esrd facility profile - illinois...medical director name: suresh mathew in-center treatments in...
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14-2711
Adams County Dialysis436 N. 10th St.QuincyAdams3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DavitaLegal Entity Owner:
Property Owner: Blessing Health System
Provides Incenter Noctural Dialysis:
Medical Director Name: Hrishikesh Ghanekar
In-Center Treatments in calendar year: 8,678Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 52
Patients treated as of 12/31/2017: (Ending patients) 62
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
12
Oct 3
12
Oct 4
12
Oct 5
12
Oct 6
12
Oct 7
12
0 29 30 29 31 32 31
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 37Transient Patients: 13Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 25Patients voluntarily discontinued: 16Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 701
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
52Total:
USE RATE for the FACILITY
15,912Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 55%Use Rate (including Missed Treatments): 59%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 109
51%61%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: 40Registered Nurse : 3Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
101
79.5%
Medicaid
4
Private Insurance
11
Charity Care
0
Private Pay
0
Other Public
11
TOTAL
127
3.1% 8.7% 0.0%0.0% 8.7% 100.0%
Patients
TOTAL 00
190
108
3124
0
0
04
292216
03
161225
<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:
127
07
453441
12771 56
127
$2,011,182 $59,836 $1,450,905 $0$0 $495,816 $4,017,739
50.1% 1.5% 36.1% 0.0%0.0% 12.3% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2619
Alton Dialysis309 Homer Adams ParkwayAltonMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Mathew
In-Center Treatments in calendar year: 11,490Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 63
Patients treated as of 12/31/2017: (Ending patients) 63
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 30 25 32 29 32 24
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 14Patients Re-Started: 5Post-Transplant Patien 0
Recovered patients: 9Transplant Recipients: 2Patients transferred out: 25Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 763
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
52Total:
USE RATE for the FACILITY
14,976Treatment 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: 0
66%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 : 5Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
92
88.5%
Medicaid
3
Private Insurance
8
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
104
2.9% 7.7% 1.0%0.0% 1.0% 100.0%
Patients
TOTAL 00
280
77
0105
0
0
07
2311
9
04
142314
<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:
105
011373423
10550 55
105
$1,994,200 $8,125 $1,013,145 $590$0 $762,517 $3,777,985
52.8% 0.2% 26.8% 0.0%0.0% 20.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2664
ARA Crystal Lake Dialysis 6298 Northwest Highway Suite 300Crystal LakeMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohammed Zahid
In-Center Treatments in calendar year: 4,811Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 29
Patients treated as of 12/31/2017: (Ending patients) 29
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1 Oct 2
16
Oct 3 Oct 4
16
Oct 5 Oct 6
16
Oct 7
33 29 31
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 15Transient Patients: 0Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 6Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 50
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
11Total:
18Total:
USE RATE for the FACILITY
14,976Treatment 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
30%30%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 : 2.5Dialysis Technician : 3.5Dietician : 0.33Social Worker: 0.33LPN : 0Other Health : 0.33Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 16Certified Stations by CMS: 0Peak 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
39
69.6%
Medicaid
4
Private Insurance
12
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
56
7.1% 21.4% 0.0%1.8% 0.0% 100.0%
Patients
TOTAL 1040
51
12440
0
06
1199
02766
<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
08
1815155635 21
56
$1,087,678 $18,506 $914,437 $0$3,209 $0 $2,023,830
53.7% 0.9% 45.2% 0.0%0.2% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2737
ARA McHenry Dialysis4209 W Shamrock Unit AMcHenryMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: American Renal AssociatesLegal Entity Owner:
Property Owner: Riggsby Companies LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohammad Zahid
8/17/2017 - Added 2 ESRD stations to existing facility; facility now has 14 ESRD stations.
In-Center Treatments in calendar year: 3,974Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 32
Patients treated as of 12/31/2017: (Ending patients) 28
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1 Oct 2
14
Oct 3 Oct 4
14
Oct 5 Oct 6
14
Oct 7
26 27 27
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 16Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 17Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 120
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
24Total:
20Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 35%Use Rate (including Missed Treatments): 36%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 46
44%39%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 11Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 3Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
44
95.7%
Medicaid
1
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
46
2.2% 2.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0020
44
0460
0
01
127
11
03057
<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
04
1212184631 15
46
$891,270 $0 $1,065,767 $0$0 $0 $1,957,037
45.5% 0.0% 54.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2662
ARA South Barrington Dialysis 33 West Higgins Rd. Suite 920-945South BarringtonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: illinois Property Solutions
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr.Mohammad Zahid
In-Center Treatments in calendar year: 7,683Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 56
Patients treated as of 12/31/2017: (Ending patients) 56
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
16
Oct 3
11
Oct 4
16
Oct 5
11
Oct 6
16
Oct 7
11
0 34 19 33 19 35 17
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 32Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 27Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 21
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
42Total:
USE RATE for the FACILITY
13,104Treatment 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: 85
67%67%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 : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
77.6%
Medicaid
4
Private Insurance
14
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
85
4.7% 16.5% 0.0%1.2% 0.0% 100.0%
Patients
TOTAL 18080
59
30550
0
04
2617
7
046
129
<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
3229168554 31
85
$1,295,858 $56,640 $1,685,008 $0$52,485 $0 $3,089,991
41.9% 1.8% 54.5% 0.0%1.7% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2628
Arlington Heights Renal Center17 W. Golf RoadArlington HeightsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Watermark Property Management, LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: George Hvostik MD
In-Center Treatments in calendar year: 9,299Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 67
Patients treated as of 12/31/2017: (Ending patients) 75
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 285.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 38 19 42 19 40 18
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 44Transient Patients: 46Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 15Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 447
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
93Total:
USE RATE for the FACILITY
16,848Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 55%Use Rate (including Missed Treatments): 58%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 93
62%69%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 : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
67
73.6%
Medicaid
11
Private Insurance
13
Charity Care
2
Private Pay
0
Other Public
0
TOTAL
91
12.1% 14.3% 2.2%0.0% 0.0% 100.0%
Patients
TOTAL 15070
59
1200
0
06
208
21
03
111014
<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
09
3118359355 38
12
$1,661,481 $67,531 $1,148,732 $52,215$435,612Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2795
Belvidere Dialysis1751 Henry Luckow LaneBelvidereBoone1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: First Rockford Group, INC
Provides Incenter Noctural Dialysis:
Medical Director Name: Mashood Ahmad
In-Center Treatments in calendar year: 3,809Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 29
Patients treated as of 12/31/2017: (Ending patients) 28
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 1
0
Oct 2
15
Oct 3
8
Oct 4
15
Oct 5
8
Oct 6
15
Oct 7
0
0 27 0 23 0 26 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 8Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 105
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
18Total:
USE RATE for the FACILITY
11,232Treatment 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: 49
40%39%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: 0
Authorized Stations as of 12/31/2017: 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
36
78.3%
Medicaid
3
Private Insurance
6
Charity Care
3
Private Pay
0
Other Public
1
TOTAL
46
6.5% 13.0% 6.5%0.0% 2.2% 100.0%
Patients
TOTAL 2040
43
13360
0
03
1175
02678
<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
1714134926 23
49
$531,469 $52,367 $644,998 $52,367$334,978Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2608
Benton DaVita Dialysis1151 State Rte #14 WestBentonFranklin5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 J. Zelman
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Cheryl Emmons
In-Center Treatments in calendar year: 5,880Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 41
Patients treated as of 12/31/2017: (Ending patients) 44
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 1
0
Oct 2
10
Oct 3
9
Oct 4
10
Oct 5
9
Oct 6
10
Oct 7
9
0 23 11 24 15 21 14
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 5Transplant Recipients: 1Patients transferred out: 7Patients voluntarily discontinued: 5Patients lost to follow up: 1Patients deceased: 4
Number of Missed Treatments: 210
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
34Total:
USE RATE for the FACILITY
12,168Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 48%Use Rate (including Missed Treatments): 50%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 73
53%56%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 : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
59
81.9%
Medicaid
7
Private Insurance
1
Charity Care
1
Private Pay
0
Other Public
5
TOTAL
72
9.7% 1.4% 1.4%0.0% 6.9% 100.0%
Patients
TOTAL 1010
71
0730
0
05
189
13
02989
<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
07
2717227345 28
73
$1,290,552 $63,440 $3,971 $960$960 $317,090 $1,676,012
77.0% 3.8% 0.2% 0.1%0.1% 18.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2638
Beverly Davita8109 South Western AveChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Dr.Mazhar M.Butt
Facility has a 4th shift on MWF.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. James Rydel
In-Center Treatments in calendar year: 13,369Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 121
Patients treated as of 12/31/2017: (Ending patients) 94
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
17.5
Oct 3
15.5
Oct 4
17.5
Oct 5
15.5
Oct 6
17.5
Oct 7
15.5
0 50 40 57 38 51 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 23Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 59Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 712
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
74Total:
45Total:
USE RATE for the FACILITY
14,976Treatment 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: 166
126%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: 1
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 9.71Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
148
89.2%
Medicaid
6
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
166
3.6% 4.2% 0.0%0.0% 3.0% 100.0%
Patients
TOTAL 01
1550
10
8158
0
0
011452810
06
282315
<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
017735125
16694 72
166
$11,915,663 $112,278 $1,664,758 $0$0 $1,317,387 $15,010,086
79.4% 0.7% 11.1% 0.0%0.0% 8.8% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2650
Buffalo Grove Dialysis 1291 W Dundee RdBuffalo GroveCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Buffalo Grove, LLCLegal Entity Owner:
Property Owner: Amalgamated Bank of Chicago
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. George Hvostik
In-Center Treatments in calendar year: 8,521Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 54
Patients treated as of 12/31/2017: (Ending patients) 58
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 40 17 38 17 39 19
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 24Transient Patients: 17Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 29Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 143
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
43Total:
USE RATE for the FACILITY
14,976Treatment 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: 97
56%60%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 : 3Dialysis Technician : 5Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
79.8%
Medicaid
0
Private Insurance
8
Charity Care
3
Private Pay
0
Other Public
11
TOTAL
94
0.0% 8.5% 3.2%0.0% 11.7% 100.0%
Patients
TOTAL 12060
79
14830
0
08
201819
0099
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:
97
08
2927339765 32
97
$1,413,796 $1,543,656 $50,445$443,523Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2817
Calumet City Dialysis1200 Sibley Blvd.Calumet CityCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Total Renal Care Legal Entity Owner:
Property Owner: Engineer Property Group
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Jamie Baylock
In-Center Treatments in calendar year: 685Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 1
Patients treated as of 12/31/2017: (Ending patients) 16
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
11
Oct 3
0
Oct 4
11
Oct 5
0
Oct 6
11
Oct 7
0
0 5 0 6 0 7 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 12Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 13
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
13Total:
28Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 5%Use Rate (including Missed Treatments): 5%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 29
1%17%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 : 2Dialysis Technician : 2.5Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
24
82.8%
Medicaid
1
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
29
3.4% 10.3% 0.0%0.0% 3.4% 100.0%
Patients
TOTAL 00
2603
2270
0
01864
01441
<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
02
12105
2919 10
29
$148,357 $4,958 $108,838 $0$0 $28,039 $290,192
51.1% 1.7% 37.5% 0.0%0.0% 9.7% 100.0%Net Revenue
12/31/20171/25/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2663
Center for Renal Replacement, LLC7301 N. Lincoln Ave., Suite 205LincolnwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: James K. Yeung, M.D.Legal Entity Owner:
Property Owner: Imperial Realty
Provides Incenter Noctural Dialysis:
Medical Director Name: James K. Yeung, M.D.
In-Center Treatments in calendar year: 9,143Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 66
Patients treated as of 12/31/2017: (Ending patients) 57
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 30 21 29 25 30 23
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 16Transient Patients: 0Patients Re-Started: 2Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 19Patients voluntarily discontinued: 3Patients lost to follow up: 1Patients deceased: 2
Number of Missed Treatments: 148
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
30Total:
20Total:
USE RATE for the FACILITY
14,976Treatment 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: 82
69%59%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 : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
59
72.0%
Medicaid
12
Private Insurance
10
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
82
14.6% 12.2% 0.0%1.2% 0.0% 100.0%
Patients
TOTAL 260
186
32
6760
0
03
122211
019
1311
<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
04
2135228248 34
82
$1,278,150 $60,339 $651,055 $0$39,606 $0 $2,029,149
63.0% 3.0% 32.1% 0.0%2.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2609
Centralia DaVita dialysis1231 IL 161 EastCentraliaMarion5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Faisal Rashid
In-Center Treatments in calendar year: 7,398Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 49
Patients treated as of 12/31/2017: (Ending patients) 51
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 207.0
Oct 1
0
Oct 2
10
Oct 3
12
Oct 4
10
Oct 5
12
Oct 6
10
Oct 7
12
0 22 23 24 22 26 21
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 5Patients transferred out: 15Patients voluntarily discontinued: 14Patients lost to follow up: 1Patients deceased: 11
Number of Missed Treatments: 280
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
48Total:
31Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 59%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 76
58%61%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 : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
84.2%
Medicaid
1
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
76
1.3% 6.6% 0.0%0.0% 7.9% 100.0%
Patients
TOTAL 00
140
62
0760
0
02
219
13
009
1210
<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
02
3021237645 31
76
$1,866,998 $946 $1,347,049 $0$0 $282,826 $3,497,819
53.4% 0.0% 38.5% 0.0%0.0% 8.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2635
Chicago Heights Davita177 W. Joe Orr RoadChicago HeightsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Davita Chicago Heights LLCLegal Entity Owner:
Property Owner: Matanky Realty
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Donald Hollandsworth
In-Center Treatments in calendar year: 12,451Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 92
Patients treated as of 12/31/2017: (Ending patients) 85
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15.5
Oct 3
15.5
Oct 4
15.5
Oct 5
15.5
Oct 6
15.5
Oct 7
15.5
0 44 39 41 36 43 33
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 29Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 21Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 15
Number of Missed Treatments: 511
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
37Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 83%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 130
96%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: 0
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
0
#Num!
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
0
#Num! #Num! #Num!#Num! #Num! #Num!
Patients
TOTAL 00
951
17
17113
0
17
09
312219
05
22139
<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
014533528
13081 49
130
$2,828,515 $174,810 $3,737,465 $0$0 $1,676,094 $8,416,885
33.6% 2.1% 44.4% 0.0%0.0% 19.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2793
Chicago Ridge Dialysis10511 S HarlemChicago RidgeCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator:Legal Entity Owner:
Property Owner: Palestra Real Estate Partners, LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Sreya Pallath
In-Center Treatments in calendar year: 6,384Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 36
Patients treated as of 12/31/2017: (Ending patients) 58
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 205.0
Oct 1
0
Oct 2
12
Oct 3
8
Oct 4
12
Oct 5
8
Oct 6
12
Oct 7
8
0 40 9 37 9 36 10
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 53Transient Patients: 16Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 36Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 9
Number of Missed Treatments: 464
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
72Total:
USE RATE for the FACILITY
14,976Treatment 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: 87
38%60%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: 40Registered Nurse : 1Dialysis Technician : 2Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 16Certified Stations by CMS: 16Peak 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
65
74.7%
Medicaid
13
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
87
14.9% 6.9% 0.0%0.0% 3.4% 100.0%
Patients
TOTAL 10
120
35
9490
10
00
131811
01564
<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
01
1824155842 16
58
$1,090,380 $53,255 $232,042 $0$588,956Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2640
Churchview DaVita417 Ware AvenueRockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers - IL.Legal Entity Owner:
Property Owner: First Midwest Group
Provides Incenter Noctural Dialysis:
Medical Director Name: Charles Sweeney
In-Center Treatments in calendar year: 13,443Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 94
Patients treated as of 12/31/2017: (Ending patients) 90
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 232.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 38 26 38 26 41 28
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 87Transient Patients: 24Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 24Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 22
Number of Missed Treatments: 718
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
114Total:
USE RATE for the FACILITY
22,464Treatment 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: 189
65%63%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 : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
114
61.3%
Medicaid
10
Private Insurance
9
Charity Care
3
Private Pay
0
Other Public
53
TOTAL
186
5.4% 4.8% 1.6%0.0% 28.5% 100.0%
Patients
TOTAL 52
530
98
2613231
31
010452626
013232224
<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:
189
023684850
189107 82
189
$3,244,835 $170,012 $3,883,341 $67,422$1,484,576Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2540
Circle Medical Management, Inc.1426 West Washington Blvd.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Edmund J. Lewis, MDLegal Entity Owner:
Property Owner: Respiratory Health Associates
Provides Incenter Noctural Dialysis:
Medical Director Name: Steven Michael Korbet
In-Center Treatments in calendar year: 15,299Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 103
Patients treated as of 12/31/2017: (Ending patients) 110
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 213.0
Oct 1
0
Oct 2
13.5
Oct 3
13
Oct 4
13.5
Oct 5
13
Oct 6
13.5
Oct 7
11
0 53 47 49 49 49 47
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 2Patients Re-Started: 5Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 25Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 841
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
49Total:
USE RATE for the FACILITY
26,208Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 62%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 144
61%65%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: 70Registered Nurse : 5Dialysis Technician : 14Dietician : 1Social Worker: 1LPN : 1Other Health : 1Other Non-Health: 5.5
Authorized Stations as of 12/31/2017: 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
107
74.3%
Medicaid
15
Private Insurance
22
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
144
10.4% 15.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
1100
33
18126
0
0
110241115
016301918
<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
126543033
14461 83
144
$7,521,014 $1,579,703 $2,855,474 $0$104,086 $0 $12,060,277
62.4% 13.1% 23.7% 0.0%0.9% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2715
Cobblestone Dialysis836 Dundee AveElginKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Palestra Properties
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Ravi Damaraju
In-Center Treatments in calendar year: 13,765Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 88
Patients treated as of 12/31/2017: (Ending patients) 92
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
17
Oct 3
14
Oct 4
17
Oct 5
14
Oct 6
17
Oct 7
14
0 49 42 48 43 53 41
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 21Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 60Patients voluntarily discontinued: 8Patients lost to follow up: 2Patients deceased: 17
Number of Missed Treatments: 311
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
90Total:
64Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 92%Use Rate (including Missed Treatments): 94%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 149
92%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: 40Registered Nurse : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 2Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
65.2%
Medicaid
19
Private Insurance
26
Charity Care
11
Private Pay
0
Other Public
3
TOTAL
138
13.8% 18.8% 8.0%0.0% 2.2% 100.0%
Patients
TOTAL 92
210
117
57920
0
016441619
06
261111
<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:
149
022702730
14995 54
149
$1,939,374 $315,353 $1,760,546 $153,695$0 $738,162 $4,753,436
40.8% 6.6% 37.0% 3.2%0.0% 15.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2698
Community Dialysis of Harvey16641 S. Halsted St. HarveyCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Yousef Musleh
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Edwin Cook
In-Center Treatments in calendar year: 9,702Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 68
Patients treated as of 12/31/2017: (Ending patients) 79
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
12
Oct 3
12
Oct 4
12
Oct 5
12
Oct 6
12
Oct 7
12
0 33 33 34 30 33 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 26Transient Patients: 14Patients Re-Started: 3Post-Transplant Patien 3
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 28Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 348
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
46Total:
USE RATE for the FACILITY
16,848Treatment 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: 116
63%73%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 : 2Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
87
75.7%
Medicaid
20
Private Insurance
6
Charity Care
1
Private Pay
0
Other Public
2
TOTAL
115
17.4% 5.2% 0.9%0.0% 1.7% 100.0%
Patients
TOTAL 00
10506
5111
0
5
010331011
04
152112
<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
014483123
11664 52
116
$1,327,566 $97,761 $556,814 $35,695$0 $1,024,633 $3,006,775
44.2% 3.3% 18.5% 1.2%0.0% 34.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2655
Concerto Dialysis, LLC14255 Cicero AveCrestwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Symphony of Crestwood
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Samson, MD
In-Center Treatments in calendar year: 2,814Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 14
Patients treated as of 12/31/2017: (Ending patients) 18
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
14
Oct 3
5
Oct 4
14
Oct 5
5
Oct 6
14
Oct 7
5
0 13 0 13 1 16 1
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 32Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 22Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 1
Number of Missed Treatments: 246
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
25Total:
32Total:
USE RATE for the FACILITY
8,424Treatment 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: 30
26%33%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 9Isolation Stations Set up in Oct 1-7:
Full-Time Work Week: 40Registered Nurse : 1Dialysis Technician : 2Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
21
70.0%
Medicaid
1
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
30
3.3% 26.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
1908
1290
3
02373
02634
<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
049
107
3015 15
30
$564,036 $38,729 $172,282 $0$4,323 $0 $779,370
72.4% 5.0% 22.1% 0.0%0.6% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2625
Danville Dialysis Services, L.L.C.910 W. Clay StreetDanvilleVermilion4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Dr. & Mrs. Brijnandan Sodhi
Provides Incenter Noctural Dialysis:
Medical Director Name: Brijnandan S. Sodhi, M.D.
In-Center Treatments in calendar year: 11,507Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 79
Patients treated as of 12/31/2017: (Ending patients) 73
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 1
0
Oct 2
12
Oct 3
11.5
Oct 4
12
Oct 5
11.5
Oct 6
12
Oct 7
11.5
0 44 31 41 32 43 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 21Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 12Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 15
Number of Missed Treatments: 186
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
23Total:
USE RATE for the FACILITY
17,784Treatment 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: 102
69%64%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 : 8Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 1Other Health :Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
84
82.4%
Medicaid
12
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
6
TOTAL
102
11.8% 0.0% 0.0%0.0% 5.9% 100.0%
Patients
TOTAL 00
520
50
1101
0
0
05
151521
05
161015
<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
010312536
10256 46
102
$1,797,068 $84,631 $0$2,187,971Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2651
Davita - Dixon Kidney Center1131 North Galena AvenueDixonLee1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Stenstrom
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Charles Sweeney
In-Center Treatments in calendar year: 3,457Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 14
Patients treated as of 12/31/2017: (Ending patients) 21
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 216.0
Oct 1
0
Oct 2
13
Oct 3
6
Oct 4
13
Oct 5
6
Oct 6
13
Oct 7
6
0 14 4 14 4 14 4
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 19Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 15Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 57
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
27Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 46%Use Rate (including Missed Treatments): 47%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 49
29%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: 0
Full-Time Work Week: 30Registered Nurse : 2Dialysis Technician : 2.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.7
Authorized Stations as of 12/31/2017: 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
0
#Num!
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
0
#Num! #Num! #Num!#Num! #Num! #Num!
Patients
TOTAL 0040
45
2470
0
00
1368
04783
<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
04
2014114927 22
49
$948,192 $183,484 $1,249,860 $11,592$0 $154,994 $2,536,530
37.4% 7.2% 49.3% 0.5%0.0% 6.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2528
Davita - Lincoln Park Dialysis Center2484 N. Elston AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Melvin K. Roseman, MD
In-Center Treatments in calendar year: 13,492Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 93
Patients treated as of 12/31/2017: (Ending patients) 91
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
15
Oct 3
15
Oct 4
15
Oct 5
15
Oct 6
15
Oct 7
15
0 49 38 48 38 50 40
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 43Transient Patients: 34Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 59Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 14
Number of Missed Treatments: 552
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
80Total:
78Total:
USE RATE for the FACILITY
23,400Treatment 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: 171
62%61%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 : 5Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
119
70.0%
Medicaid
10
Private Insurance
10
Charity Care
1
Private Pay
0
Other Public
31
TOTAL
170
5.9% 5.9% 0.6%0.0% 18.2% 100.0%
Patients
TOTAL 220
590
90
37134
0
0
017422611
012262017
<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:
171
029684628
17196 75
171
$1,748,869 $184,382 $1,728,756 $1,735$0 $1,460,303 $5,122,309
34.1% 3.6% 33.7% 0.0%0.0% 28.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2740
DaVita - Morris Dialysis1551 Creek DriveMorrisGrundy9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Z. Teresa Majka-Kravets
4/10/2017 - Relinquished permit to establish 12 station facility at 180 East Waverly Street in Morris. Facility reverts to 9 stations at 1551 Creek Drive in Morris.v
In-Center Treatments in calendar year: 5,772Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 42
Patients treated as of 12/31/2017: (Ending patients) 36
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
11
Oct 3
11
Oct 4
11
Oct 5
11
Oct 6
11
Oct 7
11
0 19 16 15 15 19 15
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 26Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 448
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
44Total:
38Total:
USE RATE for the FACILITY
8,424Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 74%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 75
78%67%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 : 3Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 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
62
82.7%
Medicaid
5
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
75
6.7% 5.3% 0.0%0.0% 5.3% 100.0%
Patients
TOTAL 1011
72
3720
0
059
1314
028
1014
<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
07
1723287541 34
75
$1,136,910 $123,820 $264,510 $0$0 $182,882 $1,708,122
66.6% 7.2% 15.5% 0.0%0.0% 10.7% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2736
DaVita Barrington Creek 28160 W. Northwest HighwayLake BarringtonLake7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Meidcal Development
Provides Incenter Noctural Dialysis:
Medical Director Name: Sumit Bector
In-Center Treatments in calendar year: 3,124Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 23
Patients treated as of 12/31/2017: (Ending patients) 20
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
10
Oct 3
0
Oct 4
10
Oct 5
0
Oct 6
10
Oct 7
0
0 20 0 14 0 17 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 13Transient Patients: 8Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 17Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 74
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
24Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 28%Use Rate (including Missed Treatments): 28%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 41
32%28%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 12
Full-Time Work Week: 40Registered Nurse : 1Dialysis Technician : 3Dietician : 0.25Social Worker: 0.25LPN : 0Other Health : 0.33Other Non-Health: 0.25
Authorized Stations as of 12/31/2017: 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
82.9%
Medicaid
1
Private Insurance
6
Charity Care
2
Private Pay
0
Other Public
0
TOTAL
41
2.4% 14.6% 4.9%0.0% 0.0% 100.0%
Patients
TOTAL 1031
38
3400
0
03
127
12
01314
<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
04
158
164334 9
43
$547,135 $0 $581,112 $49,265$98,377Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2712
Davita Big Oaks Dialysis Center5623 W. Touhy AvenueNilesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: DDR Corp
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Lynn Anderson
In-Center Treatments in calendar year: 7,606Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 36
Patients treated as of 12/31/2017: (Ending patients) 48
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 187.0
Oct 1
0
Oct 2
14
Oct 3
10
Oct 4
14
Oct 5
10
Oct 6
14
Oct 7
10
0 30 22 27 18 29 16
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 48Transient Patients: 26Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 48Patients voluntarily discontinued: 1Patients 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
57Total:
74Total:
USE RATE for the FACILITY
11,232Treatment 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: 17
50%67%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 : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
75
73.5%
Medicaid
5
Private Insurance
15
Charity Care
1
Private Pay
0
Other Public
7
TOTAL
102
4.9% 14.7% 1.0%0.0% 6.9% 100.0%
Patients
TOTAL 20061
62
6898
14
08
231317
02
131215
<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
010362532
10361 42
103
$1,158,932 $48,410 $1,198,548 $48,675$496,313Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2598
DaVita Carpentersville Dialysis2203 Randall RoadCarpentersvilleKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
4th Shift of patients
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Nasir J. Ahmad
In-Center Treatments in calendar year: 11,528Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 71
Patients treated as of 12/31/2017: (Ending patients) 80
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 38 34 37 35 40 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 42Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 23Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 178
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
50Total:
USE RATE for the FACILITY
12,168Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 95%Use Rate (including Missed Treatments): 96%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 111
91%103%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 : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
84
77.1%
Medicaid
6
Private Insurance
18
Charity Care
2
Private Pay
0
Other Public
1
TOTAL
109
5.5% 16.5% 1.8%0.0% 0.9% 100.0%
Patients
TOTAL 7050
65
3400
0
06
212524
027
1313
<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
08
283837
11176 35
34
$1,920,234 $40,115 $2,406,272 $7,670$491,165Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2822
DaVita Collinsville101 Lanter CourtCollinsvilleMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Pace Properties
Provides Incenter Noctural Dialysis:
Medical Director Name: Sriraj Kanungo
In-Center Treatments in calendar year: 343Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 11
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1 Oct 2
12
Oct 3 Oct 4
12
Oct 5 Oct 6
12
Oct 7
12 12 12
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 12Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 3Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 15
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
3Total:
14Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 5%Use Rate (including Missed Treatments): 5%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 14
0%23%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 : 0Dialysis Technician : 0Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
11
84.6%
Medicaid
2
Private Insurance
0
Charity Care
1
Private Pay
0
Other Public
0
TOTAL
13
15.4% 0.0% 7.7%0.0% 0.0% 100.0%
Patients
TOTAL 00903
2120
2
04251
00011
<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:
14
04262
1412 2
14
$65,099 $9,057 $295$15,546Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2575
DaVita Country Hills Dialysis4215 W. 167th StreetCountry Club HillsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Renal IncLegal Entity Owner:
Property Owner: Stenstrom
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Kenneth Cline
In-Center Treatments in calendar year: 12,476Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 102
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1 Oct 2
16
Oct 3
11
Oct 4
16
Oct 5
11
Oct 6
16
Oct 7
16
0 53 42 54 45 56 44
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 71Transient Patients: 37Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 89Patients voluntarily discontinued: 1Patients lost to follow up: 3Patients deceased: 15
Number of Missed Treatments: 894
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
112Total:
108Total:
USE RATE for the FACILITY
22,464Treatment 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: 46
0%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: 1
Full-Time Work Week: 40Registered Nurse : 4Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
0
#Num!
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
0
#Num! #Num! #Num!#Num! #Num! #Num!
Patients
TOTAL 00
1231
16
9140
0
0
017312515
012191812
<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
029504327
14988 61
149
$0Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2716
DaVita Crystal Springs720 Cog CircleCrystal LakeMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Apex 720, LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Sumit Bector
11/20/2017 - Facility added 2 ESRD stations; facility now has 16 ESRD stations.
In-Center Treatments in calendar year: 8,859Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 62
Patients treated as of 12/31/2017: (Ending patients) 59
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
15.5
Oct 3
11
Oct 4
15.5
Oct 5
11
Oct 6
15.5
Oct 7
11
0 34 22 30 19 33 21
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 28Patients Re-Started: 4Post-Transplant Patien 1
Recovered patients: 4Transplant Recipients: 1Patients transferred out: 38Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 112
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
56Total:
USE RATE for the FACILITY
14,976Treatment 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: 115
65%61%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 : 5Dietician : 0.75Social Worker: 0.75LPN : 0Other Health : 0.33Other Non-Health: 0.75
Authorized Stations as of 12/31/2017: 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
77.9%
Medicaid
6
Private Insurance
16
Charity Care
2
Private Pay
0
Other Public
1
TOTAL
104
5.8% 15.4% 1.9%0.0% 1.0% 100.0%
Patients
TOTAL 3051
97
17890
0
08
251712
03
14207
<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
011393719
10662 44
106
$1,615,061 $87,423 $1,796,971 $55,165$216,189Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2747
Davita Driftwood Dialysis1808 South West Ave.Freeport Stephenson1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: DavitaLegal Entity Owner:
Property Owner: Frontier Real Estate Investment co.LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: John Maynard
In-Center Treatments in calendar year: 5,223Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 38
Patients treated as of 12/31/2017: (Ending patients) 33
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 205.0
Oct 1
0
Oct 2
13
Oct 3
6
Oct 4
13
Oct 5
6
Oct 6
13
Oct 7
6
0 29 7 24 7 28 7
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 10Transient Patients: 15Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 24Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 367
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
31Total:
26Total:
USE RATE for the FACILITY
9,360Treatment 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: 63
63%55%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 : 2Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
52
83.9%
Medicaid
7
Private Insurance
1
Charity Care
1
Private Pay
0
Other Public
2
TOTAL
62
11.3% 1.6% 1.6%0.0% 3.2% 100.0%
Patients
TOTAL 00
220
40
1620
1
02
2068
018
135
<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
03
2819136336 27
63
$1,212,424 $105,401 $44,502 $7,375$219,922Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2511
DaVita Evanston Renal Center1922 Dempster StreetEvanstonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Schwab Realty and Development
Provides Incenter Noctural Dialysis:
Medical Director Name: George C. Kim
3/16/2017 - Added 2 ESRD stations to existing facility; facility now has 20 ESRD stations.
In-Center Treatments in calendar year: 12,589Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 84
Patients treated as of 12/31/2017: (Ending patients) 83
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
15
Oct 4
15
Oct 5
15
Oct 6
15
Oct 7
15
0 47 34 43 34 43 35
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 24Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 45Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 298
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
61Total:
60Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 144
70%69%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 : 4Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
97
72.9%
Medicaid
26
Private Insurance
10
Charity Care
11
Private Pay
0
Other Public
0
TOTAL
133
19.5% 7.5% 8.3%0.0% 0.0% 100.0%
Patients
TOTAL 210
580
65
27117
0
0
010361817
06
251319
<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
016613136
14481 63
144
$1,491,798 $116,223 $1,067,434 $333,350$1,301,701Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2622
Davita Hazel Crest3470 W. 183rd StreetHazel CrestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Daniel Yohay
3/10/2017 - Added 1 station to existing facility; Facility now has 20 ESRD stations.
In-Center Treatments in calendar year: 14,231Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 105
Patients treated as of 12/31/2017: (Ending patients) 104
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
21
Oct 3
16
Oct 4
21
Oct 5
16
Oct 6
21
Oct 7
16
0 52 39 53 35 59 38
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 42Transient Patients: 19Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 5Patients transferred out: 31Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 283
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
62Total:
USE RATE for the FACILITY
18,720Treatment 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: 216
88%87%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 : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
0
0.0%
Medicaid
5691
Private Insurance
0
Charity Care
3540
Private Pay
0
Other Public
0
TOTAL
5691
100.0% 0.0% 62.2%0.0% 0.0% 100.0%
Patients
TOTAL 00
1500
14
6158
0
0
019402018
010221817
<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
029623835
16497 67
164
$0Net Revenue
12/31/20171/10/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2828
Davita Huntley Dialysis10370 Haligus Road, Suite 100HuntleyMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: DavitaLegal Entity Owner:
Property Owner: Healthcare Trust of America
In November 2017 Davita Huntley was treating one patient while awaiting CMS certification. Huntley received it CMS certification on 1/18/2018.
