Skilled nursing facility · CMS certification number 155424

HICKORY CREEK AT COLUMBUS

COLUMBUS, Indiana · Medicare and Medicaid

Certified beds, as filed in Care Compare: 36

Finances, as filed

From this facility’s Medicare cost reports on form CMS-2540, each figure with the worksheet, line and column it was read from.

Cost report for 1 January 2024 to 31 December 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 28 August 2025.

Revenue and expenses, fiscal year 2024
Figure	As filed	Where it comes from
Total patient revenue	$3,723,395	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$415,274	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$4,138,669	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,768,878	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$369,791	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$21,223	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$391,014	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $391,014 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2024
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Bed days available, all components	13,176	CMS-2540-10 worksheet S300001 line 800 column 200
Medicare (Title XVIII) patient days	312	CMS-2540-10 worksheet S300001 line 800 column 400
Medicaid (Title XIX) patient days	9,219	CMS-2540-10 worksheet S300001 line 800 column 500
Other-payer patient days	1,366	CMS-2540-10 worksheet S300001 line 800 column 600
Total patient days, all components	10,897	CMS-2540-10 worksheet S300001 line 800 column 700
Medicare discharges	9	CMS-2540-10 worksheet S300001 line 800 column 900
Medicaid discharges	34	CMS-2540-10 worksheet S300001 line 800 column 1000
Other-payer discharges	28	CMS-2540-10 worksheet S300001 line 800 column 1100
Total discharges, all components	71	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	34.67	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	271.15	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	153.48	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1433579, read from the public cost report file SNF10FY2024.zip.

Fiscal year 2023, ended 31 December 2023

Cost report for 1 January 2023 to 31 December 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 16 October 2024.

Revenue and expenses, fiscal year 2023
Figure	As filed	Where it comes from
Total patient revenue	$3,485,531	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$345,433	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,830,964	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,399,699	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$431,265	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$11,812	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$443,077	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $443,077 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2023
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	10,941	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	81	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	51.73	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	211.19	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	135.07	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1396591, read from the public cost report file SNF10FY2023.zip.

Fiscal year 2022, ended 31 December 2022

Cost report for 1 January 2022 to 31 December 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 19 July 2024.

Revenue and expenses, fiscal year 2022
Figure	As filed	Where it comes from
Total patient revenue	$3,231,398	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$379,323	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,610,721	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,476,899	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$133,822	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$130,824	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$264,646	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $264,646 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2022
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	11,491	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	106	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	28.86	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	151.49	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	108.41	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1389882, read from the public cost report file SNF10FY2022.zip.

Fiscal year 2021, ended 31 December 2021

Cost report for 1 January 2021 to 31 December 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 7 November 2022.

Revenue and expenses, fiscal year 2021
Figure	As filed	Where it comes from
Total patient revenue	$3,280,172	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$512,026	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,792,198	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,409,804	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$382,394	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$136,122	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$518,516	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $518,516 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2021
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	11,500	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	54	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	132.57	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	263.57	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	212.96	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1336102, read from the public cost report file SNF10FY2021.zip.

Fiscal year 2020, ended 31 December 2020

Cost report for 1 January 2020 to 31 December 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 29 September 2021.

Revenue and expenses, fiscal year 2020
Figure	As filed	Where it comes from
Total patient revenue	$3,296,603	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$390,140	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,686,743	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,321,518	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$365,225	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$135,682	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$500,907	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $500,907 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2020
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,484	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	20	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	87.33	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	624.2	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1301370, read from the public cost report file SNF10FY2020.zip.

Fiscal year 2019, ended 31 December 2019

Cost report for 1 January 2019 to 31 December 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 8 December 2020.

Revenue and expenses, fiscal year 2019
Figure	As filed	Where it comes from
Total patient revenue	$3,281,402	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$303,105	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,584,507	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,263,953	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$320,554	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$6,714	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$327,268	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $327,268 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2019
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,546	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	30	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	48.25	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	418.2	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1275263, read from the public cost report file SNF10FY2019.zip.

Fiscal year 2018, ended 31 December 2018

Cost report for 1 January 2018 to 31 December 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 15 July 2019.

Revenue and expenses, fiscal year 2018
Figure	As filed	Where it comes from
Total patient revenue	$3,061,276	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$248,685	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,309,961	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,967,123	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$342,838	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$7,811	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$350,649	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $350,649 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2018
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,604	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	26	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	29.6	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	484.77	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1236878, read from the public cost report file SNF10FY2018.zip.

