Skilled nursing facility · CMS certification number 245368
GRAND VILLAGE
GRAND RAPIDS, Minnesota · Medicare and Medicaid
Certified beds, as filed in Care Compare: 82
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 October 2023 to 30 September 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 15 April 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $14,977,437 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,602,008 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,375,429 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,850,128 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$474,699 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,057,403 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $582,704 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $582,704 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 114 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 41,724 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 4,036 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 12,900 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 6,092 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 23,028 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 141 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 24 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 75 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 240 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 28.62 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 537.5 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 95.95 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1420412, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended 30 September 2023
Cost report for 1 October 2022 to 30 September 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 8 February 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $13,977,126 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,800,530 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,176,596 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,977,612 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$801,016 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $462,622 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$338,394 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$338,394 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 114 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 24,903 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 237 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 29.09 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,107.62 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 105.08 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1373152, read from the public cost report file SNF10FY2023.zip.
Fiscal year 2022, ended 30 September 2022
Cost report for 1 October 2021 to 30 September 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 21 March 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,109,150 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,156,239 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,952,911 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $12,189,283 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,236,372 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $997,135 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,239,237 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,239,237 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 114 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 25,264 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 185 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 24.31 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,043.4 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 136.56 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1344659, read from the public cost report file SNF10FY2022.zip.
Fiscal year 2021, ended 30 September 2021
Cost report for 1 October 2020 to 30 September 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 26 April 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $14,949,074 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,232,529 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,716,545 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $12,499,464 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$782,919 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $345,692 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$437,227 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$437,227 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 114 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 31,011 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 271 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 27.89 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 514.44 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 114.43 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1314774, read from the public cost report file SNF10FY2021.zip.
Fiscal year 2020, ended 30 September 2020
Cost report for 1 October 2019 to 30 September 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 7 June 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $15,179,371 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,376,842 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,802,529 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $12,778,774 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$976,245 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $708,104 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$268,141 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$268,141 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 114 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 32,076 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 249 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 27.56 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,328.36 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 128.82 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1285562, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended 30 September 2019
Cost report for 1 October 2018 to 30 September 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 15 April 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $17,493,024 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,717,445 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $13,775,579 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $13,341,737 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $433,842 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $181,405 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $615,247 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $615,247 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 37,644 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 463 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 22.72 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 369.62 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 81.3 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1253999, read from the public cost report file SNF10FY2019.zip.
Fiscal year 2018, ended 30 September 2018
Cost report for 1 October 2017 to 30 September 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 28 March 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $15,473,330 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,917,997 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $12,555,333 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $12,836,808 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$281,475 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $228,289 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$53,186 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$53,186 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 37,209 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 442 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 21.16 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 588.54 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 84.18 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1222081, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended 30 September 2017
Cost report for 1 October 2016 to 30 September 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 2 May 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $13,606,078 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,409,693 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,196,385 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $12,369,371 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,172,986 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $98,725 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,074,261 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,074,261 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 36,547 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 425 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 19.44 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 571.03 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 85.99 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1189185, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended 30 September 2016
Cost report for 1 October 2015 to 30 September 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 18 January 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $13,326,791 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,553,505 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,773,286 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $12,357,568 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$584,282 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $50,045 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$534,237 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$607,381 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 37,543 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 575 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 25.7 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 236.51 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 65.29 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1181885, read from the public cost report file SNF10FY2016.zip.
Fiscal year 2015, ended 30 September 2015
Cost report for 1 October 2014 to 30 September 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 20 April 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,406,732 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,294,232 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,112,500 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,502,763 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$390,263 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $52,926 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$337,337 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$337,337 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 37,712 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 575 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 23 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 283.4 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 65.59 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1122147, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended 30 September 2014
Cost report for 1 October 2013 to 30 September 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 25 February 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $11,519,831 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $858,599 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $10,661,232 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,267,330 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$606,098 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $79,494 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$526,604 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$526,604 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 39,162 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 618 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 20.44 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 313.95 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 63.37 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1119581, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended 30 September 2013
Cost report for 1 October 2012 to 30 September 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 22 September 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $11,814,683 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $786,240 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,028,443 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,703,633 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $324,810 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $50,560 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $375,370 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $375,370 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 40,856 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 606 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 23.75 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 292.01 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 67.42 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1110612, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended 30 September 2012
Cost report for 1 October 2011 to 30 September 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 27 September 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $10,820,441 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $644,889 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $10,175,552 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,805,498 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $370,054 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $75,323 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $445,377 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $445,377 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 119 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 41,188 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 565 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 23.34 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 294.61 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 72.9 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1078479, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended 30 September 2011
Cost report for 1 October 2010 to 30 September 2011 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 5 November 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,432,362 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,337,345 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $95,017 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $58,983 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $154,000 (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 | 143 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 39,186 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 489 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 24.13 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 309.01 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 80.13 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 435403, read from the public cost report file SNFFY2011.zip.