Provides Incenter Noctural Dialysis:
Medical Director Name: Amit Arora
In-Center Treatments in calendar year: 24Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 1
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
0
Oct 3
0
Oct 4
0
Oct 5
0
Oct 6
0
Oct 7
0
0 0 0 0 0 0 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
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: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
0Total:
1Total:
USE RATE for the FACILITY
0Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): #Div/0!Use Rate (including Missed Treatments): #Div/0!Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 0
#Num!#Div/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: 40Registered Nurse : 1Dialysis Technician : 1Dietician : 0.5Social Worker: 0LPN : 0Other Health : 0.5Other Non-Health: 0
Authorized Stations as of 12/31/2017: 0Certified Stations by CMS: 0Peak Authorized Stations Operated: 0
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
000
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
0
$6,665 $0Net Revenue
12/31/201711/8/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2666
Davita Lake Villa Dialysis37809 N. IL Rte. 59 Lake VillaLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Center-Illinois, INC.Legal Entity Owner:
Property Owner: Omar Dalloul
Provides Incenter Noctural Dialysis:
Medical Director Name: Omar Dalloul
In-Center Treatments in calendar year: 7,619Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 53
Patients treated as of 12/31/2017: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 218.0
Oct 1
0
Oct 2
14
Oct 3
10
Oct 4
14
Oct 5
10
Oct 6
14
Oct 7
10
0 34 19 29 20 31 18
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 26Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 43Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 134
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
51Total:
53Total:
USE RATE for the FACILITY
11,232Treatment 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: 106
74%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: 12
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
74
73.3%
Medicaid
11
Private Insurance
11
Charity Care
5
Private Pay
0
Other Public
5
TOTAL
101
10.9% 10.9% 5.0%0.0% 5.0% 100.0%
Patients
TOTAL 3070
65
31750
31
08
251921
05
10126
<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
013353127
10673 33
106
$981,555 $108,529 $1,106,228 $96,170$0 $609,772 $2,806,083
35.0% 3.9% 39.4% 3.4%0.0% 21.7% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2668
DaVita Little Village2335 W. Cermak Rd.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Crystal Realty, Co.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Ogbonnaya Aneziokoro
In-Center Treatments in calendar year: 13,531Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 91
Patients treated as of 12/31/2017: (Ending patients) 93
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 41 44 41 44 45 43
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 28Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 27Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 190
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
42Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 90%Use Rate (including Missed Treatments): 92%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 133
95%97%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: 1
Authorized Stations as of 12/31/2017: 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
84
64.1%
Medicaid
10
Private Insurance
13
Charity Care
2
Private Pay
0
Other Public
24
TOTAL
131
7.6% 9.9% 1.5%0.0% 18.3% 100.0%
Patients
TOTAL 10
290
103
98350
0
013311815
08
201612
<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
021513427
13377 56
133
$1,798,669 $217,279 $1,494,267 $843,700$1,060,605Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2534
DaVita Logan Square2838 N Kimball AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other For Profit
Legal Entity Operator: DaVitaLegal Entity Owner:
Property Owner: Kendrew Development
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Kap J No
In-Center Treatments in calendar year: 21,358Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 147
Patients treated as of 12/31/2017: (Ending patients) 152
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 75 61 70 61 75 66
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 77Transient Patients: 38Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 2Transplant Recipients: 5Patients transferred out: 75Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 759
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
98Total:
118Total:
USE RATE for the FACILITY
26,208Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 81%Use Rate (including Missed Treatments): 84%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 262
88%90%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 : 7Dialysis Technician : 11Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
153
58.8%
Medicaid
52
Private Insurance
37
Charity Care
2
Private Pay
0
Other Public
18
TOTAL
260
20.0% 14.2% 0.8%0.0% 6.9% 100.0%
Patients
TOTAL 50
625
187
165943
3
027524722
018363921
<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:
262
045888643
262148 114
262
$2,828,515 $174,810 $3,737,465 $82,895$0 $1,676,094 $8,416,884
33.6% 2.1% 44.4% 1.0%0.0% 19.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2584
DaVita Macon County1090 W McKinley AvenueDecaturMacon4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DVA Renal Heathcare, IncLegal Entity Owner:
Property Owner: DVA Decatur IL Landlord LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Hasnain
In-Center Treatments in calendar year: 10,556Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 72
Patients treated as of 12/31/2017: (Ending patients) 70
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
12
Oct 3
12
Oct 4
12
Oct 5
12
Oct 6
12
Oct 7
12
0 39 29 39 31 37 33
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 28Transient Patients: 24Patients Re-Started: 3Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 35Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 18
Number of Missed Treatments: 419
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
58Total:
56Total:
USE RATE for the FACILITY
21,528Treatment 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: 127
52%51%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 : 4Dialysis Technician : 6Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 1Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
105
82.7%
Medicaid
17
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
127
13.4% 2.4% 0.0%0.0% 1.6% 100.0%
Patients
TOTAL 00
521
74
1126
0
0
011291414
07
221515
<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:
127
018512929
12768 59
127
$2,065,491 $280,716 $720,788 $0$0 $160,503 $3,227,498
64.0% 8.7% 22.3% 0.0%0.0% 5.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2527
DaVita Metro East5105 W. Main StreetBellevilleSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Columbia Pacific Advisors, LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: R. Dalal, MD
In-Center Treatments in calendar year: 2,081Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 188
Patients treated as of 12/31/2017: (Ending patients) 185
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 341.0
Oct 1
5
Oct 2
16
Oct 3
20
Oct 4
16
Oct 5
20
Oct 6
16
Oct 7
12
15 84 86 81 85 83 69
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 89Transient Patients: 32Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 6Transplant Recipients: 2Patients transferred out: 42Patients voluntarily discontinued: 9Patients lost to follow up: 1Patients deceased: 33
Number of Missed Treatments: 1,698
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
93Total:
121Total:
USE RATE for the FACILITY
33,696Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 6%Use Rate (including Missed Treatments): 11%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 223
87%86%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 : 13.55Dialysis Technician : 26.93Dietician : 2.6Social Worker: 1.8LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
184
83.6%
Medicaid
8
Private Insurance
19
Charity Care
5
Private Pay
0
Other Public
9
TOTAL
220
3.6% 8.6% 2.3%0.0% 4.1% 100.0%
Patients
TOTAL 10
1720
39
021411
13
017452723
014452727
<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:
225
031905450
225112 113
225
$4,584,667 $64,355 $2,979,100 $40,447$1,935,558Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2660
Davita Mt. Greenwood Dialysis3401 W. 111th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DavitaLegal Entity Owner:
Property Owner: Columbia Pacific Advisors, LLC
Mon/Wed/Friday- 4 shift for patient schedule
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohamad Barakat
In-Center Treatments in calendar year: 13,463Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 98
Patients treated as of 12/31/2017: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
18
Oct 3
16
Oct 4
18
Oct 5
16
Oct 6
18
Oct 7
16
0 47 38 40 37 43 38
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 31Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 10
Number of Missed Treatments: 866
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
44Total:
USE RATE for the FACILITY
14,976Treatment 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: 128
102%88%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 : 4.95Dialysis Technician : 9.2Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
112
88.2%
Medicaid
6
Private Insurance
8
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
127
4.7% 6.3% 0.8%0.0% 0.8% 100.0%
Patients
TOTAL 00
1060
22
7121
0
0
010371015
07
258
16
<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
017621831
12872 56
128
$2,126,948 $102,518 $1,009,577 $27,730$0 $1,214,316 $4,453,359
47.8% 2.3% 22.7% 0.6%0.0% 27.3% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2818
Davita O'Fallon1941 Frank Scott Parkway East, Suite BShilohSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: RLP Development Company, Inc.
N/A
Provides Incenter Noctural Dialysis:
Medical Director Name: Bassim Assioun, M.D.
In-Center Treatments in calendar year: 1,052Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 26
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
8
Oct 3
0
Oct 4
8
Oct 5
0
Oct 6
8
Oct 7
0
0 4 0 4 0 4 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 26Transient Patients: 16Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 2Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 16
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
4Total:
42Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 9%Use Rate (including Missed Treatments): 10%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 26
0%36%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 : 0Dialysis Technician : 0Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
29
67.4%
Medicaid
4
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
43
9.3% 11.6% 0.0%0.0% 11.6% 100.0%
Patients
TOTAL 10
251
16
0430
0
04
1365
01662
<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
05
19127
4328 15
43
$188,770 $7,979 $198,329 $0$0 $49,200 $444,278
42.5% 1.8% 44.6% 0.0%0.0% 11.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2548
DaVita Olympia Fields Dialysis Center4557 Lincoln HighwayMattesonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DaVitaLegal Entity Owner:
Property Owner: Joseph Freed
Provides Incenter Noctural Dialysis:
Medical Director Name:
In-Center Treatments in calendar year: 14,482Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 103
Patients treated as of 12/31/2017: (Ending patients) 98
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 228.0
Oct 1
0
Oct 2
17
Oct 3
11
Oct 4
17
Oct 5
11
Oct 6
17
Oct 7
11
0 57 40 46 38 39 40
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 68Transient Patients: 15Patients Re-Started: 6Post-Transplant Patien 2
Recovered patients: 6Transplant Recipients: 3Patients transferred out: 43Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 1,182
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
67Total:
91Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 70%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 163
72%68%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 12/31/2017: 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
70
43.8%
Medicaid
12
Private Insurance
21
Charity Care
3
Private Pay
0
Other Public
57
TOTAL
160
7.5% 13.1% 1.9%0.0% 35.6% 100.0%
Patients
TOTAL 20
1480
13
5158
0
0
011471711
09
411413
<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
020883124
16386 77
163
$1,763,790 $157,844 $2,387,758 $52,510$0 $1,557,805 $5,867,196
30.1% 2.7% 40.7% 0.9%0.0% 26.6% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2732
DaVita Palos Park Dialysis13155 S. LaGrange Road Orland ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Sonja Marcic
In-Center Treatments in calendar year: 7,506Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 46
Patients treated as of 12/31/2017: (Ending patients) 50
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 199.0
Oct 1
0
Oct 2
13
Oct 3
9.5
Oct 4
13
Oct 5
9.5
Oct 6
13
Oct 7
9.5
0 30 21 26 22 30 20
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 30Transient Patients: 27Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 0Patients transferred out: 46Patients voluntarily discontinued: 7Patients lost to follow up: 2Patients deceased: 9
Number of Missed Treatments: 150
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
57Total:
USE RATE for the FACILITY
11,232Treatment 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: 93
64%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: 0
Full-Time Work Week: 40Registered Nurse : 3Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
64
68.8%
Medicaid
1
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
20
TOTAL
93
1.1% 8.6% 0.0%0.0% 21.5% 100.0%
Patients
TOTAL 11
190
55
3855
17
01
111319
03
111619
<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
2229389344 49
93
$1,367,585 $619 $830,906 $0$0 $409,598 $2,608,708
52.4% 0.0% 31.9% 0.0%0.0% 15.7% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2647
DaVita Rockford Dialysis3339 Rockton AvenueRockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Krishna Sankaran
In-Center Treatments in calendar year: 14,800Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 109
Patients treated as of 12/31/2017: (Ending patients) 101
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 53 37 51 41 56 37
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 43Transient Patients: 7Patients Re-Started: 6Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 51Patients voluntarily discontinued: 11Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 1,770
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
72Total:
57Total:
USE RATE for the FACILITY
20,592Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 72%Use Rate (including Missed Treatments): 80%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 158
83%77%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: 30Registered Nurse : 7Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
123
78.3%
Medicaid
16
Private Insurance
9
Charity Care
1
Private Pay
5
Other Public
4
TOTAL
157
10.2% 5.7% 0.6%3.2% 2.5% 100.0%
Patients
TOTAL 10
881
68
13145
0
0
015442117
010261312
<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:
158
025703429
15897 61
158
$2,483,336 $233,099 $784,940 $295$0 $1,170,325 $4,671,701
53.2% 5.0% 16.8% 0.0%0.0% 25.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2665
DaVita Roxbury Dialysis622 Roxbury RdRockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Stenstrom Real Estates
Provides Incenter Noctural Dialysis:
Medical Director Name: James Stim, MD
In-Center Treatments in calendar year: 13,084Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 84
Patients treated as of 12/31/2017: (Ending patients) 87
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 227.0
Oct 1
0
Oct 2
22
Oct 3
16
Oct 4
22
Oct 5
16
Oct 6
22
Oct 7
16
0 49 38 50 39 50 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 38Transient Patients: 33Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 46Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 754
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
65Total:
73Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 87%Use Rate (including Missed Treatments): 92%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 154
88%91%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 : 11Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 2Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
121
79.6%
Medicaid
7
Private Insurance
21
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
152
4.6% 13.8% 1.3%0.0% 2.0% 100.0%
Patients
TOTAL 40
382
110
24130
0
0
09
411324
06
261718
<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
015673042
15487 67
154
$3,208,306 $111,294 $2,387,271 $24,287$0 $1,044,542 $6,751,413
47.5% 1.6% 35.4% 0.4%0.0% 15.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2561
DaVita Sauget Dialysis2061 Gooselake RoadSaugetSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Union Planter Trust
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Dalal
In-Center Treatments in calendar year: 11,637Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 77
Patients treated as of 12/31/2017: (Ending patients) 92
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 337.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 39 38 41 40 41 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 55Transient Patients: 14Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 29Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 851
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
45Total:
69Total:
USE RATE for the FACILITY
22,464Treatment 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: 132
53%64%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 : 4Dialysis Technician : 8Dietician : 1Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
74
56.9%
Medicaid
26
Private Insurance
28
Charity Care
2
Private Pay
0
Other Public
2
TOTAL
130
20.0% 21.5% 1.5%0.0% 1.5% 100.0%
Patients
TOTAL 00
12605
100
0
08
5112
6
08
211511
<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
016722717
13277 55
1
$1,657,207 $1,735 $866,935 $19,740$0 $647,743 $3,173,620
52.2% 0.1% 27.3% 0.6%0.0% 20.4% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2654
Davita Schaumburg Renal Center1156 S. Roselle Rd.SchaumburgCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Schaumburg, LLC Legal Entity Owner:
Property Owner: Targo Management Inc.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mussie Beraki
In-Center Treatments in calendar year: 12,537Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 84
Patients treated as of 12/31/2017: (Ending patients) 78
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
15
Oct 3
10
Oct 4
15
Oct 5
10
Oct 6
15
Oct 7
10
0 49 27 46 28 48 30
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 50Transient Patients: 27Patients Re-Started: 2Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 34Patients voluntarily discontinued: 2Patients lost to follow up: 3Patients deceased: 17
Number of Missed Treatments: 102
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
61Total:
81Total:
USE RATE for the FACILITY
20,592Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 144
64%59%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 : 5Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 22Certified Stations by CMS: 22Peak 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
106
74.6%
Medicaid
16
Private Insurance
17
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
142
11.3% 12.0% 1.4%0.0% 2.1% 100.0%
Patients
TOTAL 291
161
95
24120
0
2
07
261634
06
171820
<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
013433454
14483 61
144
$2,136,324 $70,704 $949,617 $42,080$0 $878,493 $4,035,138
52.9% 1.8% 23.5% 1.0%0.0% 21.8% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2586
DaVita Springfield Central Dialysis932 N. Rutledge St.Springfield Sangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Ashraf Tamizuddin
1/24/2017 - Received permit to discontinue a 21 station ESRD facility at 932 North Rutledge Street in Springfield and to establish a 21 station ESRD facility at 600 North Grand Avenue West in Springfield.
In-Center Treatments in calendar year: 11,705Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 84
Patients treated as of 12/31/2017: (Ending patients) 81
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 1 Oct 2
15
Oct 3
11
Oct 4
15
Oct 5
11
Oct 6
15
Oct 7
11
46 36 43 32 40 38
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 18Patients Re-Started: 2Post-Transplant Patien 2
Recovered patients: 4Transplant Recipients: 1Patients transferred out: 30Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 1,173
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
56Total:
55Total:
USE RATE for the FACILITY
19,656Treatment 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: 129
67%64%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: 40Registered Nurse : 5Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
99
77.3%
Medicaid
17
Private Insurance
8
Charity Care
1
Private Pay
0
Other Public
4
TOTAL
128
13.3% 6.3% 0.8%0.0% 3.1% 100.0%
Patients
TOTAL 00
610
67
1128
0
1
07
331818
04
221611
<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:
129
011553429
12976 53
129
$2,114,502 $218,395 $1,170,128 $3,835$0 $417,506 $3,920,530
53.9% 5.6% 29.8% 0.1%0.0% 10.6% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2590
Davita Springfield Montvale2930 Montvale Drive Suite ASpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Marriott PropertiesLegal Entity Owner:
Property Owner: Bill Marriott, Jr
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohamed Alhosaini
In-Center Treatments in calendar year: 5,058Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 66
Patients treated as of 12/31/2017: (Ending patients) 73
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
6
Oct 2
12
Oct 3
11
Oct 4
12
Oct 5
11
Oct 6
12
Oct 7
11
10 28 39 30 36 29 24
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 26Transient Patients: 12Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 9Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 931
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
24Total:
42Total:
USE RATE for the FACILITY
15,912Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 32%Use Rate (including Missed Treatments): 38%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 104
65%72%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 : 3.39Dialysis Technician : 7.14Dietician : 0.81Social Worker: 0.65LPN : 0Other Health : 0Other Non-Health: 1.96
Authorized Stations as of 12/31/2017: 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
78
75.0%
Medicaid
11
Private Insurance
14
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
104
10.6% 13.5% 0.0%0.0% 1.0% 100.0%
Patients
TOTAL 00
410
63
2102
0
0
06
221610
01115168
<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
017373218
10454 50
104
$1,774,182 $61,688 $1,161,195 $61,688$0 $459,232 $3,456,298
51.3% 1.8% 33.6% 1.8%0.0% 13.3% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2718
DaVita Stony Island8725 S Stony IslandChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Tiebout IL LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Nicole Stankus
In-Center Treatments in calendar year: 22,857Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 178
Patients treated as of 12/31/2017: (Ending patients) 155
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
19
Oct 3
16
Oct 4
19
Oct 5
16
Oct 6
19
Oct 7
16
0 77 65 75 65 78 58
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 82Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 5Transplant Recipients: 9Patients transferred out: 48Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 19
Number of Missed Treatments: 796
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
83Total:
90Total:
USE RATE for the FACILITY
29,952Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 76%Use Rate (including Missed Treatments): 79%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 328
93%81%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: 40Registered Nurse : 8.43Dialysis Technician : 22.2Dietician : 1.5Social Worker: 2LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
178
75.1%
Medicaid
10
Private Insurance
43
Charity Care
1
Private Pay
0
Other Public
6
TOTAL
237
4.2% 18.1% 0.4%0.0% 2.5% 100.0%
Patients
TOTAL 00
23602
7231
0
0
014652019
016442931
<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:
238
030
1094950
238118 120
238
$138,160 $3,902,725 $1,350,891 $14,455$0 $1,899,786 $7,291,562
1.9% 53.5% 18.5% 0.2%0.0% 26.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2639
Davita Sycamore2200 Gateway DriveSycamoreDeKalb1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: DIALYSIS OF NORTHERN IL, LLCLegal Entity Owner:
Property Owner: PATRICA DENARDE
Provides Incenter Noctural Dialysis:
Medical Director Name: BINDU PAVITHRAN, MD
In-Center Treatments in calendar year: 8,467Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 55
Patients treated as of 12/31/2017: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 220.0
Oct 1
0
Oct 2
15
Oct 3
13
Oct 4
15
Oct 5
13
Oct 6
15
Oct 7
13
0 31 22 31 22 30 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 25Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 18Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 5
Number of Missed Treatments: 495
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
26Total:
52Total:
USE RATE for the FACILITY
11,232Treatment 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: 99
76%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 : 2Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
64
66.0%
Medicaid
24
Private Insurance
9
Charity Care
2
Private Pay
0
Other Public
0
TOTAL
97
24.7% 9.3% 2.1%0.0% 0.0% 100.0%
Patients
TOTAL 10
190
79
11880
0
07
211315
05
141212
<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
0123525279956 43
99
$1,583,145 $113,631 $824,866 $590$0 $341,551 $2,863,193
55.3% 4.0% 28.8% 0.0%0.0% 11.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2587
DaVita Taylorville901 West Spresser StreetTaylorvilleChristian3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Lawrence J. Smith, MD
1/4/2017 - Facility approved for permit to add 2 ESRD stations to an existing facility; facility now has 12 ESRD stations.
In-Center Treatments in calendar year: 6,591Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 51
Patients treated as of 12/31/2017: (Ending patients) 44
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 205.0
Oct 1
0
Oct 2
14
Oct 3
10
Oct 4
14
Oct 5
10
Oct 6
14
Oct 7
10
0 27 15 25 16 27 16
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 7Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 409
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
21Total:
15Total:
USE RATE for the FACILITY
11,232Treatment 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: 66
71%61%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 : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 12Certified Stations by CMS: 12Peak 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
53
81.5%
Medicaid
8
Private Insurance
3
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
65
12.3% 4.6% 1.5%0.0% 1.5% 100.0%
Patients
TOTAL 0020
64
0660
0
0589
13
01
119
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:
66
06
1918236635 31
66
$1,215,036 $102,073 $282,331 $4,425$0 $220,486 $1,819,927
66.8% 5.6% 15.5% 0.2%0.0% 12.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2719
Davita West Lawn Dialysis7000 S Pulaski RdChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Bob Dellitti
Provides Incenter Noctural Dialysis:
Medical Director Name: Michael Arvan, MD
In-Center Treatments in calendar year: 9,587Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 69
Patients treated as of 12/31/2017: (Ending patients) 67
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
15
Oct 4
15
Oct 5
15
Oct 6
15
Oct 7
15
0 35 26 31 28 32 29
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 34Transient Patients: 19Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 2Patients transferred out: 37Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 798
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
53Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 85%Use Rate (including Missed Treatments): 92%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 64
96%93%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 : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
39
63.9%
Medicaid
11
Private Insurance
11
Charity Care
3
Private Pay
0
Other Public
0
TOTAL
61
18.0% 18.0% 4.9%0.0% 0.0% 100.0%
Patients
TOTAL 10
170
46
42220
0
05
1088
05
14104
<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
0102418126431 33
64
$1,358,920 $175,420 $1,677,685 $42,775$0 $390,106 $3,602,131
37.7% 4.9% 46.6% 1.2%0.0% 10.8% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2599
Decatur East Wood Dialysis794 East Wood StreetDecaturMacon4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DAVITA DIALYSISLegal Entity Owner:
Property Owner: SHAMS SIDDIQUI
FA LAST DAY MARCH 22, 2018. ANY FOLLOWUP TO SURVEY NEEDS TO BE DIRECTED TO REGIONAL OPERATION DIRECTOR: CYNTHIA EMLEY AT [email protected]
Provides Incenter Noctural Dialysis:
Medical Director Name: MOHAMMAD HASNAIN
In-Center Treatments in calendar year: 9,005Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 66
Patients treated as of 12/31/2017: (Ending patients) 61
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 1
0
Oct 2
11
Oct 3
11
Oct 4
11
Oct 5
11
Oct 6
11
Oct 7
11
0 31 31 26 30 30 30
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 27Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 381
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
44Total:
44Total:
USE RATE for the FACILITY
16,848Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 53%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 99
61%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 12/31/2017: 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
59
60.8%
Medicaid
13
Private Insurance
6
Charity Care
2
Private Pay
0
Other Public
19
TOTAL
97
13.4% 6.2% 2.1%0.0% 19.6% 100.0%
Patients
TOTAL 00
500
49
000
0
010211114
04
21108
<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
0144221229956 43
0
$1,858,039 $189,561 $1,268,140 $14,160$0 $309,890 $3,625,629
51.2% 5.2% 35.0% 0.4%0.0% 8.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2505
DSI Renal Dialysis Center1101 S. Canal Street ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Davita Legal Entity Owner:
Property Owner: Canal and Taylor South LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Sheldon Hirsch
In-Center Treatments in calendar year: 15,348Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 102
Patients treated as of 12/31/2017: (Ending patients) 101
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
12
Oct 4
15
Oct 5
12
Oct 6
15
Oct 7
12
0 49 37 51 38 48 42
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 38Transient Patients: 21Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 3Patients transferred out: 40Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 835
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
60Total:
59Total:
USE RATE for the FACILITY
26,208Treatment 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: 161
61%60%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: 40Registered Nurse : 5Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health :Other Non-Health: 3
Authorized Stations as of 12/31/2017: 28Certified Stations by CMS: 28Peak 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
95
62.1%
Medicaid
31
Private Insurance
19
Charity Care
8
Private Pay
4
Other Public
4
TOTAL
153
20.3% 12.4% 5.2%2.6% 2.6% 100.0%
Patients
TOTAL 160
1200
25
13148
0
0
04
412219
08
271822
<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
012684041
16186 75
161
$2,534,831 $68,143 $1,957,654 $63,315$1,026,098Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2701
Edwardsville Dialysis235 South Buchanan StreetEdwardsvilleMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Partner LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Felicia Bentley
In-Center Treatments in calendar year: 4,902Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 37
Patients treated as of 12/31/2017: (Ending patients) 39
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
17
Oct 3
11
Oct 4
17
Oct 5
11
Oct 6
17
Oct 7
11
0 22 16 23 16 21 17
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 14Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 130
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
24Total:
36Total:
USE RATE for the FACILITY
7,488Treatment 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: 61
77%81%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 : 4Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 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
51
83.6%
Medicaid
0
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
61
0.0% 13.1% 0.0%0.0% 3.3% 100.0%
Patients
TOTAL 00
110
47
0583
3
02
1212
9
02879
<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:
61
04
2019186135 26
61
$874,281 $523,737 $0$417,207Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2580
Effingham DaVita Dialysis904 Medical Park Dr., Suite 1EffinghamEffingham5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Bashar Alzahabi
In-Center Treatments in calendar year: 6,679Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 44
Patients treated as of 12/31/2017: (Ending patients) 49
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
13
Oct 3
7
Oct 4
13
Oct 5
7
Oct 6
13
Oct 7
7
0 32 12 30 10 32 12
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 3Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 10Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 8
Number of Missed Treatments: 398
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
25Total:
19Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 45%Use Rate (including Missed Treatments): 47%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 66
46%51%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: 0LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
55
83.3%
Medicaid
5
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
66
7.6% 6.1% 0.0%0.0% 3.0% 100.0%
Patients
TOTAL 0020
64
1650
0
04
1010
9
02
101110
<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
06
2021196633 33
66
$1,935,407 $82,027 $825,648 $0 $152,063 $2,995,144
64.6% 2.7% 27.6% 0.0% 5.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2529
Emerald Dialysis710 W 43rd StChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: John Regas
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Edwin Cook
In-Center Treatments in calendar year: 14,388Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 111
Patients treated as of 12/31/2017: (Ending patients) 105
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 49 43 49 40 55 42
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 15Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 35Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 11
Number of Missed Treatments: 795
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
52Total:
40Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 68%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 149
77%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: 0
Full-Time Work Week: 35Registered Nurse : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
49.3%
Medicaid
11
Private Insurance
8
Charity Care
5
Private Pay
0
Other Public
54
TOTAL
144
7.6% 5.6% 3.5%0.0% 37.5% 100.0%
Patients
TOTAL 10
14502
14134
1
1
0284116
5
0133358
<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:
149
041742113
14990 59
149
$1,939,277 $150,453 $1,272,689 $77,585$0 $1,553,183 $4,915,602
39.5% 3.1% 25.9% 1.6%0.0% 31.6% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2568
Fox Valley Dialysis, Ltd.1300 Waterford DriveAuroraKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Operated by Renaissance Management Co. LLC Legal Entity Owner:
Property Owner: RBSG&M
Additional Related Entities Yorkville Medical Building Affiliated None RBSG&M Affiliated Building Lease Agreement
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Pardeep Sood
In-Center Treatments in calendar year: 19,870Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 131
Patients treated as of 12/31/2017: (Ending patients) 143
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 78 56 72 57 75 55
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 67Transient Patients: 12Patients Re-Started: 4Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 43Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 21
Number of Missed Treatments: 948
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
71Total:
83Total:
USE RATE for the FACILITY
27,144Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 73%Use Rate (including Missed Treatments): 77%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 214
75%82%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 : 9.01Dialysis Technician : 13.41Dietician : 1.26Social Worker: 1.4LPN : 3.24Other Health : 0.52Other Non-Health: 2.55
Authorized Stations as of 12/31/2017: 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
70.6%
Medicaid
36
Private Insurance
27
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
214
16.8% 12.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 110
390
164
90124
0
0
016533122
018362117
<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
034895239
214122 92
214
$2,818,835 $459,549 $2,422,210 $0Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2642
Freeport Dialysis1028 Kunkle BLVD Freeport Stephenson1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers of IllinoisLegal Entity Owner:
Property Owner: Edmund and Siham Totah
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. John Maynard
In-Center Treatments in calendar year: 4,125Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 27
Patients treated as of 12/31/2017: (Ending patients) 26
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 219.0
Oct 1
0
Oct 2
12
Oct 3
8
Oct 4
12
Oct 5
8
Oct 6
12
Oct 7
8
0 19 9 18 10 19 10
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 3Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 11Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 289
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
18Total:
20Total:
USE RATE for the FACILITY
9,360Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 44%Use Rate (including Missed Treatments): 47%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 46
45%43%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 : 1Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1.2Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 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
35
76.1%
Medicaid
6
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
46
13.0% 0.0% 0.0%0.0% 10.9% 100.0%
Patients
TOTAL 00
120
17
2440
17
04
1067
00496
<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
04
1415134627 19
46
$734,496 $139,301 $0 $0$0 $184,543 $1,058,340
69.4% 13.2% 0.0% 0.0%0.0% 17.4% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2827
Fresenius Kidney Care 9924 S. VincennesChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Mosaic Real Estate Investments
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ali Khan, MD
In-Center Treatments in calendar year: 15Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 1
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
7
Oct 3
0
Oct 4
7
Oct 5
0
Oct 6
7
Oct 7
0
0 1 0 1 0 1 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
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 FACILITY
11,232Treatment 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: 1Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1Dialysis Technician : 0.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 12Certified Stations by CMS: 0Peak 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
0
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
1
0.0% 100.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00100
010
0
00100
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
0010011 0
1
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2667
Fresenius Kidney Care 11630 S. Kedzie AvenueMerrionette ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: RSA Companies
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ejikeme Obasi, MD
In-Center Treatments in calendar year: 19,952Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 130
Patients treated as of 12/31/2017: (Ending patients) 137
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
17.5
Oct 3
17.5
Oct 4
17.5
Oct 5
17.5
Oct 6
17.5
Oct 7
17.5
0 67 61 60 65 61 58
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 14Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 28Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 775
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
38Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 89%Use Rate (including Missed Treatments): 92%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 168
90%95%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 : 10Dialysis Technician : 12Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
101
60.1%
Medicaid
3
Private Insurance
63
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
168
1.8% 37.5% 0.0%0.0% 0.6% 100.0%
Patients
TOTAL 20
1400
26
9159
0
0
011342518
08
242523
<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:
168
019585041
16888 80
168
$2,660,340 $48,846 $3,635,825 $0$2,938 $1,338 $6,349,287
41.9% 0.8% 57.3% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2562
Fresenius Kidney Care East Peoria 3300 N. Main StreetPeoriaTazewell2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Rosborough, MD
In-Center Treatments in calendar year: 14,743Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 101
Patients treated as of 12/31/2017: (Ending patients) 104
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
19
Oct 3
18
Oct 4
19
Oct 5
18
Oct 6
19
Oct 7
16
0 50 47 51 48 50 46
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 45Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 26Patients voluntarily discontinued: 5Patients lost to follow up: 1Patients deceased: 15
Number of Missed Treatments: 676
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
53Total:
USE RATE for the FACILITY
22,464Treatment 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: 156
70%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: 0
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 14Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
102
65.4%
Medicaid
4
Private Insurance
49
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
156
2.6% 31.4% 0.0%0.0% 0.6% 100.0%
Patients
TOTAL 00
390
117
2154
0
0
07
452517
09
171917
<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:
156
016624434
15694 62
156
$2,188,069 $45,166 $2,619,577 $0$4,050 $0 $4,856,862
45.1% 0.9% 53.9% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2670
Fresenius Kidney Care Ross-Englewood 6333 S. Green StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Ross Dialysis Englewood, LLC Legal Entity Owner:
Property Owner: AIN Investments, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: April Kennedy, MD
1/24/2017 - Received permit to discontinue a 16 station ESRD facility at 6333 South Green Street in Chicago and to establish a 24 station ESRD facility at 6226 South Sangamon Street in Chicago.