Fiscal year 2017, ended 31 December 2017

Cost report for 1 January 2017 to 31 December 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 19 July 2018.

Revenue and expenses, fiscal year 2017
Figure	As filed	Where it comes from
Total patient revenue	$2,947,001	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$271,423	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,218,424	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,912,277	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$306,147	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$8,251	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$314,398	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $314,398 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2017
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,657	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	21	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	179.67	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	602.71	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1200188, read from the public cost report file SNF10FY2017.zip.

Fiscal year 2016, ended 31 December 2016

Cost report for 1 January 2016 to 31 December 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 17 July 2017.

Revenue and expenses, fiscal year 2016
Figure	As filed	Where it comes from
Total patient revenue	$3,020,624	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$130,255	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,150,879	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,703,277	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$447,602	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$7,287	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$454,889	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $454,889 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2016
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,915	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	13	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	97	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	993.46	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1168452, read from the public cost report file SNF10FY2016.zip.

Fiscal year 2015, ended 31 December 2015

Cost report for 1 January 2015 to 31 December 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 25 July 2016.

Revenue and expenses, fiscal year 2015
Figure	As filed	Where it comes from
Total patient revenue	$2,895,769	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$24,691	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$2,871,078	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,631,300	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$239,778	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$4,742	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$244,520	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $244,520 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2015
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,343	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	32	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	57.44	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	385.72	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1135248, read from the public cost report file SNF10FY2015.zip.

Fiscal year 2014, ended 31 December 2014

Cost report for 1 January 2014 to 31 December 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 25 July 2015.

Revenue and expenses, fiscal year 2014
Figure	As filed	Where it comes from
Total patient revenue	$2,704,480	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$38,565	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$2,665,915	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,617,589	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$48,326	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$6,451	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$54,777	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $54,777 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2014
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,208	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	36	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	33.25	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	339.11	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1105225, read from the public cost report file SNF10FY2014.zip.

Fiscal year 2013, ended 31 December 2013

Cost report for 1 August 2013 to 31 December 2013 — a reporting period of 152 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 19 June 2014.

Revenue and expenses, fiscal year 2013
Figure	As filed	Where it comes from
Total patient revenue	$1,150,358	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$64,205	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$1,086,153	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$1,142,639	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$56,486	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$2,276	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	−$54,210	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$54,210 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2013
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	5,126	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	11	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	76.67	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	466	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1066154, read from the public cost report file SNF10FY2013.zip.

Fiscal year 2012, ended 31 December 2012

Cost report for 1 May 2012 to 31 December 2012 — a reporting period of 244 days, not a full year, on form CMS-2540-10, reopened, processed by CMS on 13 February 2014.

Revenue and expenses, fiscal year 2012
Figure	As filed	Where it comes from
Total patient revenue	$1,404,203	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	−$45,365	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$1,449,568	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$1,382,791	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$66,777	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$5,390	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$72,167	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $72,167 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).

Beds, days and discharges, fiscal year 2012
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	8,340	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	14	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	16.29	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days	595.71	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1055530, read from the public cost report file SNF10FY2012.zip.

Fiscal year 2011, ended 30 April 2011

Cost report for 1 May 2010 to 30 April 2011 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 26 October 2012.

Revenue and expenses, fiscal year 2011
Figure	As filed	Where it comes from
Net patient revenue	$2,026,909	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,951,545	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	$75,364	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$5,629	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $80,993 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 2011
Figure	As filed	Where it comes from
Total facility beds, all components	36	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	11,558	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	40	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	67.5	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	288.95	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 432963, read from the public cost report file SNFFY2010.zip.

Fiscal year 2010, ended 30 April 2010

Cost report for 1 May 2009 to 30 April 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 27 September 2011.

Revenue and expenses, fiscal year 2010
Figure	As filed	Where it comes from
Net patient revenue	$2,018,405	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,843,265	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	$175,140	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$1,499	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $176,639 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 2010
Figure	As filed	Where it comes from
Total facility beds, all components	38	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	11,697	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	37	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	60.8	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	316.14	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 418415, read from the public cost report file SNFFY2009.zip.

Fiscal year 2009, ended 30 April 2009

Cost report for 1 May 2008 to 30 April 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 21 July 2010.

