Skilled nursing facility · CMS certification number 175476
CMS certification number 175476
This certification number is not in CMS’s current Care Compare Provider Information file, processed on 1 August 2026.
For this facility: the citable document with full history — $795 · an email when this record changes — $99/month
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 2011 to 31 December 2011 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 27 August 2012.
None of these figures is carried on this report.
CMS report record 431887, read from the public cost report file SNFFY2011.zip.
Fiscal year 2010, ended 31 December 2010
Cost report for 1 January 2010 to 31 December 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 10 August 2011.
None of these figures is carried on this report.
CMS report record 415081, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended 31 December 2009
Cost report for 1 January 2009 to 31 December 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 19 October 2010.
None of these figures is carried on this report.
CMS report record 388689, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended 31 December 2008
Cost report for 1 January 2008 to 31 December 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 28 July 2009.
None of these figures is carried on this report.
CMS report record 352996, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended 31 December 2007
Cost report for 1 January 2007 to 31 December 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 31 July 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $946,220 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $908,119 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $38,101 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $30,789 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $2,953 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: $65,937 (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.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 28 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 7,806 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 39 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 2.5 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 212.54 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 200.15 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 322417, read from the public cost report file SNFFY2007.zip.
Fiscal year 2006, ended 31 December 2006
Cost report for 1 January 2006 to 31 December 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 16 May 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $759,640 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $845,436 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$85,796 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $95,679 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $1,964 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: $7,919 (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.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 28 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 7,268 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 38 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 45 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 187.82 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 191.26 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 309197, read from the public cost report file SNFFY2006.zip.
Fiscal year 2005, ended 31 December 2005
Cost report for 1 January 2005 to 31 December 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 19 June 2007.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $927,634 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $956,123 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$28,489 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $84,295 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $2,113 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: $53,693 (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.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 28 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 8,893 | 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, Medicaid, in days | 838.43 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 555.81 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 285214, read from the public cost report file SNFFY2005.zip.
Fiscal year 2004, ended 31 December 2004
Cost report for 1 August 2004 to 31 December 2004 — a reporting period of 152 days, not a full year, on form CMS-2540-96, settled, processed by CMS on 30 November 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $350,772 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $406,765 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$55,993 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $36,323 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $1,347 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: −$21,017 (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.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 28 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 3,488 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 10 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicaid, in days | 319.17 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 348.8 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 237770, read from the public cost report file SNFFY2004.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.
Ownership, as filed with CMS
Care Compare
Not listed in CMS’s Care Compare data.
Medicare enrollment
No owner listed for this facility in CMS’s Medicare enrollment ownership data.
Changes in ownership
No change in ownership appears in CMS’s ownership data for this facility.
Recent changes on this record
- 27 August 2012: A cost report was filed for fiscal year 2011, on form CMS-2540-96. SNFFY2011.zip
- 10 August 2011: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- 19 October 2010: A cost report was filed for fiscal year 2009, on form CMS-2540-96. SNFFY2009.zip
- 28 July 2009: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2008.zip
- 31 July 2008: A cost report was filed for fiscal year 2007, on form CMS-2540-96. SNFFY2007.zip
- 16 May 2008: A cost report was filed for fiscal year 2006, on form CMS-2540-96. SNFFY2006.zip
- 19 June 2007: A cost report was filed for fiscal year 2005, on form CMS-2540-96. SNFFY2005.zip
- 30 November 2005: A cost report was filed for fiscal year 2004, on form CMS-2540-96. SNFFY2004.zip
Inspections
Not listed in CMS’s Care Compare data.
Deficiencies cited
Not listed in CMS’s Care Compare data.
Penalties
Not listed in CMS’s Care Compare data.
Care Compare provider information
Not listed in CMS’s Care Compare data.
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On 27 August 2012: A cost report was filed for fiscal year 2011, on form CMS-2540-96. That is one line of the alert.
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The citable document for CMS certification number 175476
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 the same state 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.
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 175476.