In-Center Treatments in calendar year: 10,615Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 82
Patients treated as of 12/31/2017: (Ending patients) 75
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 275.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 39 38 39 35 35 37
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 40Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 39Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 9
Number of Missed Treatments: 1,093
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
52Total:
51Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 47%Use Rate (including Missed Treatments): 52%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 123
57%52%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 12/31/2017: 24Certified 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
71
57.7%
Medicaid
5
Private Insurance
44
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
123
4.1% 35.8% 0.0%0.8% 1.6% 100.0%
Patients
TOTAL 00
12200
1122
0
1
09
3917
9
01017148
<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
019563117
12374 49
123
$1,712,571 $21,955 $1,320,454 $0$9,404 $26,563 $3,090,947
55.4% 0.7% 42.7% 0.0%0.3% 0.9% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2658
Fresenius Kidney Care Aledo409 NW 9th AvenueAledoMercer10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: RRS Investments, LLP
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Travis Figanbaum, MD
In-Center Treatments in calendar year: 1,949Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 13
Patients treated as of 12/31/2017: (Ending patients) 12
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 400.0
Oct 1
0
Oct 2
13
Oct 3
0
Oct 4
12
Oct 5
0
Oct 6
12
Oct 7
0
0 12 0 12 0 12 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 2Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 3Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 7
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
4Total:
3Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 26%Use Rate (including Missed Treatments): 26%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 16
27%25%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 12/31/2017: 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
13
81.3%
Medicaid
0
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
16
0.0% 12.5% 0.0%0.0% 6.3% 100.0%
Patients
TOTAL 0010
15
0160
0
00331
00216
<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
167 9
16
$318,132 $0 $41,314 $0$0 $0 $359,446
88.5% 0.0% 11.5% 0.0%0.0% 0.0% 100.0%Net Revenue
1/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2630
Fresenius Kidney Care Alsip12250 S Cicero, Suite 105AlsipCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sejal Kalawadia, MD
In-Center Treatments in calendar year: 12,635Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 85
Patients treated as of 12/31/2017: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
13
Oct 4
18
Oct 5
13
Oct 6
18
Oct 7
13
0 43 42 43 42 43 42
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 32Transient Patients: 5Patients Re-Started: 3Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 21Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 357
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
41Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 116
71%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 : 5Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
72
62.1%
Medicaid
0
Private Insurance
44
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
116
0.0% 37.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
810
35
22940
0
09
251411
01
221816
<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
010473227
11659 57
116
$1,916,456 $17,898 $2,527,461 $0$11,000 $5,611 $4,478,426
42.8% 0.4% 56.4% 0.0%0.2% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2673
Fresenius Kidney Care Antioch311 Depot Street, Suite HAntiochLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Degani
In-Center Treatments in calendar year: 5,172Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 36
Patients treated as of 12/31/2017: (Ending patients) 29
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
14
Oct 3
12
Oct 4
14
Oct 5
12
Oct 6
14
Oct 7
12
0 18 10 19 11 18 13
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 22Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 30Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 131
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
36Total:
32Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 46%Use Rate (including Missed Treatments): 47%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 66
50%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: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
43
65.2%
Medicaid
1
Private Insurance
20
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
66
1.5% 30.3% 0.0%0.0% 3.0% 100.0%
Patients
TOTAL 2090
55
4620
0
02
1994
01
101110
<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
03
2920146634 32
66
$557,063 $9,844 $499,768 $0$3,299 $33,891 $1,103,865
50.5% 0.9% 45.3% 0.0%0.3% 3.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2515
Fresenius Kidney Care Aurora 455 Mercy LaneAuroraKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 , IN
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Navinchandra Dodhia, MD
In-Center Treatments in calendar year: 21,813Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 152
Patients treated as of 12/31/2017: (Ending patients) 148
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
22
Oct 3
19
Oct 4
22
Oct 5
19
Oct 6
22
Oct 7
19
0 74 63 72 67 77 64
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 53Transient Patients: 4Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 3Transplant Recipients: 6Patients transferred out: 24Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 22
Number of Missed Treatments: 598
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
56Total:
61Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 97%Use Rate (including Missed Treatments): 100%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 204
106%103%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 : 7.5Dialysis Technician : 17Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
108
52.9%
Medicaid
4
Private Insurance
80
Charity Care
0
Private Pay
9
Other Public
3
TOTAL
204
2.0% 39.2% 0.0%4.4% 1.5% 100.0%
Patients
TOTAL 50
580
137
113910
4
020492428
08
303114
<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
028795542
204121 83
204
$3,045,378 $20,873 $4,858,838 $0$80,974 $56,187 $8,062,250
37.8% 0.3% 60.3% 0.0%1.0% 0.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2653
Fresenius Kidney Care Austin Community 4800 W. Chicago Ave., Suite 2AChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Kracker, MD
In-Center Treatments in calendar year: 8,149Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 93
Patients treated as of 12/31/2017: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 31 19 29 20 31 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 15Transient Patients: 16Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 4Patients transferred out: 32Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 491
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
32Total:
USE RATE for the FACILITY
16,848Treatment 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: 60
86%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: 32Registered Nurse : 2Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
53
57.0%
Medicaid
3
Private Insurance
36
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
93
3.2% 38.7% 0.0%1.1% 0.0% 100.0%
Patients
TOTAL 00
810
12
11820
0
0112510
3
07
17119
<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
0184221129349 44
93
$1,491,726 $49,729 $1,250,539 $0$4,120 $0 $2,796,114
53.3% 1.8% 44.7% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2533
Fresenius Kidney Care Berwyn 2601 S. Harlem Ave.BerwynCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Anderson, MD
6/1/2017 - Facility added 2 ESRD stations to existing 28 station facility; facility now authorized for 30 ESRD stations.
In-Center Treatments in calendar year: 22,203Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 150
Patients treated as of 12/31/2017: (Ending patients) 151
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 72 73 72 72 71 72
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 50Transient Patients: 12Patients Re-Started: 2Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 7Patients transferred out: 47Patients voluntarily discontinued: 1Patients lost to follow up: 2Patients deceased: 7
Number of Missed Treatments: 328
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
65Total:
66Total:
USE RATE for the FACILITY
28,080Treatment 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: 228
83%84%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 : 9Dialysis Technician : 16Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2017: 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
127
55.7%
Medicaid
14
Private Insurance
75
Charity Care
0
Private Pay
12
Other Public
0
TOTAL
228
6.1% 32.9% 0.0%5.3% 0.0% 100.0%
Patients
TOTAL 10
290
194
147774
4
019673918
013381915
<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:
228
032
1055833
228143 85
228
$3,001,315 $100,744 $5,565,042 $0$136,393 $19,681 $8,823,175
34.0% 1.1% 63.1% 0.0%1.5% 0.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2539
Fresenius Kidney Care Blue Island 12200 Western Ave., Suite 120Blue IslandCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Shops at Blue Island LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Salvatore Ventura, MD
In-Center Treatments in calendar year: 17,872Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 117
Patients treated as of 12/31/2017: (Ending patients) 116
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 58 56 54 54 54 54
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 28Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 18Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 345
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
30Total:
USE RATE for the FACILITY
26,208Treatment 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: 147
70%69%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 : 8Dialysis Technician : 16Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
79
53.7%
Medicaid
1
Private Insurance
66
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
147
0.7% 44.9% 0.0%0.0% 0.7% 100.0%
Patients
TOTAL 00
12400
14133
0
23
036311415
04
181910
<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:
147
040493325
14796 51
147
$2,438,447 $25,834 $3,440,902 $0$26,349 $46,816 $5,978,348
40.8% 0.4% 57.6% 0.0%0.4% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2605
Fresenius Kidney Care Bolingbrook 329 Remington Blvd.BolingbrookWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Ph
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Huma Rohail, MD
In-Center Treatments in calendar year: 18,505Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 120
Patients treated as of 12/31/2017: (Ending patients) 126
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
20
Oct 5
18
Oct 6
18
Oct 7
18
0 62 52 61 52 65 54
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 35Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 45Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 7
Number of Missed Treatments: 291
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
62Total:
68Total:
USE RATE for the FACILITY
22,464Treatment 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: 188
83%88%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 : 14Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
102
54.3%
Medicaid
4
Private Insurance
75
Charity Care
0
Private Pay
4
Other Public
3
TOTAL
188
2.1% 39.9% 0.0%2.1% 1.6% 100.0%
Patients
TOTAL 250
680
94
39148
1
1
020482020
011252321
<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
031734341
188108 80
188
$2,914,199 $88,038 $4,207,418 $0$50,154 $60,972 $7,320,781
39.8% 1.2% 57.5% 0.0%0.7% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2637
Fresenius Kidney Care Breese 160 N. Main StreetBreeseClinton11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Oakmont Capital Resources
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Bassim Assioun, MD
In-Center Treatments in calendar year: 4,015Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 20
Patients treated as of 12/31/2017: (Ending patients) 29
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 500.0
Oct 1
0
Oct 2
13
Oct 3
13
Oct 4
13
Oct 5
13
Oct 6
13
Oct 7
13
0 14 15 16 14 16 15
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 21Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 14Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 69
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
29Total:
USE RATE for the FACILITY
7,488Treatment 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: 36
42%60%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 : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
29
80.6%
Medicaid
0
Private Insurance
6
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
36
0.0% 16.7% 0.0%2.8% 0.0% 100.0%
Patients
TOTAL 0040
32
0360
0
0182
13
02424
<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
124
173624 12
36
$643,649 $0 $267,938 $0$0 $2,175 $913,762
70.4% 0.0% 29.3% 0.0%0.0% 0.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2524
Fresenius Kidney Care Bridgeport 825 W. 35th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Bridgeport Assosiates
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Maria Sobrero, MD
In-Center Treatments in calendar year: 17,659Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 119
Patients treated as of 12/31/2017: (Ending patients) 127
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 66 48 69 49 66 46
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 67Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 4Transplant Recipients: 5Patients transferred out: 52Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 942
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
72Total:
80Total:
USE RATE for the FACILITY
25,272Treatment 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: 199
73%78%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 : 7Dialysis Technician : 13Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
122
61.3%
Medicaid
7
Private Insurance
68
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
199
3.5% 34.2% 0.0%1.0% 0.0% 100.0%
Patients
TOTAL 200
1100
69
31168
0
0
07
433019
09
363520
<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:
199
016796539
19999 100
199
$2,867,258 $53,975 $2,635,308 $0$20,598 $46,871 $5,624,010
51.0% 1.0% 46.9% 0.0%0.4% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2641
Fresenius Kidney Care Burbank 4811 W. 77th StreetBurbankCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Burbank Town Center, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Vinitha Raghavan, MD
In-Center Treatments in calendar year: 18,041Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 129
Patients treated as of 12/31/2017: (Ending patients) 129
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 64 64 64 64 64 64
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 22Transient Patients: 28Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 36Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 603
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
53Total:
USE RATE for the FACILITY
24,336Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 74%Use Rate (including Missed Treatments): 77%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 182
83%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 : 8Dialysis Technician : 16Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
97
53.3%
Medicaid
8
Private Insurance
74
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
182
4.4% 40.7% 0.0%1.6% 0.0% 100.0%
Patients
TOTAL 20
910
25
87950
64
029383517
016191711
<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
045575228
182119 63
182
$2,693,914 $137,021 $4,225,624 $0$35,107 $3,272 $7,094,938
38.0% 1.9% 59.6% 0.0%0.5% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2514
Fresenius Kidney Care Carbondale 1425 E. Main StreetCarbondaleJackson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Randy Cowart, MD
In-Center Treatments in calendar year: 11,830Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 78
Patients treated as of 12/31/2017: (Ending patients) 82
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 228.0
Oct 1
0
Oct 2
17
Oct 3
15
Oct 4
16
Oct 5
13
Oct 6
16.5
Oct 7
13
0 47 32 43 34 46 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 49Transient Patients: 11Patients Re-Started: 3Post-Transplant Patien 2
Recovered patients: 6Transplant Recipients: 3Patients transferred out: 22Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 595
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
47Total:
65Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 53%Use Rate (including Missed Treatments): 55%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 132
54%57%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 : 9.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
93
70.5%
Medicaid
5
Private Insurance
21
Charity Care
0
Private Pay
1
Other Public
12
TOTAL
132
3.8% 15.9% 0.0%0.8% 9.1% 100.0%
Patients
TOTAL 20
380
92
4128
0
0
08
312322
06
121515
<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
014433837
13284 48
132
$367,673 $20,588 $198,805 $0$1,412 $54,497 $642,975
57.2% 3.2% 30.9% 0.0%0.2% 8.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2546
Fresenius Kidney Care Centre West Springfield 1112 Centre West DriveSpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Indria D. Lakhram, ELH Mgmt. LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Merry Downer, MD
In-Center Treatments in calendar year: 10,348Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 67
Patients treated as of 12/31/2017: (Ending patients) 66
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
17
Oct 7
13
0 36 30 37 29 37 30
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 18Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 4Transplant Recipients: 3Patients transferred out: 37Patients voluntarily discontinued: 6Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 457
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
61Total:
60Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 72%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 127
70%69%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 : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
66.9%
Medicaid
1
Private Insurance
41
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
127
0.8% 32.3% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
370
90
2125
0
0
08
222322
06
111520
<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:
127
014333842
12775 52
127
$155,701 $951 $1,963,778 $0$0 $22,834 $2,143,264
7.3% 0.0% 91.6% 0.0%0.0% 1.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2588
Fresenius Kidney Care Champaign-Urbana 1405 W. Park Street, Suite 100UrbanaChampaign4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Renal Research Institute, LLC Legal Entity Owner:
Property Owner: Tim Max
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Abdel-Moneim Attia, MD
In-Center Treatments in calendar year: 15,974Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 111
Patients treated as of 12/31/2017: (Ending patients) 107
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 56 50 54 47 53 47
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 30Transient Patients: 30Patients Re-Started: 4Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 47Patients voluntarily discontinued: 12Patients lost to follow up: 0Patients deceased: 19
Number of Missed Treatments: 670
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
81Total:
64Total:
USE RATE for the FACILITY
23,400Treatment 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: 175
74%71%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 : 7Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 4
Authorized Stations as of 12/31/2017: 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
111
63.4%
Medicaid
17
Private Insurance
43
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
175
9.7% 24.6% 0.0%0.0% 2.3% 100.0%
Patients
TOTAL 20
800
89
10161
4
4
011482311
013311523
<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
024793834
17593 82
175
$1,718,791 $39,284 $2,311,187 $0$0 $137,901 $4,207,163
40.9% 0.9% 54.9% 0.0%0.0% 3.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2744
Fresenius Kidney Care Chatham 8710 S. Holland RoadChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sreedevi Chittineni, MD
In-Center Treatments in calendar year: 12,241Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 85
Patients treated as of 12/31/2017: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 37 39 33 41 39 40
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 38Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 26Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 7
Number of Missed Treatments: 842
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
49Total:
USE RATE for the FACILITY
14,976Treatment 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: 129
89%88%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 : 25Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
62.8%
Medicaid
1
Private Insurance
47
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
129
0.8% 36.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
12900
0129
0
0
010331318
06
158
26
<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:
129
016482144
12974 55
129
$2,013,635 $8,191 $1,841,189 $0$0 $9,083 $3,872,098
52.0% 0.2% 47.6% 0.0%0.0% 0.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2506
Fresenius Kidney Care Chicago 1806 Hubbard StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Hasting Center Office
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Khaleel Sayeed, MD
In-Center Treatments in calendar year: 8,536Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 61
Patients treated as of 12/31/2017: (Ending patients) 62
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 36 18 34 19 34 19
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 18Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 383
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
24Total:
USE RATE for the FACILITY
19,656Treatment 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: 79
48%49%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 : 6Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
43
54.4%
Medicaid
3
Private Insurance
33
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
79
3.8% 41.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 01
490
26
15640
3
06
2971
06
1794
<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
01246165
7943 36
79
$1,296,244 $26,600 $1,474,983 $0$12,617 $235 $2,810,679
46.1% 0.9% 52.5% 0.0%0.4% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2832
Fresenius Kidney Care Chicago Heights15 E. Independence DriveChicago HeightsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Inland Commercial Real Estate Service
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rizwan Moinuddin, MD
In-Center Treatments in calendar year: 64Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 3
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
8
Oct 3
0
Oct 4
8
Oct 5
8
Oct 6
8
Oct 7
0
0 2 0 1 1 1 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 3Transient 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:
3Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 1%Use Rate (including Missed Treatments): 1%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 3
0%4%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 : 2Dialysis Technician : 1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 12Certified 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
0
0.0%
Medicaid
0
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
3
0.0% 100.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00201
120
0
00100
00200
<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:
3
0030031 2
3
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
1/1/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2681
Fresenius Kidney Care Chicago Westside 1340 S. Damen AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Hasting Center Office
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jose Arruda, MD
In-Center Treatments in calendar year: 9,330Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 75
Patients treated as of 12/31/2017: (Ending patients) 62
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
12.5
Oct 3
12.5
Oct 4
12.5
Oct 5
12.5
Oct 6
12.5
Oct 7
12.5
0 32 28 32 28 32 28
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 34Transient Patients: 1Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 4Patients transferred out: 27Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 491
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
47Total:
37Total:
USE RATE for the FACILITY
29,016Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 32%Use Rate (including Missed Treatments): 34%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 105
40%33%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 25Isolation 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 12/31/2017: 31Certified Stations by CMS: 31Peak 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
51
48.6%
Medicaid
2
Private Insurance
51
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
105
1.9% 48.6% 0.0%1.0% 0.0% 100.0%
Patients
TOTAL 00
600
45
43620
0
0192212
6
08
2459
<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:
105
027461715
10559 46
105
$37,282 $10,177 $38,315 $0$0 $2,857,752 $2,943,526
1.3% 0.3% 1.3% 0.0%0.0% 97.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2754
Fresenius Kidney Care Cicero3000 S. Cicero AvenueCiceroCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: MR CICERO PLAZA, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Anderson, MD
In-Center Treatments in calendar year: 9,555Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 61
Patients treated as of 12/31/2017: (Ending patients) 74
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 42 29 42 29 42 29
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 35Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 5Transplant Recipients: 0Patients transferred out: 12Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 166
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
39Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 65%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 94
64%77%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 : 10Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
50
53.2%
Medicaid
3
Private Insurance
37
Charity Care
0
Private Pay
4
Other Public
0
TOTAL
94
3.2% 39.4% 0.0%4.3% 0.0% 100.0%
Patients
TOTAL 1080
85
80140
0
05
3220
5
06
1754
<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
01149259
9462 32
94
$1,155,022 $0 $3,026,192 $0$24,951 $2,019 $4,208,184
27.4% 0.0% 71.9% 0.0%0.6% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2631
Fresenius Kidney Care Congress Parkway 3410 W. Van Buren AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: CMGS, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Asad Bakir, MD
In-Center Treatments in calendar year: 15,672Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 111
Patients treated as of 12/31/2017: (Ending patients) 107
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
14
Oct 4
18
Oct 5
14
Oct 6
18
Oct 7
14
0 56 39 56 44 61 41
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 32Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 44Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 992
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
59Total:
42Total:
USE RATE for the FACILITY
28,080Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 56%Use Rate (including Missed Treatments): 59%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 151
62%59%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 : 7.5Dialysis Technician : 11Dietician : 1.5Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
86
57.0%
Medicaid
5
Private Insurance
59
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
151
3.3% 39.1% 0.0%0.7% 0.0% 100.0%
Patients
TOTAL 00
1360
15
15136
0
0
019301315
014309
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:
151
033602236
15177 74
151
$2,765,398 $114,353 $2,480,777 $0$36,293 $4,042 $5,400,863
51.2% 2.1% 45.9% 0.0%0.7% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2538
Fresenius Kidney Care Crestwood 4861W. Cal Sag Road CrestwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Akash Ahuja, MD
9/26/2017 - Facility approved to discontnue 24 station ESRD facility at 4881 Cal Sag Road in Crestwood and to establish 24 station ESRD facility at 4809 West Midlothian Turnpike in Crestwood.
In-Center Treatments in calendar year: 14,315Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 105
Patients treated as of 12/31/2017: (Ending patients) 88
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
17.5
Oct 3
12.5
Oct 4
17.5
Oct 5
12.5
Oct 6
17.5
Oct 7
12.5
0 49 40 48 37 50 38
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 17Transient Patients: 23Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 5Patients transferred out: 29Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 22
Number of Missed Treatments: 446
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
58Total:
41Total:
USE RATE for the FACILITY
22,464Treatment 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: 146
73%61%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 : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
92
63.0%
Medicaid
4
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
48
TOTAL
146
2.7% 1.4% 0.0%0.0% 32.9% 100.0%
Patients
TOTAL 01
581
86
11135
0
0
09
363619
03
141514
<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:
146
012505133
146100 46
146
$2,027,710 $66,192 $3,334,712 $0$4,655 $52,401 $5,485,670
37.0% 1.2% 60.8% 0.0%0.1% 1.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2603
Fresenius Kidney Care Decatur 1830 S. 44th StreetDecaturMacon4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammed Dawood, MD
In-Center Treatments in calendar year: 6,944Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 47
Patients treated as of 12/31/2017: (Ending patients) 50
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
12
Oct 4
15
Oct 5
12
Oct 6
15
Oct 7
12
0 24 19 22 21 24 19
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 17Transient Patients: 22Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 23Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 16
Number of Missed Treatments: 79
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
44Total:
39Total:
USE RATE for the FACILITY
11,232Treatment 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: 88
65%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: 0
Full-Time Work Week: 32Registered Nurse : 2Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
75
85.2%
Medicaid
3
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
88
3.4% 9.1% 0.0%0.0% 2.3% 100.0%
Patients
TOTAL 00
110
77
0880
0
03
211612
019
1511
<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
04
3031238852 36
88
$1,406,527 $2,961 $520,838 $0$6,521 $8,500 $1,945,347
72.3% 0.2% 26.8% 0.0%0.3% 0.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2710
Fresenius Kidney Care Deerfield 405 Lake Cook RoadDeerfieldCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Lake Cook Plaza, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Shalini Patel, MD
In-Center Treatments in calendar year: 3,795Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 23
Patients treated as of 12/31/2017: (Ending patients) 29
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
17
Oct 3
0
Oct 4
17
Oct 5
0
Oct 6
17
Oct 7
0
0 29 0 28 0 27 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 19Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 22Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 52
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
32Total:
USE RATE for the FACILITY
11,232Treatment 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: 54
32%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 : 3Dialysis Technician : 2.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
68.5%
Medicaid
0
Private Insurance
16
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
54
0.0% 29.6% 0.0%1.9% 0.0% 100.0%
Patients
TOTAL 2060
46
6480
0
028
1215
02834
<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
04
1615195437 17
54
$658,793 $0 $693,741 $0$0 $0 $1,352,534
48.7% 0.0% 51.3% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2774
Fresenius Kidney Care Des Plaines 1625 Oakton PlaceDes PlainesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Washington Center LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Daniel Kniaz, MD
In-Center Treatments in calendar year: 6,512Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 41
Patients treated as of 12/31/2017: (Ending patients) 51
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 29 18 29 17 29 20
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 27Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 28Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 81
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
43Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments): 59%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 81
57%71%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 : 4Dialysis Technician : 4Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
51
63.0%
Medicaid
2
Private Insurance
25
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
81
2.5% 30.9% 0.0%3.7% 0.0% 100.0%
Patients
TOTAL 140
132
52
16650
0
05
181211
0397
16
<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
08
2719278146 35
81
$870,780 $23,031 $701,828 $0$20,171 $20,936 $1,636,746
53.2% 1.4% 42.9% 0.0%1.2% 1.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2503
Fresenius Kidney Care Downers Grove 3825 Highland Ave., Suite 102Downers GroveDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Naresh Julka, MD
In-Center Treatments in calendar year: 10,396Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 70
Patients treated as of 12/31/2017: (Ending patients) 68
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 38 25 35 25 34 25
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 36Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 34Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 108
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
48Total:
USE RATE for the FACILITY
14,976Treatment 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: 108
73%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: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 7Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 16Certified Stations by CMS: 16Peak 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
71
65.7%
Medicaid
0
Private Insurance
32
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
108
0.0% 29.6% 0.0%1.9% 2.8% 100.0%
Patients
TOTAL 120
140
82
16920
0
05
141725
01
161020
<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:
108
06
302745
10861 47
108
$1,124,732 $7,098 $1,134,990 $0$10,276 $73,476 $2,350,572
47.8% 0.3% 48.3% 0.0%0.4% 3.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2509
Fresenius Kidney Care DuPage West 450 E. Roosevelt RoadWest ChicagoDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Gregory Kozeny, MD
In-Center Treatments in calendar year: 9,771Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 64
Patients treated as of 12/31/2017: (Ending patients) 67
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
18
Oct 3
12
Oct 4
18
Oct 5
12
Oct 6
18
Oct 7
12
0 40 25 39 23 38 26
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 4
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 33Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 5
Number of Missed Treatments: 138
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
45Total:
46Total:
USE RATE for the FACILITY
14,976Treatment 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: 103
67%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 : 6Dialysis Technician : 6Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
55.3%
Medicaid
4
Private Insurance
36
Charity Care
0
Private Pay
6
Other Public
0
TOTAL
103
3.9% 35.0% 0.0%5.8% 0.0% 100.0%
Patients
TOTAL 1161
94
33646
0
09
231912
01110127
<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
020333119
10363 40
103
$1,437,167 $36,056 $2,891,215 $0$2,029 $12,927 $4,379,394
32.8% 0.8% 66.0% 0.0%0.0% 0.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2595
Fresenius Kidney Care DuQuoin 825 Sunset AvenueDuQuoinPerry5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Randy Cowart, MD
10/10/2017 - Facility added 2 ESRD stations; facility now has 13 ESRD stations.
In-Center Treatments in calendar year: 5,767Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 35
Patients treated as of 12/31/2017: (Ending patients) 39
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
10
Oct 3
10
Oct 4
10
Oct 5
10
Oct 6
10
Oct 7
10
0 23 14 23 15 23 15
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 18Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 7Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 92
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
20Total:
USE RATE for the FACILITY
10,296Treatment 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: 53
53%59%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: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
46
86.8%
Medicaid
1
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
53
1.9% 3.8% 0.0%0.0% 7.5% 100.0%
Patients
TOTAL 0030
50
0530
0
01
109
12
00588
<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
01
1517205332 21
53
$672,446 $31,337 $325,515 $0$0 $99,359 $1,128,657
59.6% 2.8% 28.8% 0.0%0.0% 8.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2726
Fresenius Kidney Care Elgin 2130 Point Blvd., Suite 800ElginKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Pancor Construction and Development,
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Raju Ray, M.D.
In-Center Treatments in calendar year: 14,908Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 85
Patients treated as of 12/31/2017: (Ending patients) 116
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 56 50 54 50 53 53
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 66Transient Patients: 15Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 39Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 81
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
47Total:
81Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 80%Use Rate (including Missed Treatments): 80%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 157
71%97%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 : 9.5Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
97
61.8%
Medicaid
3
Private Insurance
55
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
157
1.9% 35.0% 0.0%1.3% 0.0% 100.0%
Patients
TOTAL 110
173
126
57100
0
0
014342725
09
171318
<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
023514043
157100 57
157
$1,632,865 $39,340 $1,910,347 $0$14,412 $32,382 $3,629,346
45.0% 1.1% 52.6% 0.0%0.4% 0.9% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2507
Fresenius Kidney Care Elk Grove 901 Biesterfield RoadElk Grove VillageCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Equity Partners, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lisa Pillsbury, MD
In-Center Treatments in calendar year: 18,275Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 135
Patients treated as of 12/31/2017: (Ending patients) 142
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 67 56 66 49 67 57
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 62Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 35Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 18
Number of Missed Treatments: 483
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
62Total:
69Total:
USE RATE for the FACILITY
26,208Treatment 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: 204
80%85%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 : 17Dietician : 2Social Worker: 2LPN : 1Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
146
71.6%
Medicaid
0
Private Insurance
55
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
204
0.0% 27.0% 0.0%0.5% 1.0% 100.0%
Patients
TOTAL 201
110
172
32172
0
0
012473338
07
191632
<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
019664970
204130 74
204
$3,762,753 $49,786 $3,880,203 $0$40,339 $121,650 $7,854,731
47.9% 0.6% 49.4% 0.0%0.5% 1.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2612
Fresenius Kidney Care Elmhurst 133 E Brush Hill RoadElmhurstDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rukhsana Muneer, MD
In-Center Treatments in calendar year: 16,196Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 110
Patients treated as of 12/31/2017: (Ending patients) 109
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
18
Oct 3
13
Oct 4
18
Oct 5
13
Oct 6
18
Oct 7
13
0 67 38 62 35 64 40
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 42Transient Patients: 22Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 4Transplant Recipients: 6Patients transferred out: 50Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 308
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
74Total:
66Total:
USE RATE for the FACILITY
26,208Treatment 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: 176
65%65%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 : 8Dialysis Technician : 12.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
112
63.6%
Medicaid
2
Private Insurance
60
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
176
1.1% 34.1% 0.0%1.1% 0.0% 100.0%
Patients
TOTAL 150
500
111
39137
0
0
013462520
04
272417
<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:
176
017734937
176104 72
176
$2,761,837 $48,902 $4,076,469 $0$75,714 $36,994 $6,999,916
39.5% 0.7% 58.2% 0.0%1.1% 0.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2621
Fresenius Kidney Care Evanston 2953 Cenetral StreetEvanstonCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Neeno Khosla, MD
In-Center Treatments in calendar year: 10,042Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 65
Patients treated as of 12/31/2017: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
16
Oct 3
14
Oct 4
16
Oct 5
14
Oct 6
16
Oct 7
14
0 33 26 33 26 33 26
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 18Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 10Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 150
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
25Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 77%Use Rate (including Missed Treatments): 78%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 90
77%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: 0
Full-Time Work Week: 32Registered Nurse : 4.5Dialysis Technician : 4Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
68
75.6%
Medicaid
2
Private Insurance
18
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
90
2.2% 20.0% 0.0%1.1% 1.1% 100.0%
Patients
TOTAL 40
365
43
6822
2
03
1112
9
02
192212
<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
05
3034219035 55
90
$1,761,803 $40,079 $1,316,146 $0$9,841 $24,451 $3,152,320
55.9% 1.3% 41.8% 0.0%0.3% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2823
Fresenius Kidney Care Evergreen Park 8901 S. Kedzie AvenueEvergreen ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Net3, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements. *This facility had an emergency closure in 2016 and a CON was granted, #16-035, to relocate. The facility reopened in 2017 under a new address and was given a new provider number.
Provides Incenter Noctural Dialysis:
Medical Director Name: Paul Crawford, MD
In-Center Treatments in calendar year: 427Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
11
Oct 3
0
Oct 4
8
Oct 5
0
Oct 6
11
Oct 7
0
0 2 0 1 0 2 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 24Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 1Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 7
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
2Total:
25Total:
USE RATE for the FACILITY
28,080Treatment 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: 25
0%13%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 : 6Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
17
68.0%
Medicaid
0
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
25
0.0% 32.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
2401
0250
0
00634
00543
<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
00
1177
2513 12
25
$1,819,661 $11,584 $2,014,574 $0$2,645 $25,012 $3,873,476
47.0% 0.3% 52.0% 0.0%0.1% 0.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2579
Fresenius Kidney Care Galesburg 765 N. Kellogg Street, Suite 101GalesburgKnox2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Cottage Hospital
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Parthasarathy Srinivasan, M.D.
In-Center Treatments in calendar year: 10,246Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 68
Patients treated as of 12/31/2017: (Ending patients) 74
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
19
Oct 3
17
Oct 4
19
Oct 5
17
Oct 6
19
Oct 7
17
0 36 34 30 32 37 35
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 10Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 13Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 320
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
34Total:
USE RATE for the FACILITY
13,104Treatment 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: 99
81%88%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 : 6Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
66.7%
Medicaid
1
Private Insurance
31
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
99
1.0% 31.3% 0.0%0.0% 1.0% 100.0%
Patients
TOTAL 20
190
78
9900
0
06
241811
09
109
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:
99
0153427239959 40
99
$1,197,426 $21,794 $1,077,804 $0$3,059 $95,072 $2,395,155
50.0% 0.9% 45.0% 0.0%0.1% 4.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2555
Fresenius Kidney Care Garfield 5401 S. WentworthChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Paru Kathpalia, MD
In-Center Treatments in calendar year: 13,028Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 99
Patients treated as of 12/31/2017: (Ending patients) 89
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 53 35 54 31 57 33
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 51Transient Patients: 17Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 49Patients voluntarily discontinued: 0Patients lost to follow up: 5Patients deceased: 12
Number of Missed Treatments: 669
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
70Total:
USE RATE for the FACILITY
20,592Treatment 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: 157
75%67%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 : 5Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
90
57.3%
Medicaid
4
Private Insurance
59
Charity Care
0
Private Pay
2
Other Public
2
TOTAL
157
2.5% 37.6% 0.0%1.3% 1.3% 100.0%
Patients
TOTAL 00
15340
4153
0
0
0193631
9
010251710
<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
029614819
15795 62
157
$1,929,555 $54,070 $1,580,090 $0$20,105 $40,895 $3,624,715
53.2% 1.5% 43.6% 0.0%0.6% 1.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2592
Fresenius Kidney Care Geneseo 600 N. College Ave., Suite 150GeneseoHenry10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Alla, MD
In-Center Treatments in calendar year: 2,597Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 18
Patients treated as of 12/31/2017: (Ending patients) 15
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
12
Oct 3
0
Oct 4
13
Oct 5
0
Oct 6
14
Oct 7
0
0 14 0 15 0 14 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 3Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 30
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
8Total:
5Total:
USE RATE for the FACILITY
6,552Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 40%Use Rate (including Missed Treatments): 40%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 23
43%36%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 : 1.5Dialysis Technician : 2Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
17
73.9%
Medicaid
0
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
23
0.0% 26.1% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
23
0230
0
00345
00236
<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
0057
112312 11
23
$390,473 $0 $179,995 $0$0 $0 $570,468
68.4% 0.0% 31.6% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2617
Fresenius Kidney Care Glendale Heights 130 E. Army Trail RoadGlendale HeightsDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ernest Dejesus, MD
In-Center Treatments in calendar year: 19,355Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 131
Patients treated as of 12/31/2017: (Ending patients) 131
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 72 53 62 50 70 55
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 42Transient Patients: 23Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 4Patients transferred out: 63Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 17
Number of Missed Treatments: 338
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
87Total:
67Total:
USE RATE for the FACILITY
27,144Treatment 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: 206
75%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 : 8Dialysis Technician : 13Dietician : 1.2Social Worker: 1.2LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
120
58.3%
Medicaid
12
Private Insurance
69
Charity Care
0
Private Pay
5
Other Public
0
TOTAL
206
5.8% 33.5% 0.0%2.4% 0.0% 100.0%
Patients
TOTAL 470
212
135
42164
0
1
09
543231
09
242027
<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:
206
018785258
206126 80
206
$2,725,704 $74,124 $3,770,886 $0$68,563 $36,681 $6,675,958
40.8% 1.1% 56.5% 0.0%1.0% 0.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2551
Fresenius Kidney Care Glenview 4248 Commerce WayGlenviewCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Venkata Behara, MD
In-Center Treatments in calendar year: 10,618Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 72
Patients treated as of 12/31/2017: (Ending patients) 68
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 42 24 40 23 41 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 24Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 23Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 10
Number of Missed Treatments: 87
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
36Total:
30Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 57%Use Rate (including Missed Treatments): 57%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 93
60%57%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 : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
58
62.4%
Medicaid
2
Private Insurance
32
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
93
2.2% 34.4% 0.0%1.1% 0.0% 100.0%
Patients
TOTAL 19040
70
14790
0
07
241222
0377
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:
93
0103119339365 28
93
$1,624,411 $32,918 $2,594,627 $0$33,750 $0 $4,285,706
37.9% 0.8% 60.5% 0.0%0.8% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2601
Fresenius Kidney Care Greenwood 1111 E. 87th Street, Suite 700ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Malathia Shah, MD
In-Center Treatments in calendar year: 16,202Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 115
Patients treated as of 12/31/2017: (Ending patients) 119
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 1
0
Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
17
Oct 7
13
0 61 42 59 42 62 43
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 57Transient Patients: 17Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 39Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 13
Number of Missed Treatments: 1,109
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
76Total:
USE RATE for the FACILITY
26,208Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 62%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 170
68%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: 0
Full-Time Work Week: 32Registered Nurse : 7Dialysis Technician : 13Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
91
53.5%
Medicaid
2
Private Insurance
72
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
170
1.2% 42.4% 0.0%1.2% 1.8% 100.0%
Patients
TOTAL 00
16601
2167
1
3
010482422
05
311515
<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
015793937
170104 66
170
$1,816,598 $51,363 $2,022,742 $0$48,343 $115,967 $4,055,013
44.8% 1.3% 49.9% 0.0%1.2% 2.9% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2549
Fresenius Kidney Care Gurnee 50 Tower Court, Suite BGurneeLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Greenleaf Center West/ GRG Propertie
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rakhi Khanna, MD
5/2/2017 - Facility received permit to add 8 stations to existing 16 station facility. Facility now authorized for 24 stations.