Revenue and expenses, fiscal year 2009
Figure	As filed	Where it comes from
Net patient revenue	$1,928,426	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,903,117	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	$25,309	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$366	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $25,675 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 2009
Figure	As filed	Where it comes from
Total facility beds, all components	38	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	11,235	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	47	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	54.88	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	239.04	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 382944, read from the public cost report file SNFFY2008.zip.

Fiscal year 2008, ended 30 April 2008

Cost report for 1 May 2007 to 30 April 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 22 July 2009.

None of these figures is carried on this report.

CMS report record 351917, read from the public cost report file SNFFY2007.zip.

Fiscal year 2007, ended 30 April 2007

Cost report for 1 May 2006 to 30 April 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 24 September 2008.

None of these figures is carried on this report.

CMS report record 326072, read from the public cost report file SNFFY2006.zip.

Fiscal year 2006, ended 30 April 2006

Cost report for 1 May 2005 to 30 April 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 16 May 2007.

None of these figures is carried on this report.

CMS report record 278611, read from the public cost report file SNFFY2005.zip.

Fiscal year 2005, ended 30 April 2005

Cost report for 1 May 2004 to 30 April 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 31 May 2006.

None of these figures is carried on this report.

CMS report record 250610, read from the public cost report file SNFFY2004.zip.

Fiscal year 2004, ended 30 April 2004

Cost report for 1 May 2003 to 30 April 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 16 September 2005.

None of these figures is carried on this report.

CMS report record 233189, read from the public cost report file SNFFY2003.zip.

Fiscal year 2003, ended 30 April 2003

Cost report for 1 May 2002 to 30 April 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 17 May 2004.

Revenue and expenses, fiscal year 2003
Figure	As filed	Where it comes from
Net patient revenue	$1,259,965	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,368,506	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$108,541	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$349	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: −$108,192 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 2003
Figure	As filed	Where it comes from
Total facility beds, all components	38	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	11,496	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	26	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	47.13	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	442.15	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 176448, read from the public cost report file SNFFY2002.zip.

Fiscal year 2002, ended 30 April 2002

Cost report for 1 November 2001 to 30 April 2002 — a reporting period of 180 days, not a full year, on form CMS-2540-96, settled, processed by CMS on 7 May 2003.

None of these figures is carried on this report.

CMS report record 143643, read from the public cost report file SNFFY2002.zip.

Fiscal year 2001, ended 31 October 2001

Cost report for 1 January 2001 to 31 October 2001 — a reporting period of 303 days, on form CMS-2540-96, settled, processed by CMS on 13 February 2003.

None of these figures is carried on this report.

CMS report record 131094, read from the public cost report file SNFFY2001.zip.

Fiscal year 2000, ended 31 December 2000

Cost report for 1 January 2000 to 31 December 2000 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 16 January 2002.

Revenue and expenses, fiscal year 2000
Figure	As filed	Where it comes from
Net patient revenue	$1,391,810	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,376,053	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	$15,757	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$223	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $15,980 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 2000
Figure	As filed	Where it comes from
Total facility beds, all components	40	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	13,058	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	34	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	96.13	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	384.06	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 13651, read from the public cost report file SNFFY2000.zip.

Fiscal year 1999, ended 31 December 1999

Cost report for 4 October 1999 to 31 December 1999 — a reporting period of 88 days, not a full year, on form CMS-2540-96, as submitted, processed by CMS on 15 March 2001.

Net income, stated at moderate confidence: $107,290 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

CMS report record 13650, read from the public cost report file SNFFY2000.zip.

Fiscal year 1998, ended 31 December 1998

Cost report for 1 January 1998 to 31 December 1998 — a reporting period of 364 days, on form CMS-2540-96, reopened, processed by CMS on 22 September 2001.

Revenue and expenses, fiscal year 1998
Figure	As filed	Where it comes from
Net patient revenue	$1,296,422	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,454,150	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$157,728	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$200,906	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $43,178 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 1998
Figure	As filed	Where it comes from
Total facility beds, all components	40	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	9,952	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	16	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	67.08	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	622	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 13646, read from the public cost report file SNFFY1998.zip.

Fiscal year 1997, ended 31 December 1997

Cost report for 1 January 1997 to 31 December 1997 — a reporting period of 364 days, on form CMS-2540-96, reopened, processed by CMS on 19 September 2001.

Revenue and expenses, fiscal year 1997
Figure	As filed	Where it comes from
Net patient revenue	$1,543,215	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,407,315	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	$135,900	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$6,644	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $142,544 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 1997
Figure	As filed	Where it comes from
Total facility beds, all components	40	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	12,613	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	20	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	93.25	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	630.65	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 13643, read from the public cost report file SNFFY1997.zip.

