70%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 26Isolation Stations Set up in Oct 1-7: 2
Full-Time Work Week: 40Registered Nurse : 5Dialysis Technician : 14Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2016: 32Certified Stations by CMS: 32Peak Authorized Stations Operated: 32
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
140
72.5%
Medicaid
38
Private Insurance
14
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
193
19.7% 7.3% 0.0%0.0% 0.5% 100.0%
Patients
TOTAL 00
18800
5188
0
5
024501912
019381318
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
193
043883230
193105 88
193
$2,791,907 $34,342 $1,624,020 $35,400$35,400 $1,513,570 $5,999,240
46.5% 0.6% 27.1% 0.6%0.6% 25.2% 100.0%Net Revenue
12/31/20161/1/2016 to
14-2709
Yorkville Dialysis Center1400 N. BeecherYorkvilleKendall9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2016
Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Renaissance Management Company, LLC (operateLegal Entity Owner:
Property Owner: Yorkville Medical Building Company, LLC
Source: Data based on 2016 Annual ESRD Questionnaire administered on behalf of Illinois Department of Public Health, Health Systems Development.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Valerie Heidenry
In-Center Treatments in calendar year: 2,165Facility Reported Patient Information
Patients treated as of 1/1/2016: (Beginning patients) 15
Patients treated as of 12/31/2016: (Ending patients) 13
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 10
Oct 20
Oct 311
Oct 40
Oct 511
Oct 60
Oct 711
0 0 15 0 15 0 15
Dialysis Station Utilization for the Week of Oct 1 - 7
New Patients: 9Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 8Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 48
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
13Total:
11Total:
USE RATE for the FACILITY7,488Treatment Capacity/year (based on Stations):
Use Rate (Treatments/Treatment capacity): 29%Use Rate (including Missed Treatments): 30%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 25
31%27%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 8Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 1Dialysis Technician : 1.35Dietician : 0.22Social Worker: 0LPN : 0Other Health : 0.07Other Non-Health: 0.27
Authorized Stations as of 12/31/2016: 8Certified Stations by CMS: 8Peak Authorized Stations Operated: 8
STATION INFORMATION FACILITY STAFFING - FULL TIME EQUIVALENTS
(subset of authorized stations)Number of Shifts Operated per day
Facility Utilization Information
AGE GROUPS MALE FEMALE
Patients by Age and Sex Patients by Race Patients by Ethnicity
Patients and Net Revenue by Payor Source
Medicare
22
88.0%
Medicaid
2
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
25
8.0% 4.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0030
22
5200
0
03158
02132
<15 yrs15-44 yr45-64 yr65-74 yr75 < yrsTotal
Asian Patients:Native American/ Indian:Black/ African American :Hawaiian /Pacific IslandeWhite:Unknown :TOTAL:
Hispanic Latino Patients:Non-Hispanic Latino PatientUnknown Ethnicity PatientsTOTAL:
25
0528
102517 8
25
$481,043 $131,658 $105,359 $0$0 $0 $718,060
67.0% 18.3% 14.7% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to