In-Center Treatments in calendar year: 13,929Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 90
Patients treated as of 12/31/2017: (Ending patients) 95
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 49 47 49 46 47 46
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 55Transient Patients: 7Patients Re-Started: 15Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 37Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 7
Number of Missed Treatments: 501
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
78Total:
USE RATE for the FACILITY
22,464Treatment 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: 119
63%66%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 : 6Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
68
57.1%
Medicaid
2
Private Insurance
42
Charity Care
0
Private Pay
6
Other Public
1
TOTAL
119
1.7% 35.3% 0.0%5.0% 0.8% 100.0%
Patients
TOTAL 140
420
63
40790
0
05
241416
06
271116
<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
011512532
11959 60
119
$1,645,625 $21,879 $3,733,681 $0$8,312 $45,055 $5,454,552
30.2% 0.4% 68.5% 0.0%0.2% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2607
Fresenius Kidney Care Hazel Crest 1754 E. Carriageway DriveHazel CrestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Rockford 550, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Vijaykumar Rao, MD
In-Center Treatments in calendar year: 11,962Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 88
Patients treated as of 12/31/2017: (Ending patients) 77
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
18
Oct 3
13
Oct 4
18
Oct 5
14
Oct 6
18
Oct 7
13
0 43 30 45 31 45 30
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 16Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 22Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 184
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
29Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 80%Use Rate (including Missed Treatments): 81%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 117
92%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 : 3.5Dialysis Technician : 10Dietician : 0.8Social Worker: 0.8LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
76
65.0%
Medicaid
3
Private Insurance
34
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
117
2.6% 29.1% 0.0%0.0% 3.4% 100.0%
Patients
TOTAL 10
1040
12
6111
0
0
07
271710
04
161422
<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
011433132
11761 56
117
$1,633,353 $57,770 $1,370,716 $0$8,115 $73,186 $3,143,140
52.0% 1.8% 43.6% 0.0%0.3% 2.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2782
Fresenius Kidney Care Highland Park1657 Old Skokie RoadHighland ParkLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Shepard Warrenville, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nancy Nora, MD
In-Center Treatments in calendar year: 8,480Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 53
Patients treated as of 12/31/2017: (Ending patients) 48
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
17
Oct 3
14
Oct 4
17
Oct 5
14
Oct 6
17
Oct 7
14
0 40 15 35 14 39 14
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 27Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 34Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 116
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
37Total:
USE RATE for the FACILITY
18,720Treatment 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: 90
44%40%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 12/31/2017: 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
63
70.0%
Medicaid
2
Private Insurance
24
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
90
2.2% 26.7% 0.0%1.1% 0.0% 100.0%
Patients
TOTAL 3080
79
15750
0
038
1427
015
1121
<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
04
1325489052 38
90
$1,636,366 $1,906 $2,236,103 $0$994 $2,716 $3,878,085
42.2% 0.0% 57.7% 0.0%0.0% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2547
Fresenius Kidney Care Hoffman Estates 3150 W. Higgins Road, Suite 190Hoffman EstatesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: 3100 & 2150 Higgins, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lo-Ku Chaing, MD
In-Center Treatments in calendar year: 16,025Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 108
Patients treated as of 12/31/2017: (Ending patients) 109
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
22
Oct 3
19
Oct 4
22
Oct 5
16.5
Oct 6
21.5
Oct 7
17
0 59 42 60 40 56 43
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 53Transient Patients: 11Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 3Transplant Recipients: 6Patients transferred out: 54Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 310
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
76Total:
67Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 86%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 175
90%91%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: 2
Authorized Stations as of 12/31/2017: 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
86
49.1%
Medicaid
4
Private Insurance
76
Charity Care
0
Private Pay
7
Other Public
2
TOTAL
175
2.3% 43.4% 0.0%4.0% 1.1% 100.0%
Patients
TOTAL 240
250
126
23152
0
0
014422716
07
202722
<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
021625438
17599 76
175
$1,769,943 $76,815 $4,938,049 $0$47,441 $21,793 $6,854,041
25.8% 1.1% 72.0% 0.0%0.7% 0.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2821
Fresenius Kidney Care Humboldt Park 3520 W. Grand AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Inland Commercial Real Estate Service
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. There were no revenues in 2016. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Remegio Vilbar, MD
In-Center Treatments in calendar year: 1,220Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 87
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 370.0
Oct 1
0
Oct 2
8
Oct 3
8
Oct 4
8
Oct 5
8
Oct 6
8
Oct 7
0
0 3 0 3 0 3 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 87Transient 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: 74
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
0Total:
87Total:
USE RATE for the FACILITY
31,824Treatment 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: 87
0%43%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 3Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 34Certified Stations by CMS: 34Peak Authorized Stations Operated: 34
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
58.6%
Medicaid
1
Private Insurance
35
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
87
1.1% 40.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 20
3402
36492
49
0102710
8
01
127
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
0113917208755 32
87
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2516
Fresenius Kidney Care Jackson Park 7531 S. Stony Island Ave.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Wadah Atassi, MD
In-Center Treatments in calendar year: 14,922Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 108
Patients treated as of 12/31/2017: (Ending patients) 101
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
16
Oct 3
10
Oct 4
16
Oct 5
10
Oct 6
16
Oct 7
10
0 16 10 16 10 16 10
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 13Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 37Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 22
Number of Missed Treatments: 1,073
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
64Total:
55Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 71%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 158
75%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 : 8Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2017: 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
74
46.8%
Medicaid
5
Private Insurance
74
Charity Care
0
Private Pay
4
Other Public
1
TOTAL
158
3.2% 46.8% 0.0%2.5% 0.6% 100.0%
Patients
TOTAL 00
15404
2156
0
0
0155219
6
09
271812
<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:
158
024793718
15892 66
158
$1,961,966 $41,886 $1,704,385 $0$54,350 $47,559 $3,810,146
51.5% 1.1% 44.7% 0.0%1.4% 1.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2739
Fresenius Kidney Care Joliet 721 E. Jackson Blvd.JolietWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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,
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammad Shafi, MD
10/6/2017 - Facility added 2 ESRD stations; facility now has 18 ESRD stations.
In-Center Treatments in calendar year: 10,743Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 71
Patients treated as of 12/31/2017: (Ending patients) 70
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
18
Oct 3
14
Oct 4
18
Oct 5
16
Oct 6
18
Oct 7
14
0 18 32 42 32 42 32
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 27Transient Patients: 12Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 27Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 490
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
41Total:
USE RATE for the FACILITY
14,976Treatment 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: 112
74%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 : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
57.1%
Medicaid
4
Private Insurance
37
Charity Care
0
Private Pay
4
Other Public
3
TOTAL
112
3.6% 33.0% 0.0%3.6% 2.7% 100.0%
Patients
TOTAL 20
400
22
283648
48
07
331614
05
111016
<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
012442630
11270 42
112
$1,402,511 $25,178 $1,620,562 $0$44,665 $54,400 $3,147,316
44.6% 0.8% 51.5% 0.0%1.4% 1.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2578
Fresenius Kidney Care Kewanee 230 W. South StreetKewaneeHenry10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: M. Khattak, MD
In-Center Treatments in calendar year: 4,988Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 35
Patients treated as of 12/31/2017: (Ending patients) 33
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 19 14 18 10 21 10
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 12Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 7Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 348
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
15Total:
USE RATE for the FACILITY
7,488Treatment 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: 50
73%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: 32Registered Nurse : 3Dialysis Technician : 3.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
70.0%
Medicaid
1
Private Insurance
11
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
50
2.0% 22.0% 0.0%0.0% 6.0% 100.0%
Patients
TOTAL 0040
46
6440
0
02
1539
00966
<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
02
249
155029 21
50
$663,183 $5,310 $436,354 $0$0 $53,790 $1,158,637
57.2% 0.5% 37.7% 0.0%0.0% 4.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2669
Fresenius Kidney Care Lake Bluff 101 Waukegan Road, Suite 700Lake BluffLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Bluff, LLC Legal Entity Owner:
Property Owner: Franklin Partners
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Joshua Trob, MD
In-Center Treatments in calendar year: 10,649Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 68
Patients treated as of 12/31/2017: (Ending patients) 74
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
18
Oct 3
9
Oct 4
18
Oct 5
9
Oct 6
18
Oct 7
9
0 39 29 38 29 40 32
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 30Transient Patients: 9Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 34Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 96
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
41Total:
USE RATE for the FACILITY
14,976Treatment 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: 103
71%77%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 : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
62
60.2%
Medicaid
3
Private Insurance
28
Charity Care
0
Private Pay
1
Other Public
9
TOTAL
103
2.9% 27.2% 0.0%1.0% 8.7% 100.0%
Patients
TOTAL 61
325
59
25780
0
010261712
07
129
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:
103
017382622
10365 38
103
$1,098,994 $13,520 $1,265,962 $0$9,985 $115,097 $2,503,558
43.9% 0.5% 50.6% 0.0%0.4% 4.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2679
Fresenius Kidney Care Lakeview 4008 N. Broadway, Suite 1200ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Thorek Hospital
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Haresh Muni, MD
In-Center Treatments in calendar year: 7,041Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 52
Patients treated as of 12/31/2017: (Ending patients) 52
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
16.5
Oct 7
12
0 31 13 29 15 30 16
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 19Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 19Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 265
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
28Total:
29Total:
USE RATE for the FACILITY
13,104Treatment 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: 78
62%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 12/31/2017: 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
67.9%
Medicaid
4
Private Insurance
19
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
78
5.1% 24.4% 0.0%1.3% 1.3% 100.0%
Patients
TOTAL 60
303
24
14640
15
05
2711
5
03
1485
<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:
78
08
4119107848 30
78
$1,085,731 $44,694 $1,283,855 $0$11,584 $67,060 $2,492,924
43.6% 1.8% 51.5% 0.0%0.5% 2.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2798
Fresenius Kidney Care Lemont 16177 W. 127th StreeetLemontCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Stella Asua-Larbi, MD
In-Center Treatments in calendar year: 2,805Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 12
Patients treated as of 12/31/2017: (Ending patients) 24
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 1
0
Oct 2
12
Oct 3
0
Oct 4
12
Oct 5
0
Oct 6
12
Oct 7
0
0 21 0 20 0 19 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 28Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 10Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 4
Number of Missed Treatments: 60
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
33Total:
USE RATE for the FACILITY
11,232Treatment 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: 39
17%33%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 3Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 2.5Dialysis Technician : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
84.6%
Medicaid
0
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
39
0.0% 15.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0060
33
2370
0
01657
02468
<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:
39
03
1011153919 20
39
$84,368 $0 $61,391 $0$0 $0 $145,759
57.9% 0.0% 42.1% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2766
Fresenius Kidney Care Logan Square 2721 N. Spaulding AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: VPRE Real Holdings LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Eduardo Cremer, MD
In-Center Treatments in calendar year: 8,848Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 52
Patients treated as of 12/31/2017: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
16
Oct 3
14
Oct 4
16
Oct 5
14
Oct 6
16
Oct 7
14
0 33 21 34 23 34 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 20Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 26Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 1
Number of Missed Treatments: 420
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
42Total:
USE RATE for the FACILITY
13,104Treatment 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: 94
62%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 : 3Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
46.8%
Medicaid
5
Private Insurance
40
Charity Care
0
Private Pay
3
Other Public
2
TOTAL
94
5.3% 42.6% 0.0%3.2% 2.1% 100.0%
Patients
TOTAL 20
120
79
68251
1
05
192412
03
1975
<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
08
3831179460 34
94
$784,954 $63,911 $1,409,222 $0$47,352 $11,095 $2,316,534
33.9% 2.8% 60.8% 0.0%2.0% 0.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2722
Fresenius Kidney Care Lombard 1940 Springer DriveLombardDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Golub Realty Services
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Samir Kumar, MD
In-Center Treatments in calendar year: 7,408Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 55
Patients treated as of 12/31/2017: (Ending patients) 51
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
14
Oct 3
16
Oct 4
14
Oct 5
16
Oct 6
14
Oct 7
16
0 22 24 23 23 24 25
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 24Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 4Transplant Recipients: 1Patients transferred out: 19Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 135
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
33Total:
30Total:
USE RATE for the FACILITY
11,232Treatment 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: 88
76%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 : 3Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
69.3%
Medicaid
1
Private Insurance
26
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
88
1.1% 29.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 102
140
62
9790
0
03
201520
0268
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:
88
05
2623348858 30
88
$1,280,416 $30,694 $1,847,928 $0$19,758 $0 $3,178,796
40.3% 1.0% 58.1% 0.0%0.6% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2591
Fresenius Kidney Care Macomb 523 E. Grant StreetMacombMcDonough2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: McDonough District Hospital
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements. • The Macomb facility relocated on 2/21/2018 and is now located at 212 E. Calhoun, Macomb.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sudha Cherukuri, MD
3/14/2017 - Received permit to discontinue a 6 station ESRD facility at 523 East Grant Street in Macomb and to establish an 8 station ESRD facility at 212 East Calhoun Street in Macomb.
In-Center Treatments in calendar year: 2,312Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 18
Patients treated as of 12/31/2017: (Ending patients) 20
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
11
Oct 3
8
Oct 4
11
Oct 5
8
Oct 6
11
Oct 7
8
0 10 4 12 4 11 4
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 9Transient Patients: 17Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 19Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 122
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
26Total:
28Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 31%Use Rate (including Missed Treatments): 33%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 40
38%42%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 : 2.5Dialysis Technician : 2Dietician : 0.3Social Worker: 0.3LPN : 0Other Health : 0Other Non-Health: 0.6
Authorized Stations as of 12/31/2017: 8Certified 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
27
67.5%
Medicaid
1
Private Insurance
9
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
40
2.5% 22.5% 0.0%0.0% 7.5% 100.0%
Patients
TOTAL 0070
33
0400
0
01
1292
02644
<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
03
18136
4024 16
40
$345,980 $16,293 $310,089 $0$0 $60,278 $732,640
47.2% 2.2% 42.3% 0.0%0.0% 8.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2790
Fresenius Kidney Care Maple City 1225 N. Main StreetMonmouthWarren2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Rockwell Debt Free Properties
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Parthasarathy Srinivasan, MD
In-Center Treatments in calendar year: 2,331Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 13
Patients treated as of 12/31/2017: (Ending patients) 15
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 400.0
Oct 1
0
Oct 2
12
Oct 3
0
Oct 4
12
Oct 5
0
Oct 6
12
Oct 7
0
0 15 0 14 0 15 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 5Transient Patients: 4Patients 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: 117
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
8Total:
9Total:
USE RATE for the FACILITY
8,424Treatment 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: 20
24%28%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 : 0.5Dietician : 0.5Social Worker: 0.5LPN : 0.5Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
15
75.0%
Medicaid
0
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
20
0.0% 15.0% 0.0%0.0% 10.0% 100.0%
Patients
TOTAL 0030
17
1190
0
00333
01145
<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:
20
01478
209 11
20
($103,030) ($3,779) ($84,547) $0$0 ($38,967) ($230,323)
44.7% 1.6% 36.7% 0.0%0.0% 16.9% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2566
Fresenius Kidney Care Marquette Park 6536 S. Western AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Capri Development 6517, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Satya Ahuja, MD
In-Center Treatments in calendar year: 12,712Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 90
Patients treated as of 12/31/2017: (Ending patients) 92
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
17.5
Oct 3
17.5
Oct 4
17.5
Oct 5
17.5
Oct 6
17.5
Oct 7
17.5
0 41 38 44 35 42 39
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 46Transient Patients: 12Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 3Patients transferred out: 24Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 12
Number of Missed Treatments: 769
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
44Total:
59Total:
USE RATE for the FACILITY
14,976Treatment 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: 149
94%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 : 4Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
43.2%
Medicaid
3
Private Insurance
76
Charity Care
0
Private Pay
3
Other Public
2
TOTAL
148
2.0% 51.4% 0.0%2.0% 1.4% 100.0%
Patients
TOTAL 10
7907
276854
62
019272011
01515348
<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:
149
034425419
14977 72
149
$1,435,638 $48,824 $2,729,833 $0$24,348 $45,133 $4,283,776
33.5% 1.1% 63.7% 0.0%0.6% 1.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2672
Fresenius Kidney Care McHenry 4312 W. Elm StreetMcHenryMcHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Bob Dellutri/Heidner Properites, Inc
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Karol Rosner, MD
In-Center Treatments in calendar year: 5,897Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 36
Patients treated as of 12/31/2017: (Ending patients) 42
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
14
Oct 3
13
Oct 4
14
Oct 5
13
Oct 6
14
Oct 7
13
0 24 19 24 17 24 18
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 24Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 19Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 29
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
38Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 45%Use Rate (including Missed Treatments): 45%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 70
43%50%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 : 5Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
52
74.3%
Medicaid
0
Private Insurance
12
Charity Care
0
Private Pay
2
Other Public
4
TOTAL
70
0.0% 17.1% 0.0%2.9% 5.7% 100.0%
Patients
TOTAL 1150
63
11572
0
03
1114
9
029
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:
70
05
2025207037 33
70
$223,669 $0 $194,675 $0$813 $27,155 $446,312
50.1% 0.0% 43.6% 0.0%0.2% 6.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2563
Fresenius Kidney Care McLean County 1505 Eastland DriveBloomingtonMcLean4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: OSF St. Joseph Medical Center
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Robert Bruha, MD
In-Center Treatments in calendar year: 12,562Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 85
Patients treated as of 12/31/2017: (Ending patients) 89
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
19
Oct 3
14
Oct 4
19
Oct 5
14
Oct 6
19
Oct 7
14
0 52 39 52 39 52 39
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 46Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 34Patients voluntarily discontinued: 8Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 595
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
58Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 70%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 139
71%74%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 : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
84
60.4%
Medicaid
4
Private Insurance
50
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
139
2.9% 36.0% 0.0%0.7% 0.0% 100.0%
Patients
TOTAL 30
340
89
13126
0
13
015282014
07
241318
<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
022523332
13977 62
139
$1,860,430 $44,202 $2,244,916 $0$0 $8,831 $4,158,379
44.7% 1.1% 54.0% 0.0%0.0% 0.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2554
Fresenius Kidney Care Melrose Park 1111 Superior Street, Suite 204Melrose ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Resurrection Services
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Constantine Delis, MD
In-Center Treatments in calendar year: 11,157Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 72
Patients treated as of 12/31/2017: (Ending patients) 76
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
16
Oct 3
13
Oct 4
16
Oct 5
13
Oct 6
16
Oct 7
13
0 38 27 40 29 39 31
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 38Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 25Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 224
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
52Total:
USE RATE for the FACILITY
16,848Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 68%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 113
67%70%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 : 4Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
55
48.7%
Medicaid
2
Private Insurance
55
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
113
1.8% 48.7% 0.0%0.0% 0.9% 100.0%
Patients
TOTAL 10
630
49
38750
0
015261612
09
138
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:
113
024392426
11369 44
113
$1,519,233 $19,824 $3,077,913 $0$10,853 $0 $4,627,823
32.8% 0.4% 66.5% 0.0%0.2% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2705
Fresenius Kidney Care Metropolis 20 Hospital DriveMetropolisMassac5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Johnathan Wilkerson, MD
In-Center Treatments in calendar year: 3,831Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 27
Patients treated as of 12/31/2017: (Ending patients) 24
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
12.5
Oct 3
8.5
Oct 4
12.5
Oct 5
8.5
Oct 6
12.5
Oct 7
8.5
0 13 8 13 8 12 8
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 13Transient Patients: 7Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 6Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 248
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
15Total:
20Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 51%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 47
56%50%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 : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
32
68.1%
Medicaid
3
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
7
TOTAL
47
6.4% 10.6% 0.0%0.0% 14.9% 100.0%
Patients
TOTAL 00
110
36
1460
0
07
1511
4
02215
<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
09
17129
4737 10
47
$590,520 $55,141 $438,953 $0$501 $55,654 $1,140,769
51.8% 4.8% 38.5% 0.0%0.0% 4.9% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2713
Fresenius Kidney Care Midway 6201 W. 63rd StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: AR Capital, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Edgar Lerma, MD
In-Center Treatments in calendar year: 9,826Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 63
Patients treated as of 12/31/2017: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
17.5
Oct 3
17.5
Oct 4
17.5
Oct 5
17.5
Oct 6
17.5
Oct 7
17.5
0 36 36 36 36 36 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 21Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 18Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 5
Number of Missed Treatments: 164
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
21Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 87%Use Rate (including Missed Treatments): 89%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 84
88%83%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: 1
Authorized Stations as of 12/31/2017: 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
48
57.1%
Medicaid
1
Private Insurance
35
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
84
1.2% 41.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
160
68
40440
0
05
271011
01
1866
<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
06
4516178453 31
84
$1,321,504 $6,722 $2,840,957 $0$0 $5,230 $4,174,413
31.7% 0.2% 68.1% 0.0%0.0% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2689
Fresenius Kidney Care Mokena8910 W. 192nd Street, Suite A & BMokenaWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Abraham Thomas, MD
In-Center Treatments in calendar year: 8,294Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 58
Patients treated as of 12/31/2017: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
22
Oct 3
12
Oct 4
22
Oct 5
12
Oct 6
22
Oct 7
12
0 29 16 26 19 29 18
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 29Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 23Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 17
Number of Missed Treatments: 154
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
45Total:
42Total:
USE RATE for the FACILITY
13,104Treatment 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: 100
69%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 : 6Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
69
69.0%
Medicaid
3
Private Insurance
23
Charity Care
0
Private Pay
3
Other Public
2
TOTAL
100
3.0% 23.0% 0.0%3.0% 2.0% 100.0%
Patients
TOTAL 31
200
76
6940
0
09
131920
03
121311
<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
012253231
10061 39
100
$1,273,072 $5,528 $1,506,857 $0$22,125 $44,611 $2,852,193
44.6% 0.2% 52.8% 0.0%0.8% 1.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2526
Fresenius Kidney Care Moline 400 John Deere RoadMolineRock Island10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: RRS Investments, LLP
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rajesh Alla, MD
In-Center Treatments in calendar year: 14,465Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 100
Patients treated as of 12/31/2017: (Ending patients) 88
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
17
Oct 3
14
Oct 4
17
Oct 5
14
Oct 6
17
Oct 7
14
0 57 34 56 36 58 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 54Transient Patients: 31Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 67Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 26
Number of Missed Treatments: 1,104
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
99Total:
87Total:
USE RATE for the FACILITY
33,696Treatment 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: 187
46%41%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 : 3.5Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
131
70.1%
Medicaid
5
Private Insurance
44
Charity Care
0
Private Pay
0
Other Public
7
TOTAL
187
2.7% 23.5% 0.0%0.0% 3.7% 100.0%
Patients
TOTAL 00
330
144
1416310
10
011402629
014211927
<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:
187
025614556
187106 81
187
$1,481,920 $26,156 $1,128,304 $0$703 $102,131 $2,739,214
54.1% 1.0% 41.2% 0.0%0.0% 3.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2731
Fresenius Kidney Care Mundelein 1402 Town Line RoadMundeleinLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Jaffe & Berlin, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Shalini Patel, MD
In-Center Treatments in calendar year: 8,505Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 55
Patients treated as of 12/31/2017: (Ending patients) 62
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 37 20 37 20 38 20
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 16Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 0Transplant Recipients: 3Patients transferred out: 36Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 252
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
47Total:
49Total:
USE RATE for the FACILITY
13,104Treatment 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: 99
65%74%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 : 5.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
66.7%
Medicaid
3
Private Insurance
29
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
99
3.0% 29.3% 0.0%0.0% 1.0% 100.0%
Patients
TOTAL 140
140
71
24750
0
04
202519
03
1189
<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
07
3133289968 31
99
$1,290,739 $8,715 $1,814,468 $0$9,688 $25,175 $3,148,785
41.0% 0.3% 57.6% 0.0%0.3% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2765
Fresenius Kidney Care Naperbrook 2451 S. Washington StreetNapervilleDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: BRUSHY CREEK DIALYSIS LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Schlieben, MD
3/13/2017 - Added 2 stations to existing facility; facility now has 18 ESRD stations.11/14/2017 - Received permit to add 6 ESRD stations to existing facility; facility located at 2451 South Washington Street in Naperville now has 24 ESRD stations.
In-Center Treatments in calendar year: 13,805Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 86
Patients treated as of 12/31/2017: (Ending patients) 101
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 52 51 47 49 53 51
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 67Transient Patients: 14Patients Re-Started: 4Post-Transplant Patien 4
Recovered patients: 4Transplant Recipients: 4Patients transferred out: 50Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 146
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
61Total:
89Total:
USE RATE for the FACILITY
16,848Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 82%Use Rate (including Missed Treatments): 83%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 147
80%94%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 : 6Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
94
63.9%
Medicaid
0
Private Insurance
53
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
147
0.0% 36.1% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 170
410
88
4142
1
1
010342522
05
201615
<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:
147
015544137
14791 56
147
$2,383,384 $2,140 $2,654,183 $0$254 $0 $5,039,961
47.3% 0.0% 52.7% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2678
Fresenius Kidney Care Naperville North 516 W. 5th AvenueNapervilleDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Mustang Construction, Inc.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kevin Pandya, MD
In-Center Treatments in calendar year: 10,726Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 70
Patients treated as of 12/31/2017: (Ending patients) 77
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
18
Oct 7
13
0 46 26 47 20 47 23
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 37Transient Patients: 20Patients Re-Started: 1Post-Transplant Patien 6
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 39Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 184
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
64Total:
USE RATE for the FACILITY
19,656Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 55%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 131
56%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 : 3.5Dialysis Technician : 7Dietician : 1Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
85
64.9%
Medicaid
3
Private Insurance
38
Charity Care
0
Private Pay
5
Other Public
0
TOTAL
131
2.3% 29.0% 0.0%3.8% 0.0% 100.0%
Patients
TOTAL 150
340
82
9120
2
0
014221822
03
171421
<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
017393243
13176 55
131
$17,329,270 $5,775 $2,143,273 $0$41,518 $16,379 $19,536,215
88.7% 0.0% 11.0% 0.0%0.2% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2815
Fresenius Kidney Care New City 4916 S. BishopChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: 4622 S. Bishop, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nic Hristea, MD
In-Center Treatments in calendar year: 986Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 2
Patients treated as of 12/31/2017: (Ending patients) 14
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 400.0
Oct 1
0
Oct 2
14
Oct 3
0
Oct 4
14
Oct 5
0
Oct 6
14
Oct 7
0
0 16 0 16 0 16 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 15Transient Patients: 1Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 4Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 36
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
5Total:
17Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 7%Use Rate (including Missed Treatments): 7%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 17
2%15%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 : 2Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
4
23.5%
Medicaid
1
Private Insurance
12
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
17
5.9% 70.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0040
13
1340
0
03431
01320
<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
04751
1711 6
17
$0 $0 $17,090 $0$0 $0 $17,090
0.0% 0.0% 100.0% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2559
Fresenius Kidney Care Niles 9371 N. Milwaukee AvenueNilesCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: CFT NV Developments, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Harold Bregman, MD
In-Center Treatments in calendar year: 15,281Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 106
Patients treated as of 12/31/2017: (Ending patients) 102
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
17
Oct 3
12
Oct 4
17
Oct 5
12
Oct 6
17
Oct 7
12
0 60 36 60 36 61 37
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 47Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 5Patients transferred out: 32Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 15
Number of Missed Treatments: 105
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
54Total:
USE RATE for the FACILITY
29,952Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 51%Use Rate (including Missed Treatments): 51%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 160
55%53%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 : 6Dialysis Technician : 12Dietician : 1.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
61.9%
Medicaid
3
Private Insurance
57
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
160
1.9% 35.6% 0.0%0.6% 0.0% 100.0%
Patients
TOTAL 35070
118
23137
0
0
010322243
02
141720
<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
012463963
160107 53
160
$2,658,934 $60,174 $3,273,216 $0$28,349 $0 $6,020,673
44.2% 1.0% 54.4% 0.0%0.5% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2778
Fresenius Kidney Care Normal 1531 E. College AvenueNormalMcLean4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: 1531 E. College, LLC. c/o Pier & Asso
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kumarpal Shrishrimal, MD
In-Center Treatments in calendar year: 6,102Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 45
Patients treated as of 12/31/2017: (Ending patients) 44
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
12
Oct 3
15
Oct 4
12
Oct 5
12
Oct 6
14
Oct 7
12
0 19 22 21 23 18 21
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 19Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 27Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 267
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
34Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 54%Use Rate (including Missed Treatments): 57%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 79
63%61%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 : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
72.2%
Medicaid
2
Private Insurance
19
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
79
2.5% 24.1% 0.0%1.3% 0.0% 100.0%
Patients
TOTAL 10
250
53
4750
0
07
1518
5
0389
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:
79
0102327197945 34
79
$955,480 $13,719 $700,193 $0$18,656 $16,419 $1,704,467
56.1% 0.8% 41.1% 0.0%1.1% 1.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2521
Fresenius Kidney Care Norridge 4701 N. Cumberland, Suite 15-18 ANorridgeCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Cumberland Mall, G.P.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Chirag Patel, MD
In-Center Treatments in calendar year: 11,707Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 77
Patients treated as of 12/31/2017: (Ending patients) 78
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 42 30 44 31 43 33
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 52Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 37Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 35
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
56Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 78%Use Rate (including Missed Treatments): 78%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 121
80%81%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 12/31/2017: 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
72
59.5%
Medicaid
1
Private Insurance
48
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
121
0.8% 39.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 5040
104
15100
6
8
06
222121
03
131322
<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
09
353443
12170 51
121
$1,970,366 $10,319 $1,792,546 $0$3,181 $0 $3,776,412
52.2% 0.3% 47.5% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2602
Fresenius Kidney Care North Avenue 911 W. North AvenueMelrose ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Gottlieb Memorial Hospital
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Martin Finn, MD
In-Center Treatments in calendar year: 16,872Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 116
Patients treated as of 12/31/2017: (Ending patients) 114
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 52 53 51 54 51 57
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 48Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 6Patients transferred out: 21Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 486
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
60Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 75%Use Rate (including Missed Treatments): 77%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 171
81%79%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 : 6Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
103
60.2%
Medicaid
3
Private Insurance
60
Charity Care
0
Private Pay
5
Other Public
0
TOTAL
171
1.8% 35.1% 0.0%2.9% 0.0% 100.0%
Patients
TOTAL 60
670
44
52117
2
54
018382824
05
201424
<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:
171
023584248
171108 63
171
$2,735,779 $27,558 $2,895,169 $0$76,500 $0 $5,735,006
47.7% 0.5% 50.5% 0.0%1.3% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2501
Fresenius Kidney Care North Kilpatrick 4800 N. KilpatrickChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Kilpatrick 1.0, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Madhav Rao, MD
In-Center Treatments in calendar year: 20,274Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 137
Patients treated as of 12/31/2017: (Ending patients) 136
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 340.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17.5
Oct 6
17.5
Oct 7
17
0 65 67 64 66 66 63
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 43Transient Patients: 5Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 7Patients transferred out: 31Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 262
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
50Total:
49Total:
USE RATE for the FACILITY
26,208Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 77%Use Rate (including Missed Treatments): 78%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 185
82%81%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 : 8Dialysis Technician : 14.5Dietician : 1Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
92
49.7%
Medicaid
7
Private Insurance
84
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
185
3.8% 45.4% 0.0%1.1% 0.0% 100.0%
Patients
TOTAL 220
2013
130
86990
0
014442616
010342219
<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
024784835
185100 85
185
$2,220,983 $102,033 $5,655,588 $0$78,854 $62,492 $8,119,950
27.4% 1.3% 69.7% 0.0%1.0% 0.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2531
Fresenius Kidney Care Northcenter 2620 W. Addison StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Bryton Properties LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mark Leischner, MD
In-Center Treatments in calendar year: 15Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 64
Patients treated as of 12/31/2017: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
17
Oct 7
13
0 32 20 32 20 32 20
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 25Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 5Patients transferred out: 27Patients voluntarily discontinued: 4Patients lost to follow up: 5Patients deceased: 12
Number of Missed Treatments: 271
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
56Total:
48Total:
USE RATE for the FACILITY
14,976Treatment 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: 79
67%57%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 : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
42
53.2%
Medicaid
2
Private Insurance
34
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
79
2.5% 43.0% 0.0%1.3% 0.0% 100.0%
Patients
TOTAL 31
151
58
42370
1
05
3186
04
1492
<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
09
45178
7950 29
79
$1,230,893 $50,717 $2,709,432 $0$19,838 $0 $4,010,880
30.7% 1.3% 67.6% 0.0%0.5% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2771
Fresenius Kidney Care Northfield 480 Central AvenueNorthfieldCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Richard N. Abrams
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sandeep Mehta, MD
In-Center Treatments in calendar year: 863Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 1
Patients treated as of 12/31/2017: (Ending patients) 9
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
10
Oct 3
0
Oct 4
10
Oct 5
0
Oct 6
12
Oct 7
0
0 8 0 7 0 8 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 11Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 11Patients 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
11Total:
17Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 8%Use Rate (including Missed Treatments): 8%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 18
1%13%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 3Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 32Registered Nurse : 1.5Dialysis Technician : 1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 12Certified Stations by CMS: 12Peak Authorized Stations Operated: 3
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
77.8%
Medicaid
0
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
18
0.0% 16.7% 0.0%0.0% 5.6% 100.0%
Patients
TOTAL 3010
14
1170
0
00245
01312
<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:
18
01557
1811 7
18
$5,979 $0 $2,052 $0$111 $16,359 $24,501
24.4% 0.0% 8.4% 0.0%0.5% 66.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2597
Fresenius Kidney Care Northwestern 710 N. Fairbanks CourtChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Dialysis Centers of America - Illinois, Inc. Legal Entity Owner:
Property Owner: Real Estate Strategy
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jennifer Tuazon, MD
In-Center Treatments in calendar year: 21,772Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 150
Patients treated as of 12/31/2017: (Ending patients) 170
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
18
Oct 3
17
Oct 4
18
Oct 5
17
Oct 6
18
Oct 7
17
0 75 66 74 60 76 60
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 43Transient Patients: 63Patients Re-Started: 3Post-Transplant Patien 3
Recovered patients: 5Transplant Recipients: 10Patients transferred out: 73Patients voluntarily discontinued: 3Patients lost to follow up: 28Patients deceased: 17
Number of Missed Treatments: 904
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
136Total:
112Total:
USE RATE for the FACILITY
39,312Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 55%Use Rate (including Missed Treatments): 58%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 260
60%67%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 : 11Dialysis Technician : 19Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
179
68.8%
Medicaid
3
Private Insurance
76
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
260
1.2% 29.2% 0.0%0.8% 0.0% 100.0%
Patients
TOTAL 100
1360
72
3318542
42
019663431
022382525
<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:
260
041
1045956
260150 110
260
$3,741,510 $36,901 $3,188,721 $0$31,979 $18,429 $7,017,540
53.3% 0.5% 45.4% 0.0%0.5% 0.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2764
Fresenius Kidney Care Oak Forest 5340A West 159th StreetOak ForestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: RJE Investments
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Jeanette McLaughlin, MD
In-Center Treatments in calendar year: 7,708Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 49
Patients treated as of 12/31/2017: (Ending patients) 56
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
18
Oct 3
14
Oct 4
18
Oct 5
12.5
Oct 6
18
Oct 7
12
0 35 19 31 18 33 20
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 45Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 30Patients voluntarily discontinued: 4Patients lost to follow up: 3Patients deceased: 1
Number of Missed Treatments: 234
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
55Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 71%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 89
68%78%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 : 3.5Dialysis Technician : 7Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
60
67.4%
Medicaid
1
Private Insurance
28
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
89
1.1% 31.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 21
391
44
7820
2
06
1025
8
037
246
<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
09
1749148949 40
89
$1,264,503 $0 $1,292,360 $0$0 $0 $2,556,863
49.5% 0.0% 50.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2504
Fresenius Kidney Care Oak Park 733 Madison Street Oak ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Three M & L Partnership
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Paul Balter, MD
In-Center Treatments in calendar year: 9,954Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 71
Patients treated as of 12/31/2017: (Ending patients) 63
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 34 28 31 28 33 27
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 22Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 25Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 225
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
31Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 89%Use Rate (including Missed Treatments): 91%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 90
99%88%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 : 5Dialysis Technician : 8Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
63.3%
Medicaid
1
Private Insurance
32
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
90
1.1% 35.6% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
660
24
4860
0
04
221013
07
13138
<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
0113523219049 41
90
$1,472,339 $46,314 $1,766,560 $0$3,170 $0 $3,288,383
44.8% 1.4% 53.7% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2550
Fresenius Kidney Care Orland Park 9160 W. 159th StreetOrland ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lourdes Terrado, MD
In-Center Treatments in calendar year: 9,947Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 72
Patients treated as of 12/31/2017: (Ending patients) 68
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17.5
Oct 3
13
Oct 4
17.5
Oct 5
13
Oct 6
17.5
Oct 7
13
0 41 23 42 22 43 20
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 5Patients transferred out: 21Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 50
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
32Total:
USE RATE for the FACILITY
16,848Treatment 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: 100
67%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 : 3.5Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
70
70.0%
Medicaid
1
Private Insurance
28
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
100
1.0% 28.0% 0.0%1.0% 0.0% 100.0%
Patients
TOTAL 40
130
83
2980
0
04
201520
02
101514
<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
06
303034
10059 41
100
$2,121,201 $18,991 $1,425,174 $0$6,201 $4,696 $3,576,263
59.3% 0.5% 39.9% 0.0%0.2% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2677
Fresenius Kidney Care Oswego 1051 Station DriveOswegoKendall9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Oswego Junction, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Atif Fakhruddin, MD
1/17/2017 - Added 2 stations to existing facility; facility now has 13 ESRD stations.9/26/2017 - Facility approved to add 6 ESRD stations to existing facility; facility is now authorized for 19 ESRD stations.