Fiscal year 1996, ended 31 December 1996

Cost report for 1 February 1996 to 31 December 1996 — a reporting period of 334 days, on form CMS-2540-96, reopened, processed by CMS on 12 February 2003.

Revenue and expenses, fiscal year 1996
Figure	As filed	Where it comes from
Net patient revenue	$993,912	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,052,532	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$58,620	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$294	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: −$58,326 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

Beds, days and discharges, fiscal year 1996
Figure	As filed	Where it comes from
Total facility beds, all components	40	CMS-2540-96 worksheet S300001 line 900 column 100
Total patient days, all components	9,856	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	20	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	41.58	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, all patients, in days	492.8	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 116923, read from the public cost report file SNFFY1996.zip.

Nurse staffing

Nurse staffing hours from the Payroll-Based Journal, quarter by quarter, are on this facility’s staffing page, each quarter with the file it came from.

The staffing record →

Ownership, as filed with CMS

Care Compare

As filed in the CMS file dated 1 August 2026 (Care Compare ownership).

Owner or manager	Role	Type	Ownership percentage	Association
HENRY COUNTY MEMORIAL HOSPITAL	5% OR GREATER DIRECT OWNERSHIP INTEREST	Organization	100%	since 08/01/2013
AMERICAN SENIOR COMMUNITIES LLC	ADP OF THE SNF	Organization	NOT APPLICABLE	since 03/19/2025
DICE, MARK	ADP OF THE SNF	Individual	NOT APPLICABLE	since 06/01/2023
HENRY COUNTY MEMORIAL HOSPITAL	ADP OF THE SNF	Organization	NOT APPLICABLE	since 05/07/2025
MORIO-HALE, SABRINA	ADP OF THE SNF	Individual	NOT APPLICABLE	since 10/13/2025
MUSTAKLEM, MARWAN	ADP OF THE SNF	Individual	NOT APPLICABLE	since 03/19/2025
SHANE, ANDREW	ADP OF THE SNF	Individual	NOT APPLICABLE	since 02/01/2023
VAN CAMP, STEVEN	ADP OF THE SNF	Individual	NOT APPLICABLE	since 06/01/2023
RING, BRIAN	CORPORATE OFFICER	Individual	NOT APPLICABLE	since 08/01/2022
CHIES, STEVEN	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 03/01/2021
DYNES, SHELDON	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 01/01/2013
JACKSON, BLAKE	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 03/01/2021
JACKSON, ETHAN	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 03/01/2021
JACKSON, MARK	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 03/01/2021
JACKSON, MICHAEL	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 05/14/2024
JACKSON, WESSLEY	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 03/01/2021
JUSTICE, DAVID	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 03/01/2021
KELSEY, DONNA	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 07/18/2024
PIDGEON, JOHN	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 01/01/2013
SHORE, MARION	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 01/01/2013
STITLE, STEPHEN	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 03/01/2021
WARE, DEBORAH	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 08/27/2021
WRIGHT, THERESSA	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 05/21/2021
AMERICAN SENIOR COMMUNITIES LLC	OPERATIONAL/MANAGERIAL CONTROL	Organization	NOT APPLICABLE	since 03/01/2021
BOWLING, KIMBERLY	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 02/20/2026
DICE, MARK	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 06/01/2023
MORIO-HALE, SABRINA	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 08/08/2025
MUSTAKLEM, MARWAN	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 11/22/2021
RING, BRIAN	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 08/01/2022
SHANE, ANDREW	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 02/01/2023
VAN CAMP, STEVEN	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 06/01/2023
DYNES, SHELDON	TRUSTEE OF THE SNF	Individual	NOT APPLICABLE	since 01/01/2013
PIDGEON, JOHN	TRUSTEE OF THE SNF	Individual	NOT APPLICABLE	since 01/01/2013
SHORE, MARION	TRUSTEE OF THE SNF	Individual	NOT APPLICABLE	since 01/01/2013
WARE, DEBORAH	TRUSTEE OF THE SNF	Individual	NOT APPLICABLE	since 08/27/2021

Medicare enrollment

As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of HENRY COUNTY MEMORIAL HOSPITAL (enrollment ID O20131009001448).

Owner	Individual or organization	Role	Ownership percentage	Association date	Described in the filing as
HENRY COUNTY MEMORIAL HOSPITAL	Organization	5% OR GREATER DIRECT OWNERSHIP INTEREST	100	8/1/2013	Private equity company: No Real estate investment trust: No Holding company: No
AMERICAN SENIOR COMMUNITIES LLC	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/19/2025	Private equity company: No Real estate investment trust: No Holding company: No
ANDREW SHANE	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	2/1/2023	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
HENRY COUNTY MEMORIAL HOSPITAL	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	5/7/2025	Private equity company: No Real estate investment trust: No Holding company: No
MARK DICE	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2023	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MARWAN MUSTAKLEM	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/19/2025	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
SABRINA MORIO-HALE	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	10/13/2025	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
STEVEN VAN CAMP	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2023	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: No Real estate investment trust: No Holding company: No
CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: No Real estate investment trust: No Holding company: Yes
CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: No Real estate investment trust: No Holding company: Yes
CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: No Real estate investment trust: No Holding company: Yes
BRIAN RING	Individual	CORPORATE OFFICER	0	8/1/2022	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
BLAKE JACKSON	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
DAVID JUSTICE	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
DEBORAH WARE	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	8/27/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
DONNA KELSEY	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	7/18/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
ETHAN I JACKSON	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
JOHN D PIDGEON	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2013	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MARION E SHORE	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2013	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MARK JACKSON	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MICHAEL L JACKSON	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	5/14/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
SHELDON L DYNES	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2013	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
STEPHEN STITLE	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
STEVEN CHIES	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
THERESSA WRIGHT	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	5/21/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
WESSLEY JACKSON	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/1/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
AMERICAN SENIOR COMMUNITIES LLC	Organization	OPERATIONAL/MANAGERIAL CONTROL	100	3/1/2021	Private equity company: No Real estate investment trust: No Holding company: No
ANDREW SHANE	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	2/1/2023	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
BRIAN RING	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	8/1/2022	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
KIMBERLY BOWLING	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	2/20/2026	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MARK DICE	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2023	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MARWAN MUSTAKLEM	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	11/22/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
SABRINA MORIO-HALE	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	8/8/2025	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
STEVEN VAN CAMP	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2023	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
DEBORAH WARE	Individual	TRUSTEE OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	8/27/2021	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
JOHN D PIDGEON	Individual	TRUSTEE OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2013	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MARION E SHORE	Individual	TRUSTEE OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2013	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
SHELDON L DYNES	Individual	TRUSTEE OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2013	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.

Changes in ownership

1 July 2026: KIMBERLY BOWLING no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON no longer appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON no longer appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: KIMBERLY BOWLING appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 April 2026: KIMBERLY MILLER no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
1 April 2026: KIMBERLY BOWLING appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
1 December 2025: LISA TETRICK no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 December 2025: LISA TETRICK no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 December 2025: SABRINA MORIO-HALE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 December 2025: SABRINA MORIO-HALE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 November 2025: SHELDON L DYNES no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ALECIA MOORE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DIANA GORE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DEBORAH WARE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DONNA G KELSEY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARION E SHORE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: JOHN D PIDGEON no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DAVID JUSTICE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: AMERICAN SENIOR COMMUNITIES LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: LISA TETRICK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: LISA TETRICK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ANDREW E SHANE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ANDREW E SHANE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: STEVEN E CHIES appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DEBORAH WARE appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DEBORAH WARE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: THERESSA WRIGHT appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: HENRY COUNTY MEMORIAL HOSPITAL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: STEPHEN STITLE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ETHAN JACKSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARK E DICE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARK E DICE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: STEVEN A VAN CAMP appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: WESSLEY JACKSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DONNA G KELSEY appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: BLAKE JACKSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: BRIAN RING appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARION E SHORE appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARION E SHORE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: KIMBERLY MILLER appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MICHAEL JACKSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARK A. JACKSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARWAN MUSTAKLEM appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARWAN MUSTAKLEM appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: JOHN D PIDGEON appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: JOHN D PIDGEON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: SHELDON L DYNES appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: SHELDON L DYNES appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
15 February 2023: PAUL F JANSSEN no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv
15 February 2023: BRIAN RING appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv

Recent changes on this record

1 July 2026: KIMBERLY BOWLING no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON no longer appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON no longer appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: KIMBERLY BOWLING appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MARWAN MUSTAKLEM appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: JOHN D PIDGEON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 April 2026: KIMBERLY MILLER no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
1 April 2026: KIMBERLY BOWLING appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
1 December 2025: LISA TETRICK no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 December 2025: LISA TETRICK no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 December 2025: SABRINA MORIO-HALE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 December 2025: SABRINA MORIO-HALE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-12-01.csv
1 November 2025: SHELDON L DYNES no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ALECIA MOORE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DIANA GORE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DEBORAH WARE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DONNA G KELSEY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARION E SHORE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: JOHN D PIDGEON no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DAVID JUSTICE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: AMERICAN SENIOR COMMUNITIES LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: LISA TETRICK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: LISA TETRICK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ANDREW E SHANE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ANDREW E SHANE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: STEVEN E CHIES appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DEBORAH WARE appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: DEBORAH WARE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: THERESSA WRIGHT appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: HENRY COUNTY MEMORIAL HOSPITAL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: STEPHEN STITLE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: ETHAN JACKSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARK E DICE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: MARK E DICE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: STEVEN A VAN CAMP appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
1 November 2025: WESSLEY JACKSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv

Inspections

Inspection cycle	Health inspection	Fire safety inspection	Health deficiencies	Fire safety deficiencies
1	12 September 2025	12 September 2025	3	4
2	29 August 2024	29 August 2024	2	3
3	12 June 2023	12 June 2023	3	9

From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.

Deficiencies cited

8 deficiencies on file, newest inspection first

Inspection date	Inspection type	Tag	Category	What was cited	Scope and severity	Complaint	Corrected	Correction date
12 September 2025	Health	F 0656	Resident Assessment and Care Planning Deficiencies	Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.	D	No	Deficient, Provider has date of correction	29 September 2025
12 September 2025	Health	F 0755	Pharmacy Service Deficiencies	Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.	D	No	Deficient, Provider has date of correction	29 September 2025
12 September 2025	Health	F 0812	Nutrition and Dietary Deficiencies	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.	D	No	Deficient, Provider has date of correction	29 September 2025
29 August 2024	Health	F 0580	Resident Rights Deficiencies	Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.	D	No	Deficient, Provider has date of correction	21 September 2024
29 August 2024	Health	F 0684	Quality of Life and Care Deficiencies	Provide appropriate treatment and care according to orders, resident’s preferences and goals.	D	No	Deficient, Provider has date of correction	21 September 2024
16 January 2024	Health	F 0842	Resident Assessment and Care Planning Deficiencies	Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.	D	Yes	Deficient, Provider has date of correction	3 February 2024
12 June 2023	Health	F 0686	Quality of Life and Care Deficiencies	Provide appropriate pressure ulcer care and prevent new ulcers from developing.	D	No	Deficient, Provider has date of correction	7 July 2023
12 June 2023	Health	F 0761	Pharmacy Service Deficiencies	Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.	D	No	Deficient, Provider has date of correction	7 July 2023

From the Care Compare health citations file NH_HealthCitations_Aug2026.csv, processed on 1 August 2026.

Penalties

Not yet extracted for this facility.

Care Compare provider information

Field	As filed
Provider Type	Medicare and Medicaid
Ownership Type	Government - County
Legal Business Name	HENRY COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid Services	1992-02-01
Provider Resides in Hospital	N
Continuing Care Retirement Community	N
Urban	Y
County/Parish	Bartholomew
Telephone Number	8123726136
Chain Name	AMERICAN SENIOR COMMUNITIES
Chain ID	33
Provider Changed Ownership in Last 12 Months	N
With a Resident and Family Council	Resident
Automatic Sprinkler Systems in All Required Areas	Yes
Number of Certified Beds	36
Average Number of Residents per Day	28.3
Overall Rating	4
Health Inspection Rating	4
QM Rating	5
Long-Stay QM Rating	5
Short-Stay QM Rating	5
Processing Date	2026-08-01

From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.

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One email a day naming what moved on HICKORY CREEK AT COLUMBUS: the field, the value before, the value after, and the date of the file that first showed it.

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On 1 July 2026: KIMBERLY BOWLING no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. That is one line of the alert.

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The citable document for HICKORY CREEK AT COLUMBUS

This page shows the record as it stands today. The report is the citable document: the same figures with the cell each came from, and beyond this page — five facilities of a similar size in Indiana at the same fiscal year, listed by name; every change on the record rather than the recent ones below; the inspection and staffing history in blocks of their own; and a citation block naming every CMS file it was read from.

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Every figure on this page is printed as it appears in the CMS file named beside it. A figure that does not match its file? Tell us on the corrections page, quoting certification number 155424.