In-Center Treatments in calendar year: 10,222Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 65
Patients treated as of 12/31/2017: (Ending patients) 69
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 34 33 34 31 36 37
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 27Transient Patients: 28Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 2Patients transferred out: 49Patients voluntarily discontinued: 2Patients lost to follow up: 1Patients deceased: 3
Number of Missed Treatments: 266
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
59Total:
56Total:
USE RATE for the FACILITY
12,168Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 84%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 121
83%88%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: 32Registered Nurse : 3Dialysis Technician : 5.5Dietician : 0.5Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
81
66.9%
Medicaid
3
Private Insurance
35
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
121
2.5% 28.9% 0.0%1.7% 0.0% 100.0%
Patients
TOTAL 40
280
89
31900
0
05
202214
06
212013
<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
011414227
12161 60
121
$1,614,196 $47,175 $1,844,545 $0$4,770 $50,660 $3,561,346
45.3% 1.3% 51.8% 0.0%0.1% 1.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2576
Fresenius Kidney Care Ottawa 1601 Mercury Court, Suite 3OttawaLaSalle2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Amit Jamnadas, MD
In-Center Treatments in calendar year: 5,786Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 47
Patients treated as of 12/31/2017: (Ending patients) 39
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
17
Oct 7
13
0 25 16 25 15 25 16
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 11Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 25Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 105
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
22Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 52%Use Rate (including Missed Treatments): 52%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 59
65%54%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 12/31/2017: 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
43
72.9%
Medicaid
3
Private Insurance
12
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
59
5.1% 20.3% 0.0%1.7% 0.0% 100.0%
Patients
TOTAL 0000
59
12470
0
05
1612
4
02497
<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:
59
07
2021115937 22
59
$995,341 $75,214 $1,074,791 $0$2,089 $52,375 $2,199,810
45.2% 3.4% 48.9% 0.0%0.1% 2.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2723
Fresenius Kidney Care Palatine 691 E. Dundee RoadPalatineCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Ramco Gershenson Properties Trust ,
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Manish Tanna, MD
7/10/2017 - Facility added 2 additional ESRD stations; facility now has 16 ESRD stations.8/31/2017 - Facility approved to add 1 ESRD station to existing facility; facility is now authorized for 17 ESRD stations.
In-Center Treatments in calendar year: 13,023Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 76
Patients treated as of 12/31/2017: (Ending patients) 88
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 43 46 45 40 44 43
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 48Transient Patients: 8Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 2Transplant Recipients: 9Patients transferred out: 19Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 43
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
42Total:
59Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 87%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 134
79%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: 1
Full-Time Work Week: 32Registered Nurse : 6Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
63.4%
Medicaid
1
Private Insurance
44
Charity Care
0
Private Pay
4
Other Public
0
TOTAL
134
0.7% 32.8% 0.0%3.0% 0.0% 100.0%
Patients
TOTAL 1910
00
105
20114
0
0
09
312522
04
101617
<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
013414139
13487 47
134
$1,469,188 $91,433 $3,145,668 $0$45,467 $1,971 $4,753,727
30.9% 1.9% 66.2% 0.0%1.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2571
Fresenius Kidney Care Pekin 3521 Veterans DrivePekinTazewell2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Gordon James, MD
In-Center Treatments in calendar year: 6,462Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 44
Patients treated as of 12/31/2017: (Ending patients) 46
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 340.0
Oct 1
0
Oct 2
17
Oct 3
15
Oct 4
17
Oct 5
14
Oct 6
17
Oct 7
13
0 23 16 23 16 23 16
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 19Patients 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
25Total:
27Total:
USE RATE for the FACILITY
9,360Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 71%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 62
73%77%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 12/31/2017: 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
39
62.9%
Medicaid
0
Private Insurance
19
Charity Care
0
Private Pay
1
Other Public
3
TOTAL
62
0.0% 30.6% 0.0%1.6% 4.8% 100.0%
Patients
TOTAL 0000
62
0620
0
03
139
11
0392
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:
62
06
2211236236 26
62
$718,318 $0 $998,532 $0$3,819 $73,404 $1,794,073
40.0% 0.0% 55.7% 0.0%0.2% 4.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2574
Fresenius Kidney Care Peoria Downtown 410 W. Romeo Garrett AvenuePeoriaPeoria2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Tim Pflederer, MD
In-Center Treatments in calendar year: 18,767Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 133
Patients treated as of 12/31/2017: (Ending patients) 136
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
16
Oct 2
12
Oct 3
16
Oct 4
12
Oct 5
16
Oct 6
12
Oct 7
0
0 62 59 58 58 65 52
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 52Transient Patients: 15Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 38Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 19
Number of Missed Treatments: 1,317
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
65Total:
68Total:
USE RATE for the FACILITY
29,952Treatment 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: 179
69%71%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 : 18Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
116
64.8%
Medicaid
3
Private Insurance
55
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
179
1.7% 30.7% 0.0%1.1% 1.7% 100.0%
Patients
TOTAL 00
1261
52
7172
0
0
010412110
06
323326
<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:
179
016735436
17982 97
179
$2,575,018 $11,985 $2,253,119 $0$12,847 $88,725 $4,941,694
52.1% 0.2% 45.6% 0.0%0.3% 1.8% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2613
Fresenius Kidney Care Peoria North 10405 North Juliet CourtPeoriaPeoria2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Raji Jacob, MD
2/24/2017 - Added 2 stations to existing facility; facility now has 21 ESRD stations.
In-Center Treatments in calendar year: 12,192Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 82
Patients treated as of 12/31/2017: (Ending patients) 76
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
16
Oct 3
13
Oct 4
16
Oct 5
13
Oct 6
16
Oct 7
13
0 43 37 46 35 41 37
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 44Transient Patients: 16Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 3Transplant Recipients: 2Patients transferred out: 47Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 13
Number of Missed Treatments: 441
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
70Total:
62Total:
USE RATE for the FACILITY
19,656Treatment 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: 132
65%60%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 : 4Dialysis Technician : 8.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
84
63.6%
Medicaid
1
Private Insurance
45
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
132
0.8% 34.1% 0.0%0.8% 0.8% 100.0%
Patients
TOTAL 20
350
95
5125
2
0
06
341524
06
171119
<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
012512643
13279 53
132
$1,912,146 $10,271 $2,415,842 $0$11,949 $0 $4,350,208
44.0% 0.2% 55.5% 0.0%0.3% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2707
Fresenius Kidney Care Plainfield2320 Michas DrivePlainfieldWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: ZENITH HOLDINGS, LIMITED
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Morufu Alausa, MD
In-Center Treatments in calendar year: 11,475Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 78
Patients treated as of 12/31/2017: (Ending patients) 79
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
20
Oct 3
22
Oct 4
20
Oct 5
19.25
Oct 6
19.5
Oct 7
19
0 40 40 41 38 38 39
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 23Patients Re-Started: 0Post-Transplant Patien 3
Recovered patients: 3Transplant Recipients: 4Patients transferred out: 47Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 362
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
69Total:
67Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 77%Use Rate (including Missed Treatments): 79%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 129
81%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: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
83
64.3%
Medicaid
2
Private Insurance
43
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
129
1.6% 33.3% 0.0%0.8% 0.0% 100.0%
Patients
TOTAL 100
330
86
21108
0
0
010321912
08
181812
<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:
129
018503724
12973 56
129
$2,050,856 $23,407 $2,817,760 $0$6,682 $6,846 $4,905,551
41.8% 0.5% 57.4% 0.0%0.1% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2596
Fresenius Kidney Care Plainfield North 24024 W. Riverwalk CourtPlainfieldWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: MERIDIAN INVESTMENT PARTNERS,
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Aaron Gurfinchel, MD
In-Center Treatments in calendar year: 3,228Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 13
Patients treated as of 12/31/2017: (Ending patients) 34
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
12
Oct 3
8
Oct 4
12
Oct 5
8
Oct 6
12
Oct 7
8
0 17 7 17 6 17 6
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 22Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 51
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
40Total:
USE RATE for the FACILITY
9,360Treatment 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: 53
22%57%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 : 4Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
77.4%
Medicaid
1
Private Insurance
11
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
53
1.9% 20.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 20
120
35
2501
4
01
1214
9
01277
<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
02
1421165336 17
53
$52,046 $889 $38,476 $0$0 $12,021 $103,432
50.3% 0.9% 37.2% 0.0%0.0% 11.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2502
Fresenius Kidney Care Polk 557 W. Polk StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: 571 W. Polk Street LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Marco Pagani, MD
In-Center Treatments in calendar year: 8,399Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 46
Patients treated as of 12/31/2017: (Ending patients) 57
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
12
Oct 4
18
Oct 5
12
Oct 6
18
Oct 7
12
0 39 18 37 18 38 18
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 6Transient Patients: 41Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 5Patients transferred out: 40Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 232
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
48Total:
USE RATE for the FACILITY
22,464Treatment 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: 101
32%40%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 : 4Dialysis Technician : 5.5Dietician : 1Social Worker: 1LPN : 0Other Health : 2Other Non-Health:
Authorized Stations as of 12/31/2017: 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
57
56.4%
Medicaid
2
Private Insurance
41
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
101
2.0% 40.6% 0.0%1.0% 0.0% 100.0%
Patients
TOTAL 40
631
28
19775
5
0113019
5
01
2285
<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
012522710
10165 36
101
$1,427,828 $75,354 $1,793,582 $19,125 $1,623 $3,317,512
43.0% 2.3% 54.1% 0.6% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2611
Fresenius Kidney Care Pontiac 804 W. Madison StreetPontiacLivingston4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: David Rosborough, MD
In-Center Treatments in calendar year: 4,296Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 29
Patients treated as of 12/31/2017: (Ending patients) 24
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
16
Oct 3
15
Oct 4
14
Oct 5
17
Oct 6
14
Oct 7
13
0 15 12 15 12 14 15
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 21Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 21Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 231
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
34Total:
27Total:
USE RATE for the FACILITY
8,424Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 51%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 53
54%44%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 : 3Dialysis Technician : 3Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
43
81.1%
Medicaid
2
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
53
3.8% 11.3% 0.0%0.0% 3.8% 100.0%
Patients
TOTAL 1010
49
2510
2
05
1097
01
1074
<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
06
2016115331 22
53
$499,845 $4,471 $466,711 $0$4,730 $33,794 $1,009,551
49.5% 0.4% 46.2% 0.0%0.5% 3.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2569
Fresenius Kidney Care Prairie 1717 S. Wabash AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sheldon Hirsch, MD
In-Center Treatments in calendar year: 16,194Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 109
Patients treated as of 12/31/2017: (Ending patients) 109
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 360.0
Oct 1
0
Oct 2
17.5
Oct 3
13
Oct 4
17.5
Oct 5
17
Oct 6
18
Oct 7
13
0 60 40 59 42 63 45
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 44Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 6Patients transferred out: 44Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 188
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
60Total:
59Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 72%Use Rate (including Missed Treatments): 73%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 165
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 12/31/2017: 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
95
57.6%
Medicaid
1
Private Insurance
68
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
165
0.6% 41.2% 0.0%0.0% 0.6% 100.0%
Patients
TOTAL 90
15303
3162
0
0
07
424011
05
132621
<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:
165
012556632
165100 65
165
$2,207,416 $4,086 $3,166,484 $0$1,684 $76,304 $5,455,974
40.5% 0.1% 58.0% 0.0%0.0% 1.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2589
Fresenius Kidney Care Randolph County 102 Memorial DriveChesterRandolph5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Memori
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Muhammad Kamran, MD
In-Center Treatments in calendar year: 3,404Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 23
Patients treated as of 12/31/2017: (Ending patients) 24
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
11
Oct 3
8
Oct 4
10
Oct 5
8
Oct 6
10
Oct 7
7
0 16 8 12 8 15 8
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 6Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 2Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 70
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
7Total:
7Total:
USE RATE for the FACILITY
7,488Treatment 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: 30
48%50%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 : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
73.3%
Medicaid
0
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
30
0.0% 26.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0050
25
4260
0
03543
01455
<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
04998
3015 15
30
$596,490 $0 $690,816 $0$0 $12,142 $1,299,448
45.9% 0.0% 53.2% 0.0%0.0% 0.9% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2558
Fresenius Kidney Care Regency Park 124 Regency Park Drive, Suite 1O'FallonSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Savvi Investment
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Koch, MD
In-Center Treatments in calendar year: 15,187Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 106
Patients treated as of 12/31/2017: (Ending patients) 105
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 44 51 43 45 50 53
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 42Transient Patients: 18Patients Re-Started: 4Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 31Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 26
Number of Missed Treatments: 639
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
69Total:
64Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 81%Use Rate (including Missed Treatments): 85%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 170
88%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 : 5.5Dialysis Technician : 12Dietician : 2Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
115
67.6%
Medicaid
1
Private Insurance
52
Charity Care
0
Private Pay
1
Other Public
1
TOTAL
170
0.6% 30.6% 0.0%0.6% 0.6% 100.0%
Patients
TOTAL 01
981
70
1169
0
0
012382523
05
212422
<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
017594945
17098 72
170
$2,068,549 $0 $2,510,050 $0$3,679 $51,200 $4,633,478
44.6% 0.0% 54.2% 0.0%0.1% 1.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2735
Fresenius Kidney Care River Forest 103 Forest AvenueRiver ForestCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Elliott Bay Healthcare Realty, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: George Naratadam, MD
In-Center Treatments in calendar year: 12,956Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 83
Patients treated as of 12/31/2017: (Ending patients) 91
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 49 36 48 37 49 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 36Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 6Patients transferred out: 25Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 4
Number of Missed Treatments: 279
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
47Total:
USE RATE for the FACILITY
20,592Treatment 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: 130
63%69%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 : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2.5
Authorized Stations as of 12/31/2017: 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
96
73.8%
Medicaid
1
Private Insurance
30
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
130
0.8% 23.1% 0.0%0.8% 1.5% 100.0%
Patients
TOTAL 41
940
31
9121
0
0
0113417
9
08
211515
<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
019553224
13071 59
130
$2,120,870 $30,698 $2,231,970 $0$2,431 $51,526 $4,437,495
47.8% 0.7% 50.3% 0.0%0.1% 1.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2703
Fresenius Kidney Care Rock Island 2623 17th StreetRock IslandRock Island10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: RRS Investments, LLP
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Travis Figanbaum, MD
In-Center Treatments in calendar year: 5,159Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 33
Patients treated as of 12/31/2017: (Ending patients) 35
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
12
Oct 3
0
Oct 4
12
Oct 5
0
Oct 6
12
Oct 7
0
0 35 0 35 0 35 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 15Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 12Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 213
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
22Total:
USE RATE for the FACILITY
17,784Treatment 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: 55
29%31%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 : 2.5Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
38
69.1%
Medicaid
0
Private Insurance
17
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
55
0.0% 30.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 20
190
34
0550
0
028
103
0377
15
<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
05
1517185523 32
55
$602,017 $0 $310,465 $0$0 $0 $912,482
66.0% 0.0% 34.0% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2645
Fresenius Kidney Care Rock River - Dixon 101 W. Second StreeetDixonLee1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Katherine Shaw Bethea Hospital
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Alla, MD
In-Center Treatments in calendar year: 2,418Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 19
Patients treated as of 12/31/2017: (Ending patients) 14
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
0
Oct 4
15
Oct 5
0
Oct 6
15
Oct 7
0
0 15 0 15 0 15 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 4Transient Patients: 1Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 3Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 32
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
10Total:
6Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 32%Use Rate (including Missed Treatments): 33%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 25
40%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: 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 12/31/2017: 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
80.0%
Medicaid
4
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
25
16.0% 4.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
25
2230
0
01
1251
00240
<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
01
1491
2519 6
25
$385,495 $35,295 $0 $0$0 $0 $420,790
91.6% 8.4% 0.0% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2522
Fresenius Kidney Care Rogers Park 2277 W. Howard StreeetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Arnold Berns, MD
In-Center Treatments in calendar year: 11,401Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 78
Patients treated as of 12/31/2017: (Ending patients) 81
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 310.0
Oct 1
0
Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
17
Oct 7
13
0 45 30 47 31 46 30
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 28Transient Patients: 11Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 24Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 192
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
36Total:
39Total:
USE RATE for the FACILITY
18,720Treatment 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: 117
65%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 : 4.5Dialysis Technician : 9Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
63
53.8%
Medicaid
2
Private Insurance
48
Charity Care
0
Private Pay
3
Other Public
1
TOTAL
117
1.7% 41.0% 0.0%2.6% 0.9% 100.0%
Patients
TOTAL 131
460
57
29880
0
014271015
011179
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:
117
025441929
11766 51
117
$1,805,671 $47,363 $2,388,322 $0$32,014 $54,317 $4,327,687
41.7% 1.1% 55.2% 0.0%0.7% 1.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2525
Fresenius Kidney Care Rolling Meadows 4180 Winnetka AveRolling MeadowsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: RMS Properties LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Azza Suleiman, MD
In-Center Treatments in calendar year: 13,331Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 102
Patients treated as of 12/31/2017: (Ending patients) 106
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 48 33 48 33 48 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 26Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 13
Number of Missed Treatments: 217
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
48Total:
52Total:
USE RATE for the FACILITY
22,464Treatment 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: 154
71%74%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 : 6Dialysis Technician : 7.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
102
66.2%
Medicaid
5
Private Insurance
43
Charity Care
0
Private Pay
4
Other Public
0
TOTAL
154
3.2% 27.9% 0.0%2.6% 0.0% 100.0%
Patients
TOTAL 10030
133
23123
8
8
010291838
04
141427
<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
014433265
15495 59
154
$2,375,222 $22,471 $3,645,081 $0$60,586 $18,964 $6,122,324
38.8% 0.4% 59.5% 0.0%1.0% 0.3% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2690
Fresenius Kidney Care Roseland 132 W. 111th StreeetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Roseland Medical Center
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nimeet Brahmbhatt, MD
In-Center Treatments in calendar year: 9,415Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 68
Patients treated as of 12/31/2017: (Ending patients) 69
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 32 28 32 30 33 30
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 8Transient Patients: 9Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 22Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 744
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
32Total:
19Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 84%Use Rate (including Missed Treatments): 90%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 100
94%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: 0
Full-Time Work Week: 32Registered Nurse : 3Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
51
51.0%
Medicaid
1
Private Insurance
45
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
100
1.0% 45.0% 0.0%1.0% 2.0% 100.0%
Patients
TOTAL 00
9802
0100
0
0
09
2810
5
06
238
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:
100
015511816
10052 48
100
$1,158,900 $27,921 $1,369,126 $0$0 $41,836 $2,597,783
44.6% 1.1% 52.7% 0.0%0.0% 1.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2616
Fresenius Kidney Care Round Lake 401 W. Nippersink RoadRound LakeLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Rockford 550, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Nino Alapishvili, MD
In-Center Treatments in calendar year: 11,677Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 74
Patients treated as of 12/31/2017: (Ending patients) 80
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 280.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 42 37 38 39 39 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 30Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 202
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
38Total:
USE RATE for the FACILITY
14,976Treatment 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: 108
77%83%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 : 0.8Social Worker: 0.6LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
68
63.0%
Medicaid
5
Private Insurance
29
Charity Care
0
Private Pay
3
Other Public
3
TOTAL
108
4.6% 26.9% 0.0%2.8% 2.8% 100.0%
Patients
TOTAL 5030
100
40680
0
011271813
04
111311
<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:
108
015383124
10869 39
108
$1,701,156 $52,043 $2,316,656 $0$17,733 $65,856 $4,153,444
41.0% 1.3% 55.8% 0.0%0.4% 1.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2573
Fresenius Kidney Care Saline County 275 Small Street, Suite 200HarrisburgSaline5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Invest
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Randy Coward, MD
In-Center Treatments in calendar year: 8,150Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 51
Patients treated as of 12/31/2017: (Ending patients) 59
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
12
Oct 3
11
Oct 4
12
Oct 5
11
Oct 6
12
Oct 7
11
0 26 22 23 26 25 26
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 5Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 6Transplant Recipients: 2Patients transferred out: 10Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 487
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
32Total:
31Total:
USE RATE for the FACILITY
14,976Treatment 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: 82
53%61%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 : 3Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
66
80.5%
Medicaid
6
Private Insurance
6
Charity Care
0
Private Pay
0
Other Public
4
TOTAL
82
7.3% 7.3% 0.0%0.0% 4.9% 100.0%
Patients
TOTAL 0030
79
0820
0
06
181014
019
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:
82
07
2724248248 34
82
$362,891 $22,629 $97,510 $0$0 $46,144 $529,174
68.6% 4.3% 18.4% 0.0%0.0% 8.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2700
Fresenius Kidney Care Sandwich 1310 N. Main Street, Suite 105SandwichDeKalb1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Sandwich Development Partners
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Atif Fakhruddin, MD
9/26/2017 - Facility approved to add 1 ESRD station to existing facility; facility is now authorized for 12 ESRD stations.
In-Center Treatments in calendar year: 5,551Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 37
Patients treated as of 12/31/2017: (Ending patients) 38
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 18 16 18 17 18 16
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 11Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 92
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
18Total:
19Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 49%Use Rate (including Missed Treatments): 50%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 55
51%53%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 : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 12Certified 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
37
67.3%
Medicaid
2
Private Insurance
13
Charity Care
0
Private Pay
2
Other Public
1
TOTAL
55
3.6% 23.6% 0.0%3.6% 1.8% 100.0%
Patients
TOTAL 0040
51
8470
0
03
1013
5
03957
<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
06
1918125531 24
55
$1,002,707 $29,151 $1,043,020 $0$1,058 $0 $2,075,936
48.3% 1.4% 50.2% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2675
Fresenius Kidney Care Silvis 880 Crosstown AvenueSilvisRock Island10
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: RRS Investments, LLP
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Suresh Alla, MD
In-Center Treatments in calendar year: 9,144Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 66
Patients treated as of 12/31/2017: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 33 25 35 23 35 26
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 18Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 20
Number of Missed Treatments: 344
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
38Total:
32Total:
USE RATE for the FACILITY
16,848Treatment 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: 98
61%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: 32Registered Nurse : 3Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
53
54.1%
Medicaid
1
Private Insurance
43
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
98
1.0% 43.9% 0.0%1.0% 0.0% 100.0%
Patients
TOTAL 10
110
82
9854
4
03
161712
03
151121
<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
3128339848 50
98
$946,450 $0 $808,617 $0$2,713 $0 $1,757,780
53.8% 0.0% 46.0% 0.0%0.2% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2618
Fresenius Kidney Care Skokie 9801 Woods DriveSkokieCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Christopher Najafi, MD
In-Center Treatments in calendar year: 8,770Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 63
Patients treated as of 12/31/2017: (Ending patients) 58
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
16
Oct 3
13
Oct 4
16
Oct 5
13
Oct 6
16
Oct 7
13
0 35 20 34 22 34 21
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 26Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 21
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
40Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 67%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 91
75%69%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 : 6Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
56
61.5%
Medicaid
3
Private Insurance
30
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
91
3.3% 33.0% 0.0%0.0% 2.2% 100.0%
Patients
TOTAL 250
130
53
8830
0
08
141522
0295
16
<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
0102320389159 32
91
$1,027,291 $25,409 $825,067 $0$6,006 $56,601 $1,940,374
52.9% 1.3% 42.5% 0.0%0.3% 2.9% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2519
Fresenius Kidney Care South Chicago 9200 S. South Chicago AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Rockford 550, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kareen Simpson, MD
In-Center Treatments in calendar year: 28,382Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 207
Patients treated as of 12/31/2017: (Ending patients) 195
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 98 93 91 91 95 91
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 49Transient Patients: 4Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 5Transplant Recipients: 10Patients transferred out: 32Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 24
Number of Missed Treatments: 3,697
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
71Total:
57Total:
USE RATE for the FACILITY
33,696Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 84%Use Rate (including Missed Treatments): 95%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 264
96%90%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 : 8Dialysis Technician : 21Dietician : 1.5Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
158
59.8%
Medicaid
5
Private Insurance
99
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
264
1.9% 37.5% 0.0%0.8% 0.0% 100.0%
Patients
TOTAL 00
2130
51
48216
0
0
023713741
05
362922
<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
028
1076663
264172 92
264
$3,666,562 $60,873 $5,003,069 $0$11,402 $60,812 $8,802,718
41.7% 0.7% 56.8% 0.0%0.1% 0.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2756
Fresenius Kidney Care South Deering 10559 S. Torrence AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Fresenius Medical Care South Deering, LLC Legal Entity Owner:
Property Owner: Torrence Complex,LP
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Richard Hong, MD
In-Center Treatments in calendar year: 10,500Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 78
Patients treated as of 12/31/2017: (Ending patients) 65
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 35 34 34 33 32 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 37Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 320
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
31Total:
USE RATE for the FACILITY
18,720Treatment 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: 102
65%54%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 : 13Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
72
70.6%
Medicaid
0
Private Insurance
29
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
102
0.0% 28.4% 0.0%1.0% 0.0% 100.0%
Patients
TOTAL 00
850
17
12900
0
04
281212
02
201014
<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
06
482226
10256 46
102
$1,668,377 $16,492 $1,516,334 $0$3,922 $0 $3,205,125
52.1% 0.5% 47.3% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2542
Fresenius Kidney Care South Holland 17225 S. Paxton South HollandCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Physicians Capital investments, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: R. Soundararajan, MD
In-Center Treatments in calendar year: 15,174Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 99
Patients treated as of 12/31/2017: (Ending patients) 106
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
18
Oct 3
14
Oct 4
18
Oct 5
14
Oct 6
18
Oct 7
14
0 57 42 57 41 56 42
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 39Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 33Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 6
Number of Missed Treatments: 274
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
46Total:
USE RATE for the FACILITY
22,464Treatment 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: 145
69%74%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 : 9.5Dialysis Technician : 11Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
69
47.6%
Medicaid
1
Private Insurance
71
Charity Care
0
Private Pay
1
Other Public
3
TOTAL
145
0.7% 49.0% 0.0%0.7% 2.1% 100.0%
Patients
TOTAL 00
1300
15
11134
0
0
010551413
08
171513
<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
018722926
14592 53
145
$1,744,980 $7,309 $3,344,067 $0$3,698 $20,381 $5,120,435
34.1% 0.1% 65.3% 0.0%0.1% 0.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2572
Fresenius Kidney Care South Shore 2420 E 79th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Realty Income Illinois Properties
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Clark McClurkin, MD
In-Center Treatments in calendar year: 6,931Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 46
Patients treated as of 12/31/2017: (Ending patients) 49
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
18
Oct 3
8
Oct 4
18
Oct 5
8
Oct 6
18
Oct 7
8
0 31 9 35 8 39 7
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 15Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 29Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 1,046
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
41Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 46%Use Rate (including Missed Treatments): 53%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 87
48%51%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 : 2Dialysis Technician : 5Dietician : 0.5Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
46
52.9%
Medicaid
1
Private Insurance
39
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
87
1.1% 44.8% 0.0%1.1% 0.0% 100.0%
Patients
TOTAL 00
8601
1860
0
06
1499
06879
<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
0122216186838 30
87
$786,510 $14,256 $770,078 $0$14,446 $26,638 $1,611,928
48.8% 0.9% 47.8% 0.0%0.9% 1.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2517
Fresenius Kidney Care South Suburban 2609 Lincoln HighwayOlympia FieldsCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lourdes Terrado, MD
In-Center Treatments in calendar year: 17,618Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 132
Patients treated as of 12/31/2017: (Ending patients) 118
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
17.5
Oct 3
17.5
Oct 4
17.5
Oct 5
17.5
Oct 6
17.5
Oct 7
17.5
0 64 49 61 49 58 45
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 47Transient Patients: 21Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 7Patients transferred out: 47Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 23
Number of Missed Treatments: 521
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
80Total:
69Total:
USE RATE for the FACILITY
26,208Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 201
79%70%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 : 9Dialysis Technician : 13Dietician : 1Social Worker: 2LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
123
61.2%
Medicaid
3
Private Insurance
70
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
201
1.5% 34.8% 0.0%1.0% 1.5% 100.0%
Patients
TOTAL 11
1660
19
13187
1
14
013483726
08
292218
<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:
201
021775944
201124 77
201
$2,815,305 $35,513 $4,298,738 $0$38,242 $51,839 $7,239,637
38.9% 0.5% 59.4% 0.0%0.5% 0.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2508
Fresenius Kidney Care Southside 3134 W. 76th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Guatam Bhanushali, MD
In-Center Treatments in calendar year: 27,824Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 196
Patients treated as of 12/31/2017: (Ending patients) 201
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 95 85 92 89 96 80
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 78Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 6Patients transferred out: 46Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 24
Number of Missed Treatments: 2,003
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
77Total:
83Total:
USE RATE for the FACILITY
36,504Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 76%Use Rate (including Missed Treatments): 82%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 279
84%86%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 39Isolation Stations Set up in Oct 1-7: 39
Full-Time Work Week: 32Registered Nurse : 9Dialysis Technician : 20Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
146
52.3%
Medicaid
4
Private Insurance
119
Charity Care
0
Private Pay
7
Other Public
3
TOTAL
279
1.4% 42.7% 0.0%2.5% 1.1% 100.0%
Patients
TOTAL 00
2250
54
50229
0
0
022713725
017513719
<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:
279
039
1227444
279155 124
279
$3,785,762 $74,618 $4,858,418 $0$164,345 $92,370 $8,975,513
42.2% 0.8% 54.1% 0.0%1.8% 1.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2535
Fresenius Kidney Care Southwestern Illinois 7 Professional DriveAltonMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: 04-2560009
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Erik Daniels, MD
In-Center Treatments in calendar year: 11,963Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 89
Patients treated as of 12/31/2017: (Ending patients) 78
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
12
Oct 4
15
Oct 5
12
Oct 6
15
Oct 7
12
0 42 35 41 32 43 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 22Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 23Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 21
Number of Missed Treatments: 392
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
51Total:
33Total:
USE RATE for the FACILITY
17,784Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 67%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 115
78%68%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 : 6Dialysis Technician : 7.5Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
80
69.6%
Medicaid
2
Private Insurance
32
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
115
1.7% 27.8% 0.0%0.0% 0.9% 100.0%
Patients
TOTAL 00
220
93
0115
0
0
011271722
087
212
<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
019343824
11577 38
115
$2,067,038 $39,864 $1,392,937 $0$2,476 $0 $3,502,315
59.0% 1.1% 39.8% 0.0%0.1% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2565
Fresenius Kidney Care Spoon River 340 S. Avenue BCantonFulton2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Anthony Horinek, MD
In-Center Treatments in calendar year: 5,323Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 37
Patients treated as of 12/31/2017: (Ending patients) 32
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
14
Oct 4
16
Oct 5
13
Oct 6
15.5
Oct 7
11
0 21 15 20 15 23 13
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 11Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 4Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 49
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
17Total:
USE RATE for the FACILITY
10,296Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 52%Use Rate (including Missed Treatments): 52%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 51
56%48%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 : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
39
76.5%
Medicaid
2
Private Insurance
9
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
51
3.9% 17.6% 0.0%0.0% 2.0% 100.0%
Patients
TOTAL 0010
49
1500
1
0268
12
0155
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:
51
03
1113245128 23
51
$877,342 $44,639 $271,616 $0$0 $27,295 $1,220,892
71.9% 3.7% 22.2% 0.0%0.0% 2.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2564
Fresenius Kidney Care Spring Valley 12 Wolfer Industrial DriveSpring ValleyBureau2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Usman Khan, MD
In-Center Treatments in calendar year: 9,838Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 68
Patients treated as of 12/31/2017: (Ending patients) 63
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 340.0
Oct 1
0
Oct 2
18
Oct 3
16
Oct 4
18
Oct 5
16
Oct 6
18
Oct 7
15
0 33 27 33 29 36 28
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 21Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 19Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 358
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
34Total:
30Total:
USE RATE for the FACILITY
15,912Treatment 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: 97
67%62%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 : 5.5Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
82
84.5%
Medicaid
3
Private Insurance
8
Charity Care
0
Private Pay
1
Other Public
3
TOTAL
97
3.1% 8.2% 0.0%1.0% 3.1% 100.0%
Patients
TOTAL 0030
94
17800
0
06
211711
04
136
19
<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
0103423309755 42
97
$1,316,052 $20,959 $526,828 $0$1,673 $105,650 $1,971,162
66.8% 1.1% 26.7% 0.0%0.1% 5.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2725
Fresenius Kidney Care Steger 219 E. 34th StreetStegerCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Manco Construction
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Daniel Yohay, MD
In-Center Treatments in calendar year: 8,946Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 70
Patients treated as of 12/31/2017: (Ending patients) 62
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
17.5
Oct 3
12
Oct 4
17.5
Oct 5
12
Oct 6
17.5
Oct 7
12
0 31 22 31 21 33 21
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 16Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 15
Number of Missed Treatments: 461
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
34Total:
35Total:
USE RATE for the FACILITY
16,848Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 53%Use Rate (including Missed Treatments): 56%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 100
65%57%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 : 4Dialysis Technician : 7Dietician : 5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
62
62.0%
Medicaid
1
Private Insurance
29
Charity Care
0
Private Pay
3
Other Public
5
TOTAL
100
1.0% 29.0% 0.0%3.0% 5.0% 100.0%
Patients
TOTAL 00
510
49
5950
0
09
191415
05
208
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:
100
014392225
10057 43
100
$980,550 $2,205 $627,937 $0$22,086 $95,079 $1,727,857
56.7% 0.1% 36.3% 0.0%1.3% 5.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2695
Fresenius Kidney Care Streator 2356 N. Bloomington StreetStreatorLaSalle2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Sandor Development Co. (Thomas Siff
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Amit Jamnadas, MD
In-Center Treatments in calendar year: 3,523Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 21
Patients treated as of 12/31/2017: (Ending patients) 25
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
12
Oct 3
12
Oct 4
12
Oct 5
12
Oct 6
12
Oct 7
12
0 13 11 14 11 14 9
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 15Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 1Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 156
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
11Total:
16Total:
USE RATE for the FACILITY
7,488Treatment 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: 37
44%52%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 : 2.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
33
89.2%
Medicaid
1
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
37
2.7% 5.4% 0.0%0.0% 2.7% 100.0%
Patients
TOTAL 0030
34
1360
0
03977
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:
37
03
1210123726 11
37
$529,323 $1,283 $518,714 $0$0 $28,165 $1,077,485
49.1% 0.1% 48.1% 0.0%0.0% 2.6% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2802
Fresenius Kidney Care Summit 7320 W. Archer AvenueSummitCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Net3 (Summit), LLC (N)
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rajiv Gandhi, MD
In-Center Treatments in calendar year: 2,332Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 12
Patients treated as of 12/31/2017: (Ending patients) 30
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
13
Oct 3
0
Oct 4
13
Oct 5
0
Oct 6
13
Oct 7
0
0 20 0 22 0 22 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 27Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 10Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 64
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
32Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 21%Use Rate (including Missed Treatments): 21%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 41
17%42%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 : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
16
39.0%
Medicaid
4
Private Insurance
20
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
41
9.8% 48.8% 0.0%2.4% 0.0% 100.0%
Patients
TOTAL 0060
35
12290
0
03
1245
03653
<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
06
1898
4124 17
41
$30,706 $0 $78,618 $0$0 $0 $109,324
28.1% 0.0% 71.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2692
Fresenius Kidney Care Uptown 4700 N. Marine Drive, Suite 200ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Uptown, LLC Legal Entity Owner:
Property Owner: Wellness Associates LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Neil Soifer, MD
In-Center Treatments in calendar year: 11,005Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 77
Patients treated as of 12/31/2017: (Ending patients) 79
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 35 31 36 30 38 29
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 8Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 6Patients transferred out: 24Patients voluntarily discontinued: 1Patients lost to follow up: 1Patients deceased: 6
Number of Missed Treatments: 437
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
50Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 84%Use Rate (including Missed Treatments): 87%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 127
92%94%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 : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
78
61.4%
Medicaid
2
Private Insurance
45
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
127
1.6% 35.4% 0.0%0.0% 1.6% 100.0%
Patients
TOTAL 110
630
53
13114
0
0
07
251221
09
181718
<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:
127
016432939
12765 62
127
$1,643,837 $32,264 $1,703,236 $0$16,175 $48,235 $3,443,747
47.7% 0.9% 49.5% 0.0%0.5% 1.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2789
Fresenius Kidney Care Waterloo 624 Voris-Jost DriveWaterlooMonroe11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: GAHC3 Southern Illinois MOB Portfolio
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Matthew Koch, MD
In-Center Treatments in calendar year: 1,351Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 12
Patients treated as of 12/31/2017: (Ending patients) 9
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
21
Oct 3
0
Oct 4
20
Oct 5
0
Oct 6
20
Oct 7
0
0 10 0 9 0 10 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 7Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 2Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 24
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
16Total:
7Total:
USE RATE for the FACILITY
5,616Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 24%Use Rate (including Missed Treatments): 24%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 22
33%25%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: 1
Authorized Stations as of 12/31/2017: 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
12
54.5%
Medicaid
0
Private Insurance
9
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
22
0.0% 40.9% 0.0%0.0% 4.5% 100.0%
Patients
TOTAL 0000
22
0220
0
01275
02023
<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
03298
2215 7
22
$224,157 $0 $336,033 $0$0 $0 $560,190
40.0% 0.0% 60.0% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2727
Fresenius Kidney Care Waukegan Harbor 110 N. West StreetWaukeganLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: AR Capital, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Rakhi Khanna, MD
In-Center Treatments in calendar year: 16,756Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 115
Patients treated as of 12/31/2017: (Ending patients) 115
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
18
Oct 3
17
Oct 4
18
Oct 5
17
Oct 6
18
Oct 7
17
0 56 55 56 50 54 54
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 9Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 4Patients transferred out: 22Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 0
Number of Missed Treatments: 404
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
30Total:
32Total:
USE RATE for the FACILITY
19,656Treatment 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: 145
91%91%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 : 7.5Dialysis Technician : 13Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
79
54.5%
Medicaid
2
Private Insurance
59
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
145
1.4% 40.7% 0.0%1.4% 2.1% 100.0%
Patients
TOTAL 40
630
78
56890
0
0164517
2
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:
145
023733316
14580 65
145
$2,095,731 $41,891 $3,824,865 $0$41,848 $122,126 $6,126,461
34.2% 0.7% 62.4% 0.0%0.7% 2.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2729
Fresenius Kidney Care West Batavia 2580 W. Fabyan ParkwayBataviaKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: MedProperties Group
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Navinchandra Dodhia, MD
In-Center Treatments in calendar year: 8,028Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 47
Patients treated as of 12/31/2017: (Ending patients) 55
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
17
Oct 7
13
0 33 20 32 20 31 23
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 34Transient Patients: 12Patients Re-Started: 0Post-Transplant Patien 4
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 16Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 193
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
25Total:
50Total:
USE RATE for the FACILITY
11,232Treatment 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: 89
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: 1
Full-Time Work Week: 32Registered Nurse : 5Dialysis Technician : 5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
39
43.8%
Medicaid
6
Private Insurance
41
Charity Care
0
Private Pay
1
Other Public
2
TOTAL
89
6.7% 46.1% 0.0%1.1% 2.2% 100.0%
Patients
TOTAL 40
130
72
29600
0
07
201213
01
15147
<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
08
3526208952 37
89
$676,726 $22,945 $1,712,784 $0$51,385 $60,344 $2,524,184
26.8% 0.9% 67.9% 0.0%2.0% 2.4% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2523
Fresenius Kidney Care West Belmont 4943 West Belmont AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: 4935 W Belmont, Inc.
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Neetha Dhananjaya, MD
In-Center Treatments in calendar year: 13,388Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 83
Patients treated as of 12/31/2017: (Ending patients) 91
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 48 44 48 44 48 44
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 19Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 5
Number of Missed Treatments: 249
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
35Total:
USE RATE for the FACILITY
15,912Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 84%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 118
81%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: 0
Full-Time Work Week: 32Registered Nurse : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
37
40.7%
Medicaid
3
Private Insurance
48
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
91
3.3% 52.7% 0.0%3.3% 0.0% 100.0%
Patients
TOTAL 2070
82
60310
0
0142215
5
05
14133
<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
01936288
9156 35
91
$1,344,686 $94,818 $4,147,260 $0$57,538 $0 $5,644,302
23.8% 1.7% 73.5% 0.0%1.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2702
Fresenius Kidney Care West Chicago 1859 N. Neltnor Blvd.West ChicagoDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: West Chicago Management LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: J. Kropp, MD
In-Center Treatments in calendar year: 8,382Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 55
Patients treated as of 12/31/2017: (Ending patients) 58
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 260.0
Oct 1
0
Oct 2
18
Oct 3
18
Oct 4
18
Oct 5
18
Oct 6
18
Oct 7
18
0 30 24 30 20 28 28
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 32Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 10Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 2
Number of Missed Treatments: 127
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
17Total:
36Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 75%Use Rate (including Missed Treatments): 76%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 90
76%81%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 : 0.5Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
64.4%
Medicaid
0
Private Insurance
29
Charity Care
0
Private Pay
0
Other Public
3
TOTAL
90
0.0% 32.2% 0.0%0.0% 3.3% 100.0%
Patients
TOTAL 810
70
65
12780
0
03
151819
065
1113
<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
09
2029329055 35
90
$1,273,987 $29,473 $1,243,743 $0$0 $43,201 $2,590,404
49.2% 1.1% 48.0% 0.0%0.0% 1.7% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2536
Fresenius Kidney Care West Metro 1044 N. Mozart, Suite 3ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Attention
•• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements. • As a condition to #14-047, Humboldt Park 34-station facility, the West Metro facility was permitted to reduce stations from 32 to 12. While HRSRB posted the reduction immediately upon permit approval, the facility could not reduce stations until the Humboldt Park facility was up and running and patients and staff could transfer. This transfer of patients along with the reduction of stations to 12 was accomplished effective February 6, 2017.
Provides Incenter Noctural Dialysis:
Medical Director Name: Remegio Vilbar, MD
In-Center Treatments in calendar year: 22,141Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 166
Patients treated as of 12/31/2017: (Ending patients) 76
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 76 59 72 63 77 65
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 24Transient Patients: 3Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 87Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 15
Number of Missed Treatments: 735
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
106Total:
28Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 197%Use Rate (including Missed Treatments): 204%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 192
231%106%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 32Isolation Stations Set up in Oct 1-7: 32
Full-Time Work Week: 32Registered Nurse : 11Dialysis Technician : 17Dietician : 1Social Worker: 1LPN : 2Other Health : 0Other Non-Health: 5
Authorized Stations as of 12/31/2017: 12Certified 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
113
58.9%
Medicaid
3
Private Insurance
75
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
192
1.6% 39.1% 0.0%0.5% 0.0% 100.0%
Patients
TOTAL 40
670
121
114780
0
016682015
06
232024
<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
022914039
192119 73
192
$3,544,632 $95,763 $6,056,657 $0$18,029 $45,173 $9,760,254
36.3% 1.0% 62.1% 0.0%0.2% 0.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2530
Fresenius Kidney Care West Suburban 518 N. Austin Blvd., Suite 5000Oak ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Cente
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Arthur Morris, MD
In-Center Treatments in calendar year:
Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 241
Patients treated as of 12/31/2017: (Ending patients) 235
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 126 105 119 103 125 99
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 91Transient Patients: 30Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 9Patients transferred out: 59Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 25
Number of Missed Treatments: 1,340
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
99Total:
123Total:
USE RATE for the FACILITY
43,056Treatment 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: 334
87%85%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: 4
Authorized Stations as of 12/31/2017: 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
189
56.6%
Medicaid
5
Private Insurance
132
Charity Care
0
Private Pay
3
Other Public
5
TOTAL
334
1.5% 39.5% 0.0%0.9% 1.5% 100.0%
Patients
TOTAL 30
3140
17
013
321
0
027753737
016505042
<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:
334
043
1258779
334176 158
334
$4,560,137 $72,686 $5,784,341 $0$107,359 $155,636 $10,680,159
42.7% 0.7% 54.2% 0.0%1.0% 1.5% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2730
Fresenius Kidney Care West Willow 1444 W. WillowChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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, LLC Legal Entity Owner:
Property Owner: Elston Industrial Loft LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohamed Salem, MD
In-Center Treatments in calendar year: 5,184Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 36
Patients treated as of 12/31/2017: (Ending patients) 40
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
12
Oct 3
17
Oct 4
12
Oct 5
17
Oct 6
12
Oct 7
12
0 14 19 20 15 19 15
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 17Transient Patients: 5Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 13Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 87
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
21Total:
24Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 46%Use Rate (including Missed Treatments): 47%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 58
50%56%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 : 4.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
36
62.1%
Medicaid
0
Private Insurance
22
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
58
0.0% 37.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 30
310
24
6520
0
04
159
11
01855
<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
05
2314165839 19
58
$920,023 $12,847 $943,488 $0$0 $0 $1,876,358
49.0% 0.7% 50.3% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2520
Fresenius Kidney Care Westchester 2400 Wolf Road, Suite 101AWestchesterCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other For Profit
Legal Entity Operator: DuPage Dialysis, LTD Legal Entity Owner:
Property Owner: TANDEM REAL ESTATE, LLC
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Leonard Potempa, MD
1/26/2017 - Added 2 stations to existing facility; facility now has 22 ESRD stations.
In-Center Treatments in calendar year: 12,051Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 78
Patients treated as of 12/31/2017: (Ending patients) 82
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
18
Oct 3
14
Oct 4
18
Oct 5
14
Oct 6
18
Oct 7
14
0 49 34 46 34 50 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 16Transient Patients: 45Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 54Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 156
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
64Total:
64Total:
USE RATE for the FACILITY
20,592Treatment 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: 138
59%62%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: 2
Authorized Stations as of 12/31/2017: 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
86
62.3%
Medicaid
4
Private Insurance
46
Charity Care
0
Private Pay
2
Other Public
0
TOTAL
138
2.9% 33.3% 0.0%1.4% 0.0% 100.0%
Patients
TOTAL 50
480
85
15123
0
0
011362018
05
181614
<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
016543632
13885 53
138
$2,078,908 $16,142 $2,349,622 $0$41,878 $100,486 $4,587,036
45.3% 0.4% 51.2% 0.0%0.9% 2.2% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2627
Fresenius Kidney Care Williamson County 900 Skyline Drive, Suite 200MarionWilliamson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: Muhammad Kamran, MD
In-Center Treatments in calendar year: 7,535Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 50
Patients treated as of 12/31/2017: (Ending patients) 51
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 250.0
Oct 1
0
Oct 2
11
Oct 3
10
Oct 4
11
Oct 5
10
Oct 6
11
Oct 7
10
0 26 24 24 21 25 21
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 34Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 15Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 25
Number of Missed Treatments: 420
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
44Total:
41Total:
USE RATE for the FACILITY
14,040Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 54%Use Rate (including Missed Treatments): 57%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 91
56%57%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: 32Registered Nurse : 6Dialysis Technician : 4.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
65
71.4%
Medicaid
4
Private Insurance
14
Charity Care
0
Private Pay
0
Other Public
8
TOTAL
91
4.4% 15.4% 0.0%0.0% 8.8% 100.0%
Patients
TOTAL 10
132
75
0910
0
07
151316
02
111710
<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
09
2630269151 40
91
$308,569 $15,135 $249,844 $0$1,793 $36,605 $611,946
50.4% 2.5% 40.8% 0.0%0.3% 6.0% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2632
Fresenius Kidney Care Willowbrook 6300 Kingery Hwy, Suite 408WillowbrookDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
• Fresenius Kidney 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. The cost of providing uncompensated care in Illinois was approximately $3,000,000. Most of our Medicaid patients have moved to managed care “Medicaid Risk” programs which reimburse at rates comparable to Medicaid and Medicare, however these patients/revenues are accounted for under Private Insurance. Approximately 9% of the Illinois hemodialysis patients Fresenius treated in 2017 were covered by either Medicaid or a managed Medicaid insurance. • Patient counts are from 2017 and financial data was obtained from 2016 Audited Financial Statements.
Provides Incenter Noctural Dialysis:
Medical Director Name: May Chow, MD
In-Center Treatments in calendar year: 11,132Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 73
Patients treated as of 12/31/2017: (Ending patients) 71
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
17
Oct 3
17
Oct 4
17
Oct 5
17
Oct 6
17
Oct 7
17
0 39 32 38 34 37 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 43Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 7Transplant Recipients: 2Patients transferred out: 35Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 185
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
57Total:
56Total:
USE RATE for the FACILITY
18,720Treatment 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: 130
61%59%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 : 3Dialysis Technician : 9Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
67.7%
Medicaid
2
Private Insurance
37
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
130
1.5% 28.5% 0.0%2.3% 0.0% 100.0%
Patients
TOTAL 110
210
98
7123
0
0
06
231822
03
211423
<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
09
443245
13069 61
130
$2,054,713 $48,680 $1,369,525 $0$16,374 $4,832 $3,494,124
58.8% 1.4% 39.2% 0.0%0.5% 0.1% 100.0%Net Revenue
12/31/20161/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2777
Garfield Kidney Center3250 W. Franklin Blvd.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
4th shift in operation on Monday, Wednesday and Friday during week of October 1st - 7th 2017
Provides Incenter Noctural Dialysis:
Medical Director Name: Ogbonnaya Aneziokoro, M.D.
In-Center Treatments in calendar year: 15,053Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 103
Patients treated as of 12/31/2017: (Ending patients) 106
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
19
Oct 3
15
Oct 4
19
Oct 5
15
Oct 6
19
Oct 7
15
0 45 33 45 32 44 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 54Transient Patients: 12Patients Re-Started: 11Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 56Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 15
Number of Missed Treatments: 662
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
76Total:
77Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 101%Use Rate (including Missed Treatments): 105%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 166
107%110%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 : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 2Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
110
67.1%
Medicaid
43
Private Insurance
11
Charity Care
2
Private Pay
0
Other Public
0
TOTAL
164
26.2% 6.7% 1.2%0.0% 0.0% 100.0%
Patients
TOTAL 10
1160
49
45121
0
0
0175722
9
09
28186
<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
026854015
166105 61
166
$2,282,012 $302,776 $1,020,240 $59,000$1,160,720Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2728
Grand Crossing Dialysis7319 S Cottage Grove AvenueChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DaVitaLegal Entity Owner:
Property Owner: Frontline Real Estate Partners
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohamed Salem, MD
In-Center Treatments in calendar year: 8,688Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 64
Patients treated as of 12/31/2017: (Ending patients) 65
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 204.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 30 32 29 29 29 29
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 62Transient Patients: 38Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 39Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 997
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
54Total:
103Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 77%Use Rate (including Missed Treatments): 86%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 135
89%90%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 12
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
104
77.6%
Medicaid
15
Private Insurance
8
Charity Care
1
Private Pay
0
Other Public
7
TOTAL
134
11.2% 6.0% 0.7%0.0% 5.2% 100.0%
Patients
TOTAL 00
13400
1134
0
1
017421910
05
2877
<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:
135
022702617
13588 47
135
$1,159,571 $102,712 $390,581 $12,390$0 $1,078,258 $2,731,123
42.5% 3.8% 14.3% 0.5%0.0% 39.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2537
Granite City Dialysis Center9 American Village Shopping CenterGranite CityMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Central Plaza Partners
Provides Incenter Noctural Dialysis:
Medical Director Name: Kenneth Gerdes
In-Center Treatments in calendar year: 13,277Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 100
Patients treated as of 12/31/2017: (Ending patients) 98
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 206.0
Oct 1
0
Oct 2
14
Oct 3
10
Oct 4
14
Oct 5
10
Oct 6
14
Oct 7
10
0 49 36 47 35 50 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 36Transient Patients: 10Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 7Transplant Recipients: 2Patients transferred out: 24Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 10
Number of Missed Treatments: 631
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
48Total:
46Total:
USE RATE for the FACILITY
18,720Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 71%Use Rate (including Missed Treatments): 74%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 142
83%82%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 : 4Dialysis Technician : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
103
74.1%
Medicaid
11
Private Insurance
17
Charity Care
3
Private Pay
0
Other Public
8
TOTAL
139
7.9% 12.2% 2.2%0.0% 5.8% 100.0%
Patients
TOTAL 20
440
96
8134
0
0
010332013
06
222711
<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
016554724
14276 66
142
$2,174,520 $94,844 $764,432 $30,444$1,429,241Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2633
Illini Renal Dialysis507 E. University AveChampaignChampaign4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Barr Real Estate
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Attia, Abdel-Moneim
11/14/2017 - Received permit to discontinue 12 station ESRD at 507 East University Avenue in Champaign and to establish an 18 station ESRD facility at 1004 West Anthony Drive in Champaign.
In-Center Treatments in calendar year: 8,700Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 65
Patients treated as of 12/31/2017: (Ending patients) 67
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 1
0
Oct 2
14
Oct 3
15
Oct 4
14
Oct 5
14
Oct 6
15
Oct 7
15
0 27 32 27 28 30 34
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 37Transient Patients: 14Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 38Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 488
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
54Total:
USE RATE for the FACILITY
11,232Treatment 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: 117
90%93%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 : 5Dialysis Technician : 6Dietician : 1Social Worker: 0.75LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
79
69.3%
Medicaid
12
Private Insurance
12
Charity Care
3
Private Pay
0
Other Public
11
TOTAL
114
10.5% 10.5% 2.6%0.0% 9.6% 100.0%
Patients
TOTAL 10
431
67
5112
0
5
012192415
06
22136
<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
018413721
11770 47
117
$1,849,545 $143,741 $880,178 $10,984$0 $776,623 $3,650,087
50.7% 3.9% 24.1% 0.3%0.0% 21.3% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2581
Jacksonville Dialysis1515 W. Walnut, Bldg. # 11JacksonvilleMorgan3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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.
Provides Incenter Noctural Dialysis:
Medical Director Name: Lawrence Smith, MD
In-Center Treatments in calendar year: 7,409Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 50
Patients treated as of 12/31/2017: (Ending patients) 53
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 212.0
Oct 1
0
Oct 2
13
Oct 3
13
Oct 4
13
Oct 5
13
Oct 6
13
Oct 7
13
0 24 26 22 22 26 26
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 26Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 18Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 583
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
30Total:
32Total:
USE RATE for the FACILITY
13,104Treatment 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: 81
60%63%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 : 3.5Dialysis Technician : 4Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
90.1%
Medicaid
4
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
81
4.9% 4.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0060
75
0810
0
05
119
16
03
141310
<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
08
2522268141 40
81
$1,600,980 $22,123 $98,578 $0$0 $192,270 $1,913,951
83.6% 1.2% 5.2% 0.0%0.0% 10.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2636
Jerseyville Dialysis917 South State StreetJerseyvilleJersey3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Raul Walters Properties
Provides Incenter Noctural Dialysis:
Medical Director Name: Meher S. Mallick, MD
1/24/2017 - Received permit to add 8 ESRD stations to an existing facility at 917 South State Street in Jerseyville. The facility will have a total of 17 ESRD stations.
In-Center Treatments in calendar year: 5,361Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 44
Patients treated as of 12/31/2017: (Ending patients) 38
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
13
Oct 3
11
Oct 4
12
Oct 5
10
Oct 6
12
Oct 7
10.5
0 18 15 12 14 17 13
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 6Transient Patients: 1Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 4Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 494
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
21Total:
9Total:
USE RATE for the FACILITY
8,424Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 70%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 56
81%70%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: 40Registered Nurse : 4Dialysis Technician : 3Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
0
#Num!
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
0
#Num! #Num! #Num!#Num! #Num! #Num!
Patients
TOTAL 0010
55
00
56
0
03
1177
01
11106
<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
04
2217135628 28
56
$1,030,514 $111,950 $145,523 $0$0 $221,542 $1,509,529
68.3% 7.4% 9.6% 0.0%0.0% 14.7% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2313
John H. Stroger Hospital of Cook County Dialysis 1900 West Harrison ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Government County
Legal Entity Operator: John H. Stroger Hospital of Cook County Legal Entity Owner:
Property Owner: Cook County
Page 8 - Section II. Net Revenue by source during the fiscal year. The total dollars amount reported in this section represents the total revenue for all services of the hospital. Actual cost of charity care The total dollar amount reported in this section represents the total costs of charity care provided at all services in the hospital.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kalyani Perumal, MD
In-Center Treatments in calendar year: 3,311Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 18
Patients treated as of 12/31/2017: (Ending patients) 21
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 180.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 12 8 13 8 14 8
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 21Transient Patients: 0Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 14Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 2
Number of Missed Treatments: 50
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
19Total:
22Total:
USE RATE for the FACILITY
8,424Treatment 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: 39
33%39%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 : 9Dialysis Technician : 5Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
5
13.5%
Medicaid
28
Private Insurance
1
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
37
75.7% 2.7% 5.4%0.0% 8.1% 100.0%
Patients
TOTAL 40
170
18
19200
0
08
1420
07431
<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:
39
0151851
3924 15
39
$71,596,921 $98,900,548 $50,315,213 $281,015,133$10,958,656 $299,413,823 $531,185,161
13.5% 18.6% 9.5% 52.9%2.1% 56.4% 100.0%Net Revenue
11/30/201612/1/2015 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2685
Kankakee County DaVita581 William Latham Drive, Suite 104BourbonnaisKankakee9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers - Ililinois, Inc.Legal Entity Owner:
Property Owner: FAZ Properties LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Nashib Hashmi
3/21/2017 - Added 2 ESRD stations to existing facility; facility now has 14 ESRD stations.
In-Center Treatments in calendar year: 8,989Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 64
Patients treated as of 12/31/2017: (Ending patients) 70
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 211.0
Oct 1
0
Oct 2
16
Oct 3
12
Oct 4
16
Oct 5
12
Oct 6
16
Oct 7
12
0 38 25 32 23 35 25
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 32Transient Patients: 8Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 8Patients voluntarily discontinued: 7Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 789
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
24Total:
42Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 69%Use Rate (including Missed Treatments): 75%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 108
76%83%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 : 2Dialysis Technician : 6Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
80
74.8%
Medicaid
12
Private Insurance
8
Charity Care
1
Private Pay
0
Other Public
7
TOTAL
107
11.2% 7.5% 0.9%0.0% 6.5% 100.0%
Patients
TOTAL 10
340
58
10944
15
07
281915
04
101213
<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:
108
011383128
10869 39
108
$1,258,981 $59,528 $335,753 $7,375$0 $1,008,503 $2,662,765
47.3% 2.2% 12.6% 0.3%0.0% 37.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2717
Kenwood Dialysis4259 S. Cottage GroveChicago Cook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Bob Ernst
Provides Incenter Noctural Dialysis:
Medical Director Name: Bharathi Reddy
In-Center Treatments in calendar year: 18,277Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 131
Patients treated as of 12/31/2017: (Ending patients) 136
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
20
Oct 3
12.5
Oct 4
20
Oct 5
12.5
Oct 6
20
Oct 7
12.5
0 68 52 64 47 66 51
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 26Transient Patients: 37Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 6Patients transferred out: 30Patients voluntarily discontinued: 0Patients lost to follow up: 6Patients deceased: 10
Number of Missed Treatments: 956
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
52Total:
64Total:
USE RATE for the FACILITY
29,952Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 64%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 192
68%71%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 : 3Dialysis Technician : 15Dietician : 1Social Worker: 1LPN : 0Other Health : 2Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
139
74.3%
Medicaid
30
Private Insurance
15
Charity Care
5
Private Pay
0
Other Public
3
TOTAL
187
16.0% 8.0% 2.7%0.0% 1.6% 100.0%
Patients
TOTAL 10
18203
2186
4
6
015352317
01953219
<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
034884426
19290 102
192
$3,180,358 $92,011 $881,858 $61,950$0 $1,393,210 $5,547,437
57.3% 1.7% 15.9% 1.1%0.0% 25.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2552
Lake County Dialysis Services565 Lakeview Parkway Ste 176Vernon HillsLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: TRC Renal Care Inc.Legal Entity Owner:
Property Owner: Globe Corporation
Please note: Facility has 4th shift + Nocturnal on MWF.
Provides Incenter Noctural Dialysis:
Medical Director Name: Leon Sujata
In-Center Treatments in calendar year: 10,135Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 67
Patients treated as of 12/31/2017: (Ending patients) 68
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 245.0
Oct 1
0
Oct 2
19.5
Oct 3
19
Oct 4
19.5
Oct 5
19
Oct 6
19.5
Oct 7
19
0 47 22 43 20 44 26
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 30Transient Patients: 25Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 3Patients transferred out: 42Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 246
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
55Total:
56Total:
USE RATE for the FACILITY
16,848Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 60%Use Rate (including Missed Treatments): 62%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 122
62%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 : 5.5Dialysis Technician : 8.5Dietician : 1Social Worker: 0.8LPN : 0Other Health : 0Other Non-Health: 1.25
Authorized Stations as of 12/31/2017: 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
82
71.9%
Medicaid
5
Private Insurance
21
Charity Care
8
Private Pay
3
Other Public
3
TOTAL
114
4.4% 18.4% 7.0%2.6% 2.6% 100.0%
Patients
TOTAL 31
215
83
219110
9
015251920
08
148
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:
122
023392733
12279 43
122
$1,757,565 $32,649 $1,813,404 $24,890$972 $361,709 $3,966,299
44.3% 0.8% 45.7% 0.6%0.0% 9.1% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2768
Lawndale Dialysis3934 West 24th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: COWELL DIALYSIS LLCLegal Entity Owner:
Property Owner: SDO DEVELEOPMENT LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: OGBONNAYA ANEZIOKORO
In-Center Treatments in calendar year: 14,243Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 99
Patients treated as of 12/31/2017: (Ending patients) 96
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 203.0
Oct 1
0
Oct 2
17
Oct 3
14
Oct 4
17
Oct 5
14
Oct 6
17
Oct 7
14
0 50 42 52 41 49 41
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 31Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 28Patients voluntarily discontinued: 1Patients lost to follow up: 5Patients deceased: 11
Number of Missed Treatments: 483
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
49Total:
46Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 95%Use Rate (including Missed Treatments): 98%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 145
103%100%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 : 3Dialysis Technician : 10Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
59.9%
Medicaid
36
Private Insurance
18
Charity Care
8
Private Pay
0
Other Public
1
TOTAL
137
26.3% 13.1% 5.8%0.0% 0.7% 100.0%
Patients
TOTAL 20
530
90
87580
0
0154118
9
09
271610
<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
024683419
14583 62
145
$1,555,434 $364,571 $1,290,717 $211,220$0 $1,400,730 $4,611,452
33.7% 7.9% 28.0% 4.6%0.0% 30.4% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2582
Lincoln Dialysis2100 5th StreetLincolnLogan3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DaVitaLegal Entity Owner:
Property Owner: Sheley Group LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Allen Krall MD
In-Center Treatments in calendar year: 5,142Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 30
Patients treated as of 12/31/2017: (Ending patients) 37
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 334.0
Oct 1
0
Oct 2
12
Oct 3
7
Oct 4
11
Oct 5
7
Oct 6
11
Oct 7
7
0 27 6 24 6 23 9
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 13Transient Patients: 7Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 9Patients voluntarily discontinued: 5Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 235
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
21Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 39%Use Rate (including Missed Treatments): 41%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 54
36%44%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 : 4Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
45
83.3%
Medicaid
5
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
54
9.3% 7.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 1020
51
10
53
0
02
108
14
00866
<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
02
1814205434 20
54
$79,264 $972,513 $236,092 $0$209,754Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2583
Litchfield Dialysis915 St. Francis WayLitchfieldMontgomery3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Sis
Provides Incenter Noctural Dialysis:
Medical Director Name: Xueguang Chen, MD
In-Center Treatments in calendar year: 7,015Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 57
Patients treated as of 12/31/2017: (Ending patients) 44
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
11.5
Oct 3
11
Oct 4
11.5
Oct 5
11
Oct 6
11.5
Oct 7
10.5
0 24 17 23 19 24 17
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 15Transient Patients: 18Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 37Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 394
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
35Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 62%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 90
79%61%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 : 1Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 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
66
73.3%
Medicaid
5
Private Insurance
6
Charity Care
0
Private Pay
1
Other Public
12
TOTAL
90
5.6% 6.7% 0.0%1.1% 13.3% 100.0%
Patients
TOTAL 00
110
79
2880
0
07
181016
03
131310
<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
0103123269051 39
90
$1,366,485 $98,870 $576,841 $0$0 $120,786 $2,162,982
63.2% 4.6% 26.7% 0.0%0.0% 5.6% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2329
Loyola Center for Dialysis on Roosevelt1201 West Roosevelt RoadMaywoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Not for Profit Corporatio
Legal Entity Operator: LUMCLegal Entity Owner:
Property Owner: Loyola University Medical Center
Provides Incenter Noctural Dialysis:
Medical Director Name: Vinod Bansal, M.D.
In-Center Treatments in calendar year: 21,973Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 146
Patients treated as of 12/31/2017: (Ending patients) 147
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 76 66 78 67 77 67
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 57Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 4
Recovered patients: 2Transplant Recipients: 15Patients transferred out: 23Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 19
Number of Missed Treatments: 637
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
60Total:
62Total:
USE RATE for the FACILITY
29,016Treatment 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: 222
78%79%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 31Isolation Stations Set up in Oct 1-7: 0
Full-Time Work Week: 40Registered Nurse : 10Dialysis Technician : 15Dietician : 2Social Worker: 2LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
136
61.3%
Medicaid
26
Private Insurance
55
Charity Care
0
Private Pay
5
Other Public
0
TOTAL
222
11.7% 24.8% 0.0%2.3% 0.0% 100.0%
Patients
TOTAL 90
1100
103
59163
0
0
326492411
015323626
<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:
222
341816037
222113 109
222
$364,595,524 $231,298,877 $493,821,862 $9,695,769$5,811,794 $6,480,354 $1,102,008,411
33.1% 21.0% 44.8% 0.9%0.5% 0.6% 100.0%Net Revenue
6/30/20177/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2806
Machesney Park Dialysis7170 N Perryville RdMachesney ParkWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Total Renal CareLegal Entity Owner:
Property Owner: First Midwest Group
Facility opened a TTS shift Oct 17th.
Provides Incenter Noctural Dialysis:
Medical Director Name: Michael Robertson
In-Center Treatments in calendar year: 5,274Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 30
Patients treated as of 12/31/2017: (Ending patients) 39
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
16
Oct 3
0
Oct 4
16
Oct 5
0
Oct 6
16
Oct 7
0
0 33 0 34 0 35 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 14Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 174
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
19Total:
28Total:
USE RATE for the FACILITY
11,232Treatment 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: 55
42%54%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 : 2Dialysis Technician : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 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
86.8%
Medicaid
2
Private Insurance
3
Charity Care
2
Private Pay
0
Other Public
2
TOTAL
53
3.8% 5.7% 3.8%0.0% 3.8% 100.0%
Patients
TOTAL 0052
41
7480
7
01
131012
00676
<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
01
1917185536 19
55
$1,172,138 $21,519 $95,248 $15,045$0 $162,858 $1,451,763
80.7% 1.5% 6.6% 1.0%0.0% 11.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2671
Manteno Dialysis Centre 1 E. Division St.Manteno Kankakee9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other For Profit
Legal Entity Operator: Manteno Dialysis CentreLegal Entity Owner:
Property Owner: Jerry Curwick
Provides Incenter Noctural Dialysis:
Medical Director Name: Paritosh Tiwari
In-Center Treatments in calendar year: 6,319Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 42
Patients treated as of 12/31/2017: (Ending patients) 44
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 216.0
Oct 1
0
Oct 2
12
Oct 3
9.5
Oct 4
12
Oct 5
9.5
Oct 6
12
Oct 7
9.5
0 26 12 23 10 27 12
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 19Transient Patients: 1Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 5Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 660
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
18Total:
21Total:
USE RATE for the FACILITY
14,040Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 45%Use Rate (including Missed Treatments): 50%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 62
47%49%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 15Isolation Stations Set up in Oct 1-7: 15
Full-Time Work Week: 40Registered Nurse : 4.7Dialysis Technician : 2.7Dietician : 0.375Social Worker: 0.8LPN : 1.8Other Health : 0.6Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
34
60.7%
Medicaid
1
Private Insurance
21
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
56
1.8% 37.5% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 00
120
50
3590
0
01
158
13
0068
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:
62
01
2116246237 25
62
$1,612,035 $71,171 $557,598 $0$0 $0 $2,240,804
71.9% 3.2% 24.9% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2643
Marengo City Dialysis910 Greenlee Street, Suite BMarengo McHenry8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Luciano Zecchin
Provides Incenter Noctural Dialysis:
Medical Director Name: Aamir Memon
In-Center Treatments in calendar year: 4,210Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 23
Patients treated as of 12/31/2017: (Ending patients) 28
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 1
0
Oct 2
15
Oct 3
0
Oct 4
15
Oct 5
0
Oct 6
15
Oct 7
0
0 31 0 30 0 30 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 0Patients transferred out: 13Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 45
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
29Total:
USE RATE for the FACILITY
11,232Treatment 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
32%39%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: 30Registered Nurse : 1Dialysis Technician : 2Dietician : 0Social Worker: 0LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
39
76.5%
Medicaid
3
Private Insurance
7
Charity Care
1
Private Pay
0
Other Public
2
TOTAL
51
5.9% 13.7% 2.0%0.0% 3.9% 100.0%
Patients
TOTAL 1030
48
12400
0
039
115
053
106
<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
08
1221115228 24
52
$1,134,784 $47,364 $184,334 $45,430$0 $76,323 $1,442,805
78.7% 3.3% 12.8% 3.1%0.0% 5.3% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2570
Marion Dialysis324S. 4th streetMarionWilliamson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
The facility operated a fourth shift in October 2017.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kevin Chen MD
In-Center Treatments in calendar year: 5,161Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 44
Patients treated as of 12/31/2017: (Ending patients) 32
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1 Oct 2
13
Oct 3 Oct 4
13
Oct 5 Oct 6
13
Oct 7
3
34 32 33 2
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 5Transient Patients: 7Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 0Patients transferred out: 17Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 421
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
14Total:
USE RATE for the FACILITY
12,168Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 42%Use Rate (including Missed Treatments): 46%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 77
56%41%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 : 4.56Dialysis Technician : 5.55Dietician : 0.63Social Worker: 0.57LPN : 0Other Health : 0Other Non-Health: 1.09
Authorized Stations as of 12/31/2017: 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
49
64.5%
Medicaid
2
Private Insurance
4
Charity Care
1
Private Pay
0
Other Public
21
TOTAL
76
2.6% 5.3% 1.3%0.0% 27.6% 100.0%
Patients
TOTAL 00
120
65
3740
0
05
191014
06
1076
<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
0112917207748 29
77
$2,828,515 $174,810 $3,737,465 $82,895$0 $1,676,094 $8,416,885
33.6% 2.1% 44.4% 1.0%0.0% 19.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2634
Maryville Dialysis2102 Vadalabene Drive, Suite 1MaryvilleMadison11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Maryville Medical Park Fund LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Henry Purcell
In-Center Treatments in calendar year: 9,504Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 71
Patients treated as of 12/31/2017: (Ending patients) 65
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 214.0
Oct 1
0
Oct 2
15
Oct 3
12
Oct 4
15
Oct 5
12
Oct 6
15
Oct 7
12
0 34 27 37 28 36 25
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 47Transient Patients: 17Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 26Patients voluntarily discontinued: 8Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 48
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
67Total:
USE RATE for the FACILITY
14,976Treatment 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: 118
74%68%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 : 6.5Dialysis Technician : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
104
89.7%
Medicaid
1
Private Insurance
8
Charity Care
2
Private Pay
0
Other Public
3
TOTAL
116
0.9% 6.9% 1.7%0.0% 2.6% 100.0%
Patients
TOTAL 00
260
89
3115
0
3
010182016
02
191320
<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
012373336
11864 54
118
$1,657,207 $1,735 $866,935 $19,740$0 $647,743 $3,173,620
52.2% 0.1% 27.3% 0.6%0.0% 20.4% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2585
Mattoon Dialysis6051 Development DrCharlestonColes4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Allen Krall
In-Center Treatments in calendar year: 9,293Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 64
Patients treated as of 12/31/2017: (Ending patients) 59
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 1 Oct 2
14
Oct 3
12
Oct 4
14
Oct 5
12
Oct 6
14
Oct 7
12
0 30 29 31 28 31 29
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 29Transient Patients: 6Patients Re-Started: 4Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 7Patients voluntarily discontinued: 3Patients 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
16Total:
40Total:
USE RATE for the FACILITY
14,976Treatment 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: 89
67%61%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 : 6Dietician : 1Social Worker: 0LPN : 1Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
61
70.9%
Medicaid
11
Private Insurance
9
Charity Care
3
Private Pay
0
Other Public
5
TOTAL
86
12.8% 10.5% 3.5%0.0% 5.8% 100.0%
Patients
TOTAL 0121
85
3860
0
07
2112
3
06
102010
<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
0133132138943 46
89
$1,971,395 $273,366 $982,944 $19,612$0 $318,315 $3,546,020
55.6% 7.7% 27.7% 0.6%0.0% 9.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2315
Memorial Medical Centeer701 N First StreetSpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Not for Profit Corporatio
Legal Entity Operator: Memorial Health SystemLegal Entity Owner:
Property Owner: Memorial Health System
Provides Incenter Noctural Dialysis:
Medical Director Name: Lawrence Smith, MD
In-Center Treatments in calendar year: 0Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 0
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 0.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 0 0 0 0 0 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 0Transient 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:
0Total:
USE RATE for the FACILITY
5,616Treatment 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: 0
0%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: 36Registered Nurse : 12.6Dialysis Technician : 0Dietician : 1Social Worker: 1LPN : 0.5Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 6Certified Stations by CMS: 6Peak Authorized Stations Operated: 0
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
#Num!
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
0
#Num! #Num! #Num!#Num! #Num! #Num!
Patients
TOTAL 00000
000
0
00000
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:
0
0000000 0
0
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
9/30/201710/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2649
Montclare Dialysis Center7009 W Belmont AveChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Robert Olsen & Gladys Olsen
Provides Incenter Noctural Dialysis:
Medical Director Name: Kenneth Kuznetsky
In-Center Treatments in calendar year: 13,561Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 95
Patients treated as of 12/31/2017: (Ending patients) 98
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 253.0
Oct 1
0
Oct 2
12.5
Oct 3
12.5
Oct 4
12.5
Oct 5
12.5
Oct 6
12.5
Oct 7
12.5
0 41 45 42 42 43 44
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 60Transient Patients: 17Patients Re-Started: 26Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 5Patients transferred out: 52Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 369
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
68Total:
103Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 91%Use Rate (including Missed Treatments): 93%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 149
99%102%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 : 3.18Dialysis Technician : 8.34Dietician : 0.8Social Worker: 0.9LPN : 0Other Health : 0Other Non-Health: 2.42
Authorized Stations as of 12/31/2017: 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
106
73.6%
Medicaid
12
Private Insurance
25
Charity Care
5
Private Pay
0
Other Public
1
TOTAL
144
8.3% 17.4% 3.5%0.0% 0.7% 100.0%
Patients
TOTAL 90
290
111
57920
0
010412311
011231713
<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:
149
021644024
14985 64
149
$1,987,762 $210,859 $2,169,831 $113,575$0 $770,371 $5,138,824
38.7% 4.1% 42.2% 2.2%0.0% 15.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2813
Montgomery County Dialysis 1822 Senator Miller DriveHillsboroMontgomery3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Palestra Real Estate Partners, INC.
Provides Incenter Noctural Dialysis:
Medical Director Name: Ashraf Tamizuddin, MD.
In-Center Treatments in calendar year: 2,188Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 1
Patients treated as of 12/31/2017: (Ending patients) 19
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
11
Oct 3
7
Oct 4
11
Oct 5
7
Oct 6
11
Oct 7
7
0 15 5 14 5 13 6
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 2Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 171
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
8Total:
26Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 29%Use Rate (including Missed Treatments): 32%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 27
2%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: 1
Full-Time Work Week: 40Registered Nurse : 1Dialysis Technician : 1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
21
77.8%
Medicaid
4
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
27
14.8% 7.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0010
26
0270
0
01162
01745
<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:
27
028
107
2710 17
27
$335,305 $57,715 $636,562 $0$0 $145,169 $1,174,752
28.5% 4.9% 54.2% 0.0%0.0% 12.4% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2541
Mount Vernon Dialysis4102 North Water Tower PlaceMount Vernon Jefferson5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Nephroplex Service Corporation-
Provides Incenter Noctural Dialysis:
Medical Director Name: Steven Zelman
In-Center Treatments in calendar year: 8,806Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 65
Patients treated as of 12/31/2017: (Ending patients) 59
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 213.0
Oct 1
0
Oct 2
11
Oct 3
11
Oct 4
11
Oct 5
11
Oct 6
11
Oct 7
11
0 28 25 26 26 26 28
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 26Transient Patients: 5Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 10Patients voluntarily discontinued: 8Patients lost to follow up: 0Patients deceased: 20
Number of Missed Treatments: 355
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
33Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 59%Use Rate (including Missed Treatments): 61%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 92
68%61%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 : 9Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
77
83.7%
Medicaid
0
Private Insurance
8
Charity Care
0
Private Pay
0
Other Public
7
TOTAL
92
0.0% 8.7% 0.0%0.0% 7.6% 100.0%
Patients
TOTAL 10
150
76
1910
0
07
171318
016
1416
<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
2327349255 37
92
$1,892,745 $69,146 $1,274,752 $0$273,139Net Revenue
12/31/20181/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2302
Mt. Sinai Hospital1500 S.CaliforniaAveChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Not for Profit Corporatio
Legal Entity Operator: Mt.Sinai Hosptial and Medical CenterLegal Entity Owner:
Property Owner: Mt. Sinai Hospital and Medical Center
Provides Incenter Noctural Dialysis:
Medical Director Name: Andres Serrano MD
In-Center Treatments in calendar year: 11,597Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 88
Patients treated as of 12/31/2017: (Ending patients) 84
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 215.0
Oct 1 Oct 2
15
Oct 3
15
Oct 4
15
Oct 5
15
Oct 6
15
Oct 7
15
43 41 43 41 43 41
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 19Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 16Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 574
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
23Total:
23Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 77%Use Rate (including Missed Treatments): 81%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 84
92%88%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: 40Registered Nurse : 11Dialysis Technician : 5Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
50
61.7%
Medicaid
26
Private Insurance
5
Charity Care
3
Private Pay
0
Other Public
0
TOTAL
81
32.1% 6.2% 3.7%0.0% 0.0% 100.0%
Patients
TOTAL 10
470
36
35490
0
08
2378
08
1875
<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
0164114138446 38
84
$908,630 $414,224 $358,252 $118,301Net Revenue
6/30/20177/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2600
Nephron Dialysis Center, Ltd.5140 N. California Ave., Suite 510ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Swedish Covenant Hospital
Provides Incenter Noctural Dialysis:
Medical Director Name: Hamid Humayun MD
In-Center Treatments in calendar year: 13,037Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 88
Patients treated as of 12/31/2017: (Ending patients) 88
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
13.3
Oct 3
13.3
Oct 4
13.3
Oct 5
13.3
Oct 6
13.3
Oct 7
13.3
0 44 42 40 40 41 44
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 41Transient Patients: 2Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 0Transplant Recipients: 4Patients transferred out: 29Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 955
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
47Total:
47Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 87%Use Rate (including Missed Treatments): 93%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 124
92%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: 40Registered Nurse : 3Dialysis Technician : 8.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 5.5
Authorized Stations as of 12/31/2017: 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
106
85.5%
Medicaid
13
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
124
10.5% 4.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 440
180
62
19105
0
0
05
262918
00
101521
<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
05
364439
12478 46
124
$2,095,138 $729,639 $664,568 $0$1,500 $0 $3,490,846
60.0% 20.9% 19.0% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2797
Nocturnal Dialysis Spa, LLC1634 S Ardmore AveVilla ParkDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator:Legal Entity Owner:
Property Owner: HCT Trust
Provides Incenter Noctural Dialysis:
Medical Director Name: Hamid Humayun, MD
In-Center Treatments in calendar year: 466Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 3
Patients treated as of 12/31/2017: (Ending patients) 5
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
7
Oct 3
0
Oct 4
7
Oct 5
0
Oct 6
7
Oct 7
0
0 2 0 2 0 2 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 7Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 1Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 21
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
3Total:
8Total:
USE RATE for the FACILITY
11,232Treatment 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: 10
4%7%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: 20Registered Nurse : 1Dialysis Technician : 1Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 12Certified Stations by CMS: 12Peak 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
60.0%
Medicaid
0
Private Insurance
0
Charity Care
0
Private Pay
1
Other Public
3
TOTAL
10
0.0% 0.0% 0.0%10.0% 30.0% 100.0%
Patients
TOTAL 30601
0100
0
00421
00030
<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
00451
107 3
10
$80,874 $0$1,250 $879Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2779
NxStage Kidney Care Oak Brook, LLC1600 West 16th Street, Ste 13Oak BrookCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: NxStage Kidney Care Oak Brook, LLCLegal Entity Owner:
Property Owner: Newport Capital Partners
Information reported includes all dialysis modalities (Home (HHD,PD) & In Center (HD)) except where request is specifically for In Center information only.
Provides Incenter Noctural Dialysis:
Medical Director Name: William Whittier
In-Center Treatments in calendar year: 3,602Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 14
Patients treated as of 12/31/2017: (Ending patients) 21
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 45.0
Oct 1
8
Oct 2
8
Oct 3
8
Oct 4
8
Oct 5
8
Oct 6
8
Oct 7
8
4 29 20 20 19 22 25
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 18Transient Patients:Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 5Patients voluntarily discontinued: 0Patients lost to follow up: 1Patients deceased: 3
Number of Missed Treatments: 232
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
10Total:
Total:
USE RATE for the FACILITY
7,488Treatment 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:
29%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: 40Registered Nurse : 3.11Dialysis Technician : 1.98Dietician : 0.21Social Worker: 0.12LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
23
52.3%
Medicaid
5
Private Insurance
16
Charity Care
1
Private Pay
0
Other Public
0
TOTAL
44
11.4% 36.4% 2.3%0.0% 0.0% 100.0%
Patients
TOTAL 00000
00
45
45
04953
06
1242
<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
0102195
4521 24
45
$805,303 ($23,769) $937,379 $50,283($49,453) $168,644 $1,838,104
43.8% -1.3% 51.0% 2.7%-2.7% 9.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2644
Oak Park Kidney Center, LLC610 S Maple Avenue. Suite 4100Oak ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator:Legal Entity Owner:
Property Owner: Rush University Medical Center
Provides Incenter Noctural Dialysis:
Medical Director Name: Hamid Humayun, MD
In-Center Treatments in calendar year: 9,727Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 68
Patients treated as of 12/31/2017: (Ending patients) 58
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 270.0
Oct 1
0
Oct 2
13.5
Oct 3
13.5
Oct 4
13.5
Oct 5
13.5
Oct 6
13.5
Oct 7
13.5
0 36 32 27 28 28 32
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 35Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 20Patients voluntarily discontinued: 1Patients lost to follow up: 2Patients deceased: 22
Number of Missed Treatments:
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
39Total:
USE RATE for the FACILITY
16,848Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 58%Use Rate (including Missed Treatments):Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 110
63%54%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: 2
Authorized Stations as of 12/31/2017: 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
78
70.9%
Medicaid
16
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
9
TOTAL
110
14.5% 6.4% 0.0%0.0% 8.2% 100.0%
Patients
TOTAL 20
880
20
5105
0
0
06
222012
05
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:
110
011393723
11060 50
110
$17,000,000 $239,752 $850,307 $0$0 $126,678 $18,216,737
93.3% 1.3% 4.7% 0.0%0.0% 0.7% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2674
Olney Dialysis Unit117 N Boone OlneyRichland5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Andy Shuetz previous
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Rafeal Lao
In-Center Treatments in calendar year: 3,288Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 28
Patients treated as of 12/31/2017: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 261.0
Oct 1
0
Oct 2
12
Oct 3
6.5
Oct 4
12
Oct 5
6.5
Oct 6
12
Oct 7
6.5
0 15 5 15 5 15 5
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 12Transient Patients: 3Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 0Patients transferred out: 6Patients voluntarily discontinued: 8Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 123
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
21Total:
16Total:
USE RATE for the FACILITY
6,552Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 50%Use Rate (including Missed Treatments): 52%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 44
67%55%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 7Isolation Stations Set up in Oct 1-7: 7
Full-Time Work Week: 40Registered Nurse : 1.5Dialysis Technician : 2.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 0.8
Authorized Stations as of 12/31/2017: 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
37
86.0%
Medicaid
1
Private Insurance
1
Charity Care
1
Private Pay
1
Other Public
3
TOTAL
43
2.3% 2.3% 2.3%2.3% 7.0% 100.0%
Patients
TOTAL 0010
42
1430
1
02878
02539
<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
1310174425 19
44
$736,840 $8,606 $11,385 $0$2,655 $52,460 $811,947
90.7% 1.1% 1.4% 0.0%0.3% 6.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2708
Pittsfield Dialysis640 W WashingtonPittsfieldPike3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Health System - Illini Hospital
Provides Incenter Noctural Dialysis:
Medical Director Name: Hrishikesh Ghanekar MD
In-Center Treatments in calendar year: 1,747Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 13
Patients treated as of 12/31/2017: (Ending patients) 15
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 225.0
Oct 1
0
Oct 2
13.5
Oct 3
0
Oct 4
13.5
Oct 5
0
Oct 6
15
Oct 7
0
0 11 0 11 0 12 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 8Transient Patients: 4Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 6Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 45
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
10Total:
15Total:
USE RATE for the FACILITY
4,680Treatment 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: 24
43%50%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: 40Registered Nurse : 1.56Dialysis Technician : 1.5Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
19
79.2%
Medicaid
1
Private Insurance
3
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
24
4.2% 12.5% 0.0%0.0% 4.2% 100.0%
Patients
TOTAL 0000
24
0240
0
02375
00232
<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
025
107
2417 7
24
$455,107 $757 $186,875 $0$0 $44,778 $687,517
66.2% 0.1% 27.2% 0.0%0.0% 6.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2335
Presence Resurrection Medical Center7435 W. TalcottChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Non-Profit Church-Related
Legal Entity Operator: Presence Chicago Hospitals Network d/b/a Legal Entity Owner:
Property Owner: Presence Chicago Hospital d/b/a
Unit was closed from 3/17/2017 to 9/26/2017
Provides Incenter Noctural Dialysis:
Medical Director Name: Anna Gopaniuk M.D.
In-Center Treatments in calendar year: 2,135Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 20
Patients treated as of 12/31/2017: (Ending patients) 20
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 180.0
Oct 1
0
Oct 2
12
Oct 3
0
Oct 4
12
Oct 5
0
Oct 6
12
Oct 7
0
0 16 0 16 0 17 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 6Transient Patients: 0Patients Re-Started: 20Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 49Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 27
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
53Total:
26Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 16%Use Rate (including Missed Treatments): 16%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 49
24%24%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 : 3.6Dialysis Technician : 3.6Dietician : 0.6Social Worker: 0.6LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
48
98.0%
Medicaid
0
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
49
0.0% 2.0% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 6000
39
1453
4
006
117
0044
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:
49
00
1015244924 25
49
$1,940,469 $0 $225,020 $0$0 $0 $2,165,489
89.6% 0.0% 10.4% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2318
Presence St. Mary's Hospital 455 West Court Street KankakeeKankakee9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Not for Profit Corporatio
Legal Entity Operator: Presence St. Mary's HospitalLegal Entity Owner:
Property Owner: Presence St. Mary's Hospital
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Hizon
In-Center Treatments in calendar year: 13,039Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 84
Patients treated as of 12/31/2017: (Ending patients) 94
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
11
Oct 4
15
Oct 5
11
Oct 6
15
Oct 7
11
0 53 38 51 35 57 35
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 50Transient Patients: 6Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 17Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 26
Number of Missed Treatments: 460
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
46Total:
59Total:
USE RATE for the FACILITY
22,464Treatment 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: 148
58%65%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: 36Registered Nurse : 9Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 1Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
73
77.7%
Medicaid
10
Private Insurance
6
Charity Care
0
Private Pay
2
Other Public
3
TOTAL
94
10.6% 6.4% 0.0%2.1% 3.2% 100.0%
Patients
TOTAL 10
510
42
4900
0
03
281110
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:
94
08
3924239452 42
94
$3,580,456 $308,035 $1,224,099 $0$0 $774,734 $5,887,324
60.8% 5.2% 20.8% 0.0%0.0% 13.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2772
Red Bud Dialysis1500 East Market StreetRed BudRandolph5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Meher Mallick
In-Center Treatments in calendar year: 2,230Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 17
Patients treated as of 12/31/2017: (Ending patients) 19
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 255.0
Oct 1
0
Oct 2
13
Oct 3
0
Oct 4
13
Oct 5
0
Oct 6
13
Oct 7
0
0 16 0 15 0 16 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 12Transient Patients: 3Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 5Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 107
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
15Total:
15Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 30%Use Rate (including Missed Treatments): 31%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 15
35%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: 1
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 0Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 1Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 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
12
80.0%
Medicaid
2
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
15
13.3% 6.7% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0020
13
0150
0
00233
01240
<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
01473
158 7
15
$446,636 $38,324 $199,746 $0$0 $79,634 $764,340
58.4% 5.0% 26.1% 0.0%0.0% 10.4% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2741
Renal Center New Lenox1890 Silver Cross Blvd, Suite 150New LenoxWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: NexCore Properties
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Naila Ahmed
In-Center Treatments in calendar year: 15,326Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 96
Patients treated as of 12/31/2017: (Ending patients) 103
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 213.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 45 47 39 40 49 50
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 64Transient Patients: 5Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 44Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 424
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
65Total:
70Total:
USE RATE for the FACILITY
17,784Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 86%Use Rate (including Missed Treatments): 89%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 153
84%90%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 : 6.48Dialysis Technician : 9.19Dietician : 0.79Social Worker: 0.84LPN : 0Other Health : 0Other Non-Health: 1.93
Authorized Stations as of 12/31/2017: 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
128
84.2%
Medicaid
14
Private Insurance
9
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
152
9.2% 5.9% 0.7%0.0% 0.7% 100.0%
Patients
TOTAL 10
340
105
1412613
13
08
262730
05
171822
<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
013434552
15391 62
153
$2,860,870 $16,725 $806,514 $21,240$0 $764,720 $4,448,829
64.3% 0.4% 18.1% 0.5%0.0% 17.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2742
Renal Center West Joliet1051 Essington Rd.Suite 160JolietWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Midwest Community Real Estate Corp.
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Preeti Nagarkatte
In-Center Treatments in calendar year: 17,271Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 125
Patients treated as of 12/31/2017: (Ending patients) 119
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
15
Oct 3
15
Oct 4
15
Oct 5
15
Oct 6
15
Oct 7
15
0 66 50 64 46 67 48
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 60Transient Patients: 30Patients Re-Started: 1Post-Transplant Patien 3
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 33Patients voluntarily discontinued: 2Patients lost to follow up: 2Patients deceased: 25
Number of Missed Treatments: 451
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
67Total:
94Total:
USE RATE for the FACILITY
26,208Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments): 68%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 209
74%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 : 7.5Dialysis Technician : 12Dietician : 1Social Worker: 1.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
74.9%
Medicaid
5
Private Insurance
25
Charity Care
2
Private Pay
0
Other Public
22
TOTAL
207
2.4% 12.1% 1.0%0.0% 10.6% 100.0%
Patients
TOTAL 21675
3103
20184
5
10
021392740
09
252028
<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
030644768
209127 82
209
$2,986,190 $40,161 $2,019,949 $5,900$0 $1,208,497 $6,254,797
47.7% 0.6% 32.3% 0.1%0.0% 19.3% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2714
Robinson Dialysis1215 N Allen St STE BRobinsonCrawford5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Crawford Memorial Hospital
Provides Incenter Noctural Dialysis:
Medical Director Name: Rafael Lao
In-Center Treatments in calendar year: 5,409Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 33
Patients treated as of 12/31/2017: (Ending patients) 36
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 208.0
Oct 1
0
Oct 2
14
Oct 3
12
Oct 4
14
Oct 5
12
Oct 6
14
Oct 7
12
0 17 18 18 16 17 17
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 14Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 24Patients voluntarily discontinued: 6Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 31
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
23Total:
USE RATE for the FACILITY
8,424Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 65%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 34
61%67%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: 40Registered Nurse : 2Dialysis Technician : 3.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0Other Non-Health: 1.5
Authorized Stations as of 12/31/2017: 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
37
82.2%
Medicaid
3
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
45
6.7% 8.9% 0.0%0.0% 2.2% 100.0%
Patients
TOTAL 0010
44
000
0
0153
16
01946
<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
147
224525 20
0
$1,077,559 $59,159 $290,950 $0$134,584Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2312
Rush University Medical Center1620 W. Harrison Street, Suite 735 Kellogg BldgChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Not for Profit Corporatio
Legal Entity Operator: Rush University Medical CenterLegal Entity Owner:
Property Owner: Rush University Medical Center
The above information is data from January1 2017-September 15,2017 as our facility discontinued providing on site dialysis service after that date.
Provides Incenter Noctural Dialysis:
Medical Director Name: Sara Jandeska, MD
In-Center Treatments in calendar year: 557Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 4
Patients treated as of 12/31/2017: (Ending patients) 0
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 180.0
Oct 1
0
Oct 2
0
Oct 3
0
Oct 4
0
Oct 5
0
Oct 6
0
Oct 7
0
0 0 0 0 0 0 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 4Transient Patients: 0Patients Re-Started: 2Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 8Patients 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
8Total:
6Total:
USE RATE for the FACILITY
0Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): #Div/0!Use Rate (including Missed Treatments): #Div/0!Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 8
#Div/0!#Num!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: 36Registered Nurse : 0Dialysis Technician : 1.5Dietician : 0.6Social Worker: 0.5LPN : 0.5Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 0Certified Stations by CMS: 0Peak 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
4
50.0%
Medicaid
3
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
8
37.5% 0.0% 0.0%0.0% 12.5% 100.0%
Patients
TOTAL 00404
350
0
21000
14000
<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:
8
3500083 5
8
$0 $0 $0 $0$0 $0 $0
#Num! #Num! #Num! #Num!#Num! #Num! #Num!Net Revenue
7/1/20177/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2620
Rushville Dialysis112 Sullivan DriveRushvilleSchuyler3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohamad Alhosaini
In-Center Treatments in calendar year: 2,810Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 16
Patients treated as of 12/31/2017: (Ending patients) 21
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
15
Oct 3
0
Oct 4
15
Oct 5
4
Oct 6
15
Oct 7
0
0 20 0 20 1 21 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 12Transient Patients: 6Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 3Patients voluntarily discontinued: 4Patients 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
8Total:
19Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 38%Use Rate (including Missed Treatments): 39%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 33
33%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: 30Registered Nurse : 1Dialysis Technician : 2Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
24
72.7%
Medicaid
4
Private Insurance
5
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
33
12.1% 15.2% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
33
4290
0
03952
00545
<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
03
1497
3319 14
33
$599,288 $50,133 $275,656 $0$0 $108,854 $1,033,932
58.0% 4.8% 26.7% 0.0%0.0% 10.5% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2758
SAH Dialysis Center at 26th Street3059 W 26th St.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Non-Profit Church-Related
Legal Entity Operator: Saint Anthony HospitalLegal Entity Owner:
Property Owner: Chicago Title Land # 22630
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Izabella Gurau
In-Center Treatments in calendar year: 6,646Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 41
Patients treated as of 12/31/2017: (Ending patients) 48
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
10
Oct 3
10
Oct 4
10
Oct 5
10
Oct 6
10
Oct 7
10
0 26 19 27 19 27 17
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 17Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 8Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 294
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
12Total:
19Total:
USE RATE for the FACILITY
14,040Treatment 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: 60
46%53%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 : 2.5Dialysis Technician : 4.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 0.5
Authorized Stations as of 12/31/2017: 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
32
53.3%
Medicaid
17
Private Insurance
10
Charity Care
0
Private Pay
1
Other Public
0
TOTAL
60
28.3% 16.7% 0.0%1.7% 0.0% 100.0%
Patients
TOTAL 0060
54
5370
0
05
2083
06
1062
<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
01130145
6036 24
60
$2,356,160 $1,202,042 $745,626 $0$204,660 $0 $4,508,488
52.3% 26.7% 16.5% 0.0%4.5% 0.0% 100.0%Net Revenue
6/30/20177/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2746
Satellite Dialysis of Glenview 2601 Compass Road GlenviewCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Not for Profit
Legal Entity Operator: Satellite Health CareLegal Entity Owner:
Property Owner:
Provides Incenter Noctural Dialysis:
Medical Director Name: Sprague, S. MD
In-Center Treatments in calendar year: 4,991Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 51
Patients treated as of 12/31/2017: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1 Oct 2
16
Oct 3
11
Oct 4
16
Oct 5
11
Oct 6
16
Oct 7
11
42 22 37 18 39 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 38Transient Patients: 0Patients Re-Started: 3Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 3Patients transferred out: 25Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 740
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
42Total:
USE RATE for the FACILITY
14,976Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 33%Use Rate (including Missed Treatments): 38%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 56
53%63%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 : 5Dialysis Technician : 7Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
47
83.9%
Medicaid
3
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
2
TOTAL
56
5.4% 7.1% 0.0%0.0% 3.6% 100.0%
Patients
TOTAL 12050
38
3521
1
0198
16
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:
56
02
1615235634 22
56
$1,848,957 $58,471 $345,430 $0$39,717 $26,981 $2,319,556
79.7% 2.5% 14.9% 0.0%1.7% 1.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2624
Shelbyville Dialysis410 S. Heinlein DrShelbyvilleShelby4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Partner
Legal Entity Operator: Renal Therapies, LLCLegal Entity Owner:
Property Owner: John and Linda Hodel
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohamud Qureshi
In-Center Treatments in calendar year: 3,407Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 20
Patients treated as of 12/31/2017: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
11
Oct 3
6
Oct 4
11
Oct 5
6
Oct 6
11
Oct 7
6
0 16 7 15 7 15 7
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 11Transient Patients: 3Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 6Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 62
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
13Total:
15Total:
USE RATE for the FACILITY
8,424Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 40%Use Rate (including Missed Treatments): 41%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 35
37%43%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 : 1.9Dialysis Technician : 1.74Dietician : 0.5Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
31
88.6%
Medicaid
0
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
35
0.0% 11.4% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0000
35
0350
0
00748
01366
<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
01
1010143519 16
35
$743,923 $183,875 $0Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2753
Shiloh Dialysis1095 North Green Mount RoadBellevilleSt. Clair11
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Threlkeld Family Investments, LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Rashid Dalal
In-Center Treatments in calendar year: 8,886Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 65
Patients treated as of 12/31/2017: (Ending patients) 64
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
16.5
Oct 3
12
Oct 4
16.5
Oct 5
12
Oct 6
16.5
Oct 7
12
0 37 22 37 25 35 24
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 35Transient Patients: 20Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 30Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 1,042
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
56Total:
USE RATE for the FACILITY
13,104Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 68%Use Rate (including Missed Treatments): 76%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 117
77%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: 40Registered Nurse : 4Dialysis Technician : 5Dietician : 0Social Worker: 0LPN : 1Other Health : 1Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
97
85.1%
Medicaid
3
Private Insurance
9
Charity Care
3
Private Pay
0
Other Public
5
TOTAL
114
2.6% 7.9% 2.6%0.0% 4.4% 100.0%
Patients
TOTAL 10
680
45
2114
1
3
05
321811
04
191810
<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
513621
11766 51
117
$1,750,108 $22,579 $1,067,404 $17,181$0 $398,931 $3,239,022
54.0% 0.7% 33.0% 0.5%0.0% 12.3% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2544
South Holland Renal Center16110 S. LaSalle StreetSouth HollandCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Genesis KC Development, LLC
During the week of October 1 - October 7,2017 we had a fourth shift on M-W-F only.
Provides Incenter Noctural Dialysis:
Medical Director Name: Kenneth Cline, MD
In-Center Treatments in calendar year: 16,716Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 124
Patients treated as of 12/31/2017: (Ending patients) 122
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 221.0
Oct 1
0
Oct 2
17.5
Oct 3
16
Oct 4
17.5
Oct 5
16
Oct 6
17.5
Oct 7
16
0 52 53 50 47 58 49
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 39Transient Patients: 13Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 1Patients transferred out: 39Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 11
Number of Missed Treatments: 817
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
54Total:
52Total:
USE RATE for the FACILITY
18,720Treatment 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: 176
103%102%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 : 9.5Dialysis Technician : 11.3Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 3
Authorized Stations as of 12/31/2017: 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
137
78.3%
Medicaid
17
Private Insurance
19
Charity Care
1
Private Pay
0
Other Public
2
TOTAL
175
9.7% 10.9% 0.6%0.0% 1.1% 100.0%
Patients
TOTAL 00
1580
18
8168
0
0
014472224
010261221
<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:
176
024733445
176107 69
176
$2,775,461 $146,915 $1,998,862 $23,010$0 $1,145,601 $6,066,838
45.7% 2.4% 32.9% 0.4%0.0% 18.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2733
Springfield South Dialysis2930 S 6th StreetSpringfieldSangamon3
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: William Furling
Provides Incenter Noctural Dialysis:
Medical Director Name: Xueguang Chen
In-Center Treatments in calendar year: 5,540Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 44
Patients treated as of 12/31/2017: (Ending patients) 46
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
15
Oct 3
10
Oct 4
15
Oct 5
10
Oct 6
15
Oct 7
10
0 28 17 28 17 28 17
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 25Transient Patients: 23Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 35Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 482
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
43Total:
49Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 49%Use Rate (including Missed Treatments): 54%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 88
61%64%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 12Isolation Stations Set up in Oct 1-7: 12
Full-Time Work Week: 40Registered Nurse : 2Dialysis Technician : 2Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
64
72.7%
Medicaid
11
Private Insurance
13
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
88
12.5% 14.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
310
56
2860
0
06
201112
02
18127
<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
08
3823198849 39
88
$1,789,566 $88,748 $1,911,806 $0$0 $413,520 $4,203,640
42.6% 2.1% 45.5% 0.0%0.0% 9.8% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2615
Stonecrest Dialysis1302 E. State St. RockfordWinnebago1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator:Legal Entity Owner:
Property Owner: Lilibridge Healthcare Services, Inc
Provides Incenter Noctural Dialysis:
Medical Director Name: Joanna Niemiec
In-Center Treatments in calendar year:
Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 72
Patients treated as of 12/31/2017: (Ending patients) 67
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
16
Oct 3
16
Oct 4
16
Oct 5
16
Oct 6
16
Oct 7
16
0 29 31 32 30 29 30
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 12Patients Re-Started:Post-Transplant Patien 2
Recovered patients: 1Transplant Recipients: 2Patients transferred out: 16Patients voluntarily discontinued: 6Patients lost to follow up:Patients deceased: 6
Number of Missed Treatments:
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
Total:
Total:
USE RATE for the FACILITY
11,232Treatment 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: 106
100%93%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 : 0.6Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 1.3
Authorized Stations as of 12/31/2017: 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
87
84.5%
Medicaid
9
Private Insurance
5
Charity Care
3
Private Pay
0
Other Public
2
TOTAL
103
8.7% 4.9% 2.9%0.0% 1.9% 100.0%
Patients
TOTAL 40
560
28
18880
18
05
231611
03
191415
<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
08
423026
10655 51
106
$1,840,443 $113,368 $482,711 $5,605$522,300Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2661
Stony Creek Dialysis6246 W. 95th SreetOak LawnCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: James Rydel
In-Center Treatments in calendar year: 10,760Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 75
Patients treated as of 12/31/2017: (Ending patients) 83
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 210.0
Oct 1
0
Oct 2
17
Oct 3
15
Oct 4
17
Oct 5
15
Oct 6
17
Oct 7
15
0 37 36 38 34 38 36
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 49Transient Patients: 27Patients Re-Started: 1Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 2Patients transferred out: 46Patients voluntarily discontinued: 4Patients lost to follow up: 1Patients deceased: 16
Number of Missed Treatments: 575
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
69Total:
78Total:
USE RATE for the FACILITY
13,104Treatment 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: 1
89%99%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 : 8Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
92
76.0%
Medicaid
18
Private Insurance
10
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
121
14.9% 8.3% 0.8%0.0% 0.8% 100.0%
Patients
TOTAL 20
300
90
13109
0
0
05
242420
04
171117
<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:
122
09
413537
12273 49
122
$22,969 $1,688,983 $1,000,980 $52,510$0 $893,794 $3,606,726
0.6% 46.8% 27.8% 1.5%0.0% 24.8% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2553
Sun Health Inc.2121 Oneida StJolietWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Bhuvan Chawla, MDLegal Entity Owner:
Property Owner: Triumph Joliet LLC
This program is not allowing me to input "totals", so some boxes are left unfilled. Any Question, Please contact me at my email, and I can submit hardcopy. Thanks Anita
Provides Incenter Noctural Dialysis:
Medical Director Name: Bhuvan Chawla, MD
In-Center Treatments in calendar year: 8,232Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 53
Patients treated as of 12/31/2017: (Ending patients) 60
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 265.0
Oct 1
0
Oct 2
15.5
Oct 3
11
Oct 4
15.5
Oct 5
11
Oct 6
15.5
Oct 7
11
0 34 18 33 18 33 19
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 24Transient Patients: 2Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 0Patients transferred out: 10Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 9
Number of Missed Treatments: 50
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
29Total:
USE RATE for the FACILITY
15,912Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 52%Use Rate (including Missed Treatments): 52%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 82
52%59%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 : 5.5Dialysis Technician : 6.62Dietician : 0.62Social Worker: 0.62LPN : 0Other Health : 0.13Other Non-Health: 2.62
Authorized Stations as of 12/31/2017: 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
52
63.4%
Medicaid
5
Private Insurance
10
Charity Care
0
Private Pay
1
Other Public
14
TOTAL
82
6.1% 12.2% 0.0%1.2% 17.1% 100.0%
Patients
TOTAL 00
211
60
9730
0
03
131217
019
1116
<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
04
2223338245 37
82
$1,202,745 $1,945 $3,041,068 $0$134,475 $666,226 $5,046,459
23.8% 0.0% 60.3% 0.0%2.7% 13.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2767
Tazewell County Dialysis1021 Court St PekinTazewell2
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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:
Provides Incenter Noctural Dialysis:
Medical Director Name: Mohammed Shakaib
In-Center Treatments in calendar year: 3,275Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 22
Patients treated as of 12/31/2017: (Ending patients) 34
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 217.0
Oct 1
0
Oct 2
16
Oct 3
6
Oct 4
16
Oct 5
6
Oct 6
16
Oct 7
6
0 13 5 13 6 11 4
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 33Transient Patients: 12Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 14Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 587
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
22Total:
48Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 44%Use Rate (including Missed Treatments): 52%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 64
46%71%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:Registered Nurse : 3.5Dialysis Technician : 3Dietician : 0.2Social Worker: 0.2LPN : 0Other Health : 0.5Other Non-Health: 0.9
Authorized Stations as of 12/31/2017: 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
30
47.6%
Medicaid
2
Private Insurance
6
Charity Care
1
Private Pay
0
Other Public
25
TOTAL
63
3.2% 9.5% 1.6%0.0% 39.7% 100.0%
Patients
TOTAL 20
100
52
1630
0
03
1217
3
04
11131
<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
07
23304
6435 29
64
$668,496 $4,275 $258,478 $7,375$0 $398,091 $1,329,341
50.3% 0.3% 19.4% 0.6%0.0% 29.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2763
Timber Creek Dialysis1001 S. Annie Glidden RDDeKalbDeKalb1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Donald E. Myers Jr
Provides Incenter Noctural Dialysis:
Medical Director Name: Bindu Pavithran
In-Center Treatments in calendar year: 3,729Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 26
Patients treated as of 12/31/2017: (Ending patients) 25
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 223.0
Oct 1 Oct 2
14
Oct 3 Oct 4
14
Oct 5 Oct 6
14
Oct 7
26 26 26
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 21Transient Patients: 7Patients Re-Started: 4Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 2Patients transferred out: 19Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 2
Number of Missed Treatments: 142
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
29Total:
32Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 33%Use Rate (including Missed Treatments): 34%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 55
36%35%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 : 0.5Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 0.75
Authorized Stations as of 12/31/2017: 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
80.4%
Medicaid
4
Private Insurance
4
Charity Care
4
Private Pay
0
Other Public
2
TOTAL
51
7.8% 7.8% 7.8%0.0% 3.9% 100.0%
Patients
TOTAL 10
170
37
6490
0
04
2092
033
113
<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
07
23205
5535 20
55
$727,895 $68,456 $216,824 $28,320$0 $75,117 $1,088,293
66.9% 6.3% 19.9% 2.6%0.0% 6.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2810
Tinley Park Dialysis16767 80th AvenueTinley ParkCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: DaVita and Kidney Care South LLC Legal Entity Owner:
Property Owner: Tinley Park Healthcare LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Naila Ahmed
In-Center Treatments in calendar year: 1,670Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 1
Patients treated as of 12/31/2017: (Ending patients) 19
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 213.0
Oct 1
0
Oct 2
11
Oct 3
0
Oct 4
11
Oct 5
0
Oct 6
11
Oct 7
0
0 15 0 15 0 16 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 35Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 5Transplant Recipients: 1Patients transferred out: 12Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 56
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
39Total:
USE RATE for the FACILITY
11,232Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 15%Use Rate (including Missed Treatments): 15%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 36
1%26%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:Registered Nurse : 1Dialysis Technician : 2Dietician : 0.13Social Worker: 0.13LPN : 0Other Health : 0Other Non-Health: 0.47
Authorized Stations as of 12/31/2017: 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
30
83.3%
Medicaid
1
Private Insurance
4
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
36
2.8% 11.1% 0.0%0.0% 2.8% 100.0%
Patients
TOTAL 2070
27
2340
0
01895
00346
<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
01
1113113623 13
36
$331,579 $4,643 $365,181 $0$0 $60,437 $761,840
43.5% 0.6% 47.9% 0.0%0.0% 7.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2604
TRC Children's Dialysis Center1333 N Kingsbury StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: DaVitaLegal Entity Owner:
Property Owner: North Kingsbury Chicago Real Estate
Note our address is no longer 2611 N Halsted Chicago, IL 60614 We moved 3.5 years ago New address: 1333 N Kingsbury Street Chicago, IL 60642
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr Craig Langman
In-Center Treatments in calendar year: 2,675Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 17
Patients treated as of 12/31/2017: (Ending patients) 17
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 300.0
Oct 1
0
Oct 2
10
Oct 3
10
Oct 4
10
Oct 5
10
Oct 6
10
Oct 7
10
0 8 5 6 7 6 7
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 11Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 2
Recovered patients: 0Transplant Recipients: 7Patients transferred out: 6Patients 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
13Total:
13Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 36%Use Rate (including Missed Treatments): 36%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 30
35%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 : 0.8Social Worker: 0.8LPN : 0Other Health : 2Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
9
30.0%
Medicaid
9
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
30
30.0% 23.3% 0.0%0.0% 16.7% 100.0%
Patients
TOTAL 80
100
12
8220
0
125000
67000
<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
1812000
3017 13
30
$407,831 $286,613 $1,534,112 $0$0 $368,352 $2,596,908
15.7% 11.0% 59.1% 0.0%0.0% 14.2% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2614
Tri-Cities Dialysis, LLC306 Randall RoadGenevaKane8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Operated by Renaissance Management Co., LLCLegal Entity Owner:
Property Owner: Delnor Community Healthcare Foundati
Related Entities Yorkville Dialysis Center, LLC Affiliate None Fox Valley Acute Dialysis Services, LLC Affiliate None Yorkville Medical Building Affiliate None
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Harry Rubinstein
In-Center Treatments in calendar year: 9,942Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 70
Patients treated as of 12/31/2017: (Ending patients) 72
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
18
Oct 3
12
Oct 4
18
Oct 5
12
Oct 6
18
Oct 7
12
0 39 23 39 20 39 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 36Transient Patients: 4Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 4Transplant Recipients: 0Patients transferred out: 20Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 14
Number of Missed Treatments: 164
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
39Total:
41Total:
USE RATE for the FACILITY
18,720Treatment 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: 111
58%60%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 : 4.21Dialysis Technician : 5.93Dietician : 0.9Social Worker: 0.59LPN : 0Other Health : 0.13Other Non-Health: 1.32
Authorized Stations as of 12/31/2017: 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
93
83.8%
Medicaid
6
Private Insurance
12
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
111
5.4% 10.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 10
151
94
8103
0
0
07
141927
03
111119
<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
010253046
11167 44
111
$1,612,298 $37,968 $1,378,650 $0$0 $0 $3,028,916
53.2% 1.3% 45.5% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2755
U.S. Renal Care Villa Park Dialysis200 E. North AvenueVilla ParkDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: U.S. Renal CareLegal Entity Owner:
Property Owner: DCSL Management
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Michael Cohan
In-Center Treatments in calendar year: 9,008Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 62
Patients treated as of 12/31/2017: (Ending patients) 62
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 1
0
Oct 2
13.5
Oct 3
13.5
Oct 4
13.5
Oct 5
13.5
Oct 6
13.5
Oct 7
13.5
0 32 27 30 26 30 27
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 17Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 4Patients transferred out: 12Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 8
Number of Missed Treatments: 606
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
27Total:
18Total:
USE RATE for the FACILITY
12,168Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 74%Use Rate (including Missed Treatments): 79%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 87
79%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: 1
Full-Time Work Week: 40Registered Nurse : 2.9Dialysis Technician : 5.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
66
75.9%
Medicaid
2
Private Insurance
19
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
87
2.3% 21.8% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 21
161
46
36618
21
06
131716
02
10149
<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
08
2331258752 35
87
$1,768,666 $36,446 $2,167,855 $0$0 ($420) $3,972,547
44.5% 0.9% 54.6% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2316
University of Illinois Hospital Dialysis1859 West Taylor StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Other Government
Legal Entity Operator: The Board of Trustees of the University of IllinoiLegal Entity Owner:
Property Owner: The Board of Trustees - Univ. of IL
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Jose A. Arruda
In-Center Treatments in calendar year: 19,376Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 140
Patients treated as of 12/31/2017: (Ending patients) 137
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
3
Oct 3
3
Oct 4
3
Oct 5
3
Oct 6
3
Oct 7
3
0 68 60 68 56 71 58
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 0Patients Re-Started: 0Post-Transplant Patien 7
Recovered patients: 0Transplant Recipients: 9Patients transferred out: 14Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 1,943
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
35Total:
30Total:
USE RATE for the FACILITY
24,336Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 80%Use Rate (including Missed Treatments): 88%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 172
90%88%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 : 7.9Dialysis Technician : 22Dietician : 2Social Worker: 1LPN : 1Other Health : 17Other Non-Health: 7.5
Authorized Stations as of 12/31/2017: 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
107
78.1%
Medicaid
13
Private Insurance
14
Charity Care
0
Private Pay
3
Other Public
0
TOTAL
137
9.5% 10.2% 0.0%2.2% 0.0% 100.0%
Patients
TOTAL 10
750
61
54830
0
01740
97
01524178
<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
032642615
13773 64
137
$391,920 $49,630 $105,437 $0$1,499 $0 $548,486
71.5% 9.0% 19.2% 0.0%0.3% 0.0% 100.0%Net Revenue
6/30/20177/1/2016 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2518
US Renal Care Scottsdale4651 West 79th StreetChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Jeanette McLaughlin
In-Center Treatments in calendar year: 17,386Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 128
Patients treated as of 12/31/2017: (Ending patients) 126
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1 Oct 2
17
Oct 3
13
Oct 4
17
Oct 5
13
Oct 6
17
Oct 7
13
70 45 66 44 62 51
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 27Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 3Transplant Recipients: 4Patients transferred out: 19Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 23
Number of Missed Treatments: 1,336
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
51Total:
36Total:
USE RATE for the FACILITY
33,696Treatment 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: 175
59%58%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 35Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 1Dialysis Technician : 1Dietician : 0.75Social Worker: 0.75LPN : 0Other Health : 1Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
138
80.2%
Medicaid
17
Private Insurance
17
Charity Care
3
Private Pay
0
Other Public
0
TOTAL
172
9.9% 9.9% 1.7%0.0% 0.0% 100.0%
Patients
TOTAL 20
781
64
24145
6
30
010432116
05
232829
<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
015664945
17590 85
175
$3,838,147 $369,136 $3,530,492 $64,773$790 $636,022 $8,374,587
45.8% 4.4% 42.2% 0.8%0.0% 7.6% 100.0%Net Revenue
12/31/20171/31/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2750
US Renalcare Oak Brook Dialysis1201-B Butterfield RdDowners GroveDuPage7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: US RenalcareLegal Entity Owner:
Property Owner: Cedar Street Commercial
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Anis Rauf
In-Center Treatments in calendar year: 7,414Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 49
Patients treated as of 12/31/2017: (Ending patients) 57
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 190.0
Oct 1
0
Oct 2
14
Oct 3
14
Oct 4
14
Oct 5
14
Oct 6
14
Oct 7
14
0 34 20 30 20 33 21
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 23Transient Patients: 2Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 1Patients transferred out: 19Patients voluntarily discontinued: 3Patients lost to follow up: 1Patients deceased: 9
Number of Missed Treatments: 564
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
34Total:
25Total:
USE RATE for the FACILITY
12,168Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 61%Use Rate (including Missed Treatments): 66%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 91
63%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 : 2.9Dialysis Technician : 4.5Dietician : 0.5Social Worker: 0.5LPN : 0.9Other Health : 0.5Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
77
85.6%
Medicaid
6
Private Insurance
7
Charity Care
1
Private Pay
0
Other Public
0
TOTAL
90
6.7% 7.8% 1.1%0.0% 0.0% 100.0%
Patients
TOTAL 61
150
62
1846
7
03
211915
0179
16
<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
04
2828319158 33
91
$1,602,397 $100,941 $638,510 $1,741$4,950 $57,076 $2,403,875
66.7% 4.2% 26.6% 0.1%0.2% 2.4% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2749
USRC Bolingbrook Dialysis 396 Remington BlvdBolingbrookWill9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Mohamed Ahmed
In-Center Treatments in calendar year: 7,781Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 58
Patients treated as of 12/31/2017: (Ending patients) 58
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 201.0
Oct 1
0
Oct 2
13
Oct 3
13
Oct 4
13
Oct 5
13
Oct 6
13
Oct 7
13
0 25 23 20 23 27 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 20Transient Patients: 2Patients Re-Started: 1Post-Transplant Patien 0
Recovered patients: 4Transplant Recipients: 5Patients transferred out: 19Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 12
Number of Missed Treatments: 666
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
40Total:
23Total:
USE RATE for the FACILITY
12,168Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 64%Use Rate (including Missed Treatments): 69%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 95
74%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: 1
Full-Time Work Week: 40Registered Nurse : 2.8Dialysis Technician : 4.5Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.5Other Non-Health: 1
Authorized Stations as of 12/31/2017: 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
74
81.3%
Medicaid
2
Private Insurance
15
Charity Care
4
Private Pay
0
Other Public
0
TOTAL
91
2.2% 16.5% 4.4%0.0% 0.0% 100.0%
Patients
TOTAL 100
250
42
77711
18
07
201810
04
101214
<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
0113030249555 40
95
$1,602,397 $100,941 $638,510 $0$4,950 $57,076 $2,403,875
66.7% 4.2% 26.6% 0.0%0.2% 2.4% 100.0%Net Revenue
12/31/20171/30/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2738
USRC Streamwood149 E. Irving Park RoadStreamwoodCook7
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Commercial Property
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Richard Lee
In-Center Treatments in calendar year: 5,848Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 38
Patients treated as of 12/31/2017: (Ending patients) 45
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 200.0
Oct 1
0
Oct 2
11
Oct 3
11
Oct 4
11
Oct 5
11
Oct 6
11
Oct 7
11
0 21 21 23 19 20 22
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 16Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 12Patients voluntarily discontinued: 1Patients lost to follow up: 0Patients deceased: 6
Number of Missed Treatments: 346
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
20Total:
17Total:
USE RATE for the FACILITY
12,168Treatment 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: 62
49%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: 40Registered Nurse : 3Dialysis Technician : 2.4Dietician : 0.5Social Worker: 0.6LPN : 0.5Other Health : 0.5Other Non-Health: 0.8
Authorized Stations as of 12/31/2017: 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
49
79.0%
Medicaid
3
Private Insurance
10
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
62
4.8% 16.1% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 8062
26
54215
20
02989
027
205
<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
04
1628146228 34
62
$1,243,960 $47,646 $1,076,777 $0$63,690Net Revenue
12/31/20171/30/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2693
Vandalia DaVita Dialysis301 Mattes AvenueVandaliaFayette5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Capitol Retail
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Bashar Alzahabi
In-Center Treatments in calendar year: 2,966Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 22
Patients treated as of 12/31/2017: (Ending patients) 25
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 220.0
Oct 1
0
Oct 2
9
Oct 3
7
Oct 4
9
Oct 5
7
Oct 6
9
Oct 7
7
0 16 8 14 7 15 7
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 7Transient Patients: 6Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 7Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 4
Number of Missed Treatments: 308
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
15Total:
13Total:
USE RATE for the FACILITY
7,488Treatment 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: 37
46%52%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 : 3Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 1Other Non-Health: 2
Authorized Stations as of 12/31/2017: 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
34
91.9%
Medicaid
0
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
37
0.0% 5.4% 0.0%0.0% 2.7% 100.0%
Patients
TOTAL 0020
35
0370
0
00883
01584
<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:
37
01
13167
3719 18
37
$755,154 $2,347 $71,244 $0$170,245Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2812
Vermilion County Dialysis26 E. West Newell Rd.DanvilleVermilion4
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: Genesis KC Development, LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Erlandas Ulozas, MD
In-Center Treatments in calendar year: 2,594Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 3
Patients treated as of 12/31/2017: (Ending patients) 30
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 214.0
Oct 1
0
Oct 2
12
Oct 3
0
Oct 4
12
Oct 5
0
Oct 6
12
Oct 7
0
0 21 0 21 0 21 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 39Transient Patients: 6Patients Re-Started: 2Post-Transplant Patien 1
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 14Patients voluntarily discontinued: 2Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 280
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
18Total:
48Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 35%Use Rate (including Missed Treatments): 38%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 48
6%63%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: 36Registered Nurse : 1Dialysis Technician : 1Dietician : 0Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
27
56.3%
Medicaid
6
Private Insurance
7
Charity Care
0
Private Pay
0
Other Public
8
TOTAL
48
12.5% 14.6% 0.0%0.0% 16.7% 100.0%
Patients
TOTAL 10
180
29
4440
0
010
885
03653
<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
01314138
4831 17
48
$204,948 $112,167 $579,543 $885$0 $342,166 $1,238,824
16.5% 9.1% 46.8% 0.1%0.0% 27.6% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-9999
Washington Heights Dialysis10620 S. Halsted St.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: George Novogroder
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Abdessamad
In-Center Treatments in calendar year: 20Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 1
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
0
Oct 3
0
Oct 4
0
Oct 5
0
Oct 6
0
Oct 7
0
0 0 0 0 0 0 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
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: 0
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
0Total:
1Total:
USE RATE for the FACILITY
0Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): #Div/0!Use Rate (including Missed Treatments): #Div/0!Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 1
#Num!#Div/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: 24Registered Nurse : 0.75Dialysis Technician : 0.75Dietician : 0.5Social Worker: 0.5LPN : 0Other Health : 0.75Other Non-Health: 1
Authorized Stations as of 12/31/2017: 0Certified Stations by CMS: 0Peak 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
0
Private Insurance
0
Charity Care
0
Private Pay
0
Other Public
1
TOTAL
1
0.0% 0.0% 0.0%0.0% 100.0% 100.0%
Patients
TOTAL 00100
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$4,942Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2577
Waukegan Renal Center3350 West Grand Avenue Suite 100 WaukeganLake8
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: ISD Renal, IncLegal Entity Owner:
Property Owner: Waukegan Plaza II, L.L.C
Provides Incenter Noctural Dialysis:
Medical Director Name: Salima Din
In-Center Treatments in calendar year: 21,004Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 135
Patients treated as of 12/31/2017: (Ending patients) 145
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
16.5
Oct 3
16.5
Oct 4
16.5
Oct 5
16.5
Oct 6
16.5
Oct 7
16.5
0 70 63 71 60 70 63
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 28Transient Patients: 2Patients Re-Started: 1Post-Transplant Patien 2
Recovered patients: 3Transplant Recipients: 4Patients transferred out: 19Patients voluntarily discontinued: 4Patients lost to follow up: 0Patients deceased: 7
Number of Missed Treatments: 457
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
37Total:
33Total:
USE RATE for the FACILITY
22,464Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 94%Use Rate (including Missed Treatments): 96%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 177
94%101%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 : 14.2Dietician : 1.25Social Worker: 1.25LPN : 0Other Health : 0Other Non-Health: 2.25
Authorized Stations as of 12/31/2017: 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
123
72.4%
Medicaid
17
Private Insurance
22
Charity Care
7
Private Pay
0
Other Public
8
TOTAL
170
10.0% 12.9% 4.1%0.0% 4.7% 100.0%
Patients
TOTAL 52
720
98
63114
0
0
015551915
06
271921
<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
021823836
177104 73
177
$3,041,563 $268,087 $2,662,229 $136,290$1,437,906Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2688
Wayne County Davita303 N.W. 11th St.Fairfield Wayne5
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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 Association
Provides Incenter Noctural Dialysis:
Medical Director Name: Dr. Steven Zelman
In-Center Treatments in calendar year: 3,579Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 27
Patients treated as of 12/31/2017: (Ending patients) 23
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 209.0
Oct 1
0
Oct 2
10
Oct 3
7
Oct 4
10
Oct 5
7
Oct 6
10
Oct 7
7
0 15 8 15 8 14 9
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 8Transient Patients: 9Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 2Transplant Recipients: 1Patients transferred out: 7Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 5
Number of Missed Treatments: 50
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
18Total:
17Total:
USE RATE for the FACILITY
7,488Treatment 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: 315
56%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: 40Registered Nurse : 2.05Dialysis Technician : 2Dietician : 0.28Social Worker: 0LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
31
81.6%
Medicaid
1
Private Insurance
1
Charity Care
0
Private Pay
0
Other Public
5
TOTAL
38
2.6% 2.6% 0.0%0.0% 13.2% 100.0%
Patients
TOTAL 0000
38
000
0
02976
02633
<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
15109
3824 14
0
$742,324 $36,039 $511,314 $0$241,607Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2783
West Side Dialysis Center1600 W. 13th St . Unit 3ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: RPAI US Management LLC
Provides Incenter Noctural Dialysis:
Medical Director Name: Edwin J Cook
In-Center Treatments in calendar year: 4,760Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 32
Patients treated as of 12/31/2017: (Ending patients) 40
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 218.0
Oct 1
0
Oct 2
12
Oct 3
10
Oct 4
12
Oct 5
10
Oct 6
12
Oct 7
10
0 26 11 22 11 22 10
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 22Transient Patients: 36Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 0Transplant Recipients: 1Patients transferred out: 39Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 1
Number of Missed Treatments: 237
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
41Total:
58Total:
USE RATE for the FACILITY
11,232Treatment 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: 8
44%56%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 : 2.425Dialysis Technician : 3.7Dietician : 0.53Social Worker: 0.4LPN : 0Other Health : 1Other Non-Health: 0.8
Authorized Stations as of 12/31/2017: 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
54
62.1%
Medicaid
22
Private Insurance
10
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
87
25.3% 11.5% 1.1%0.0% 1.1% 100.0%
Patients
TOTAL 40
560
24
20644
4
09
2756
08
17124
<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
0174417108847 41
88
$673,598 $92,464 $173,948 $590$447,852Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2648
Whiteside Dialysis2600 N Locust StSterlingWhiteside1
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: For Profit Corporation
Legal Entity Operator: Renal Treatment Centers-IL IncLegal Entity Owner:
Property Owner: CGH Medical Center
Provides Incenter Noctural Dialysis:
Medical Director Name: Charlene Murdakes
3/14/2017 - Received permit to discontinue a 15 station ESRD facility at 2600 North Locust, Suite D in Sterling and to establish a 15 station ESRD facility at 4320 East Lincolnway in Sterling.
In-Center Treatments in calendar year: 8,383Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 0
Patients treated as of 12/31/2017: (Ending patients) 59
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 3.0
Oct 1
0
Oct 2
18
Oct 3
14
Oct 4
18
Oct 5
14
Oct 6
18
Oct 7
14
0 34 20 32 23 36 18
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 29Transient Patients: 3Patients Re-Started: 3Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 0Patients transferred out: 7Patients voluntarily discontinued: 3Patients lost to follow up: 0Patients deceased: 13
Number of Missed Treatments: 251
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
24Total:
35Total:
USE RATE for the FACILITY
14,040Treatment 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: 91
0%66%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 : 3.5Dialysis Technician : 4.8Dietician : 0.5Social Worker: 0.5LPN : 1Other Health : 0Other Non-Health: 0.9
Authorized Stations as of 12/31/2017: 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
70
77.8%
Medicaid
15
Private Insurance
5
Charity Care
1
Private Pay
0
Other Public
0
TOTAL
90
16.7% 5.6% 1.1%0.0% 0.0% 100.0%
Patients
TOTAL 1030
80
7840
7
03
131915
01
111613
<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
04
2435289150 41
91
$1,685,040 $1,685,040 $484,889 $19,470$0 $243,563 $4,098,532
41.1% 41.1% 11.8% 0.5%0.0% 5.9% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2721
Woodlawn Dialysis5060 S State St.ChicagoCook6
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, 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: South Central Medical Center Building
Provides Incenter Noctural Dialysis:
Medical Director Name: Mary Hammes, MD
In-Center Treatments in calendar year: 19,674Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 137
Patients treated as of 12/31/2017: (Ending patients) 140
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 240.0
Oct 1
0
Oct 2
18
Oct 3
17
Oct 4
18
Oct 5
17
Oct 6
18
Oct 7
17
0 69 60 70 59 69 62
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 56Transient Patients: 17Patients Re-Started: 0Post-Transplant Patien 0
Recovered patients: 1Transplant Recipients: 7Patients transferred out: 36Patients voluntarily discontinued: 0Patients lost to follow up: 2Patients deceased: 10
Number of Missed Treatments:
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
56Total:
73Total:
USE RATE for the FACILITY
29,952Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 66%Use Rate (including Missed Treatments):Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 196
71%73%Use Rate (Year end Patients/Stations*6):
Authorized Stations Setup and Staffed in Oct 1-7: 30Isolation Stations Set up in Oct 1-7: 1
Full-Time Work Week: 40Registered Nurse : 7Dialysis Technician : 14Dietician : 1Social Worker: 1LPN : 0Other Health : 0Other Non-Health: 0
Authorized Stations as of 12/31/2017: 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
155
79.5%
Medicaid
33
Private Insurance
6
Charity Care
1
Private Pay
0
Other Public
1
TOTAL
195
16.9% 3.1% 0.5%0.0% 0.5% 100.0%
Patients
TOTAL 00
18801
7189
0
7
0213744
8
012243218
<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:
196
033617626
196110 86
196
$3,214,779 $87,451 $855,614 $35,400$1,933,451Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.
14-2709
Yorkville Dialysis Center, LLC1400 N. Beecher RoadYorkvilleKendall9
END STAGE RENAL DIALYSIS - FACILITY PROFILE 2017Ownership, Management and General Information
Address:Name:
City:County:
Medicare ID:HSA: Other Ownership:
Ownership Type: Limited Liability Company
Legal Entity Operator: Operated by Renaissance Management Co., LLCLegal Entity Owner:
Property Owner: Yorkville Medical Building Co., LLC
Related Entities: Tri-Cities Dialysis, LLC Affiliate None
Provides Incenter Noctural Dialysis:
Medical Director Name:
In-Center Treatments in calendar year: 2,254Facility Reported Patient Information
Patients treated as of 1/1/2017: (Beginning patients) 14
Patients treated as of 12/31/2017: (Ending patients) 18
Facility Reported Treatment Information
Average Daily Treatments: 0.0Average Treatment Time (min): 215.0
Oct 1
0
Oct 2
12
Oct 3
0
Oct 4
12
Oct 5
0
Oct 6
12
Oct 7
0
0 14 0 13 0 14 0
Dialysis Station Utilization for the Week of Oct 1 - 7, 2017
New Patients: 13Transient Patients: 1Patients Re-Started: 0Post-Transplant Patien 1
Recovered patients: 0Transplant Recipients: 0Patients transferred out: 8Patients voluntarily discontinued: 0Patients lost to follow up: 0Patients deceased: 3
Number of Missed Treatments: 53
PATIENT ADDITIONS PATIENT LOSSES
Date of Operation
Hours operated
Number of Patients Treated
11Total:
15Total:
USE RATE for the FACILITY
7,488Treatment Capacity/year (based on Stations):Use Rate (Treatments/Treatment capacity): 30%Use Rate (including Missed Treatments): 31%Use Rate (Begining patients treated):
Total Unduplicated patients treated in calendar year: 29
29%38%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 : 1.02Dialysis Technician : 0.9Dietician : 0.07Social Worker: 0.24LPN : 0Other Health : 0.1Other Non-Health: 0.16
Authorized Stations as of 12/31/2017: 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
24
82.8%
Medicaid
3
Private Insurance
2
Charity Care
0
Private Pay
0
Other Public
0
TOTAL
29
10.3% 6.9% 0.0%0.0% 0.0% 100.0%
Patients
TOTAL 0140
24
5240
0
02255
03525
<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
0577
102914 15
29
$509,831 $51,229 $124,403 $0$0 $0 $685,463
74.4% 7.5% 18.1% 0.0%0.0% 0.0% 100.0%Net Revenue
12/31/20171/1/2017 to
Source: Data based on 2017 Annual ESRD Questionnaire administered by the Illinois Department of Public Health.