Fiscal year 2010, ended 30 September 2010
Cost report for 1 October 2009 to 30 September 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 14 February 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,133,917 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,412,903 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$278,986 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $154,644 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$124,342 (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 | 143 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 43,213 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 366 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 23.38 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 598.07 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 118.07 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 424672, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended 30 September 2009
Cost report for 1 October 2008 to 30 September 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 8 March 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $10,084,059 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,832,294 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $251,765 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $61,886 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $210 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: $313,441 (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 | 143 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 46,582 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 303 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 26.99 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 749.67 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 153.74 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 395184, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended 30 September 2008
Cost report for 1 October 2007 to 30 September 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 13 January 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,929,391 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,551,429 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $377,962 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $102,365 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $266,583 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: $213,744 (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 | 143 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 48,124 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 308 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 30.02 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,081.96 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 156.25 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 362285, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended 30 September 2007
Cost report for 1 October 2006 to 30 September 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 13 March 2009.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,227,230 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,225,539 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $1,691 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $90,018 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $91,709 (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 | 153 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 47,907 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 282 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 31.7 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 736.71 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 169.88 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 335257, read from the public cost report file SNFFY2007.zip.
Fiscal year 2006, ended 30 September 2006
Cost report for 1 October 2005 to 30 September 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 7 March 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,842,715 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,795,736 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $46,979 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $39,254 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $86,233 (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 | 153 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 51,675 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 282 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 42.69 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 493.91 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 183.24 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 303865, read from the public cost report file SNFFY2006.zip.
Fiscal year 2005, ended 30 September 2005
Cost report for 1 October 2004 to 30 September 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 16 January 2007.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $9,423,603 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,997,053 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $426,550 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $70,419 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $496,969 (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 | 153 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 52,216 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 322 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 44.18 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 581.22 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 162.16 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 270522, read from the public cost report file SNFFY2005.zip.
Fiscal year 2004, ended 30 September 2004
Cost report for 1 October 2003 to 30 September 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 21 March 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $7,068,064 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,035,441 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $32,623 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $61,588 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $94,211 (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 | 133 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 43,073 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 125 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 56.29 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 597.4 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 344.58 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 245582, read from the public cost report file SNFFY2004.zip.
Fiscal year 2003, ended 30 September 2003
Cost report for 1 October 2002 to 30 September 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 26 January 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,413,090 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,259,283 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $153,807 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $254,495 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $408,302 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,699 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 75 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 58.78 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 870.19 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 569.32 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 205357, read from the public cost report file SNFFY2003.zip.
Fiscal year 2002, ended 30 September 2002
Cost report for 1 October 2001 to 30 September 2002 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 11 March 2004.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,147,307 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,188,834 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$41,527 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $203,664 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $162,137 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,693 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 87 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 47.62 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 912.55 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 490.72 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 170795, read from the public cost report file SNFFY2002.zip.
Fiscal year 2001, ended 30 September 2001
Cost report for 1 October 2000 to 30 September 2001 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 29 May 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,865,405 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,803,857 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $61,548 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $238,372 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $299,920 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,752 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 149 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 65.77 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 508.71 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 286.93 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 146335, read from the public cost report file SNFFY2001.zip.
Fiscal year 2000, ended 30 September 2000
Cost report for 1 October 1999 to 30 September 2000 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 25 February 2002.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,177,837 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,259,874 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$82,037 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $232,918 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $150,881 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,824 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 115 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 103.58 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 844 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 372.38 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 42226, read from the public cost report file SNFFY2000.zip.
Fiscal year 1999, ended 30 September 1999
Cost report for 1 October 1998 to 30 September 1999 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 5 June 2001.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,926,088 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,065,255 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$139,167 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $248,805 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $109,638 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,652 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 105 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 82.93 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 802.08 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 406.21 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 42224, read from the public cost report file SNFFY1999.zip.
Fiscal year 1998, ended 30 September 1998
Cost report for 1 October 1997 to 30 September 1998 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 21 November 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,854,466 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,735,670 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $118,796 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $159,160 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $277,956 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,629 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 142 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 74.2 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 647.43 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 300.2 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 42223, read from the public cost report file SNFFY1998.zip.
Fiscal year 1997, ended 30 September 1997
Cost report for 1 October 1996 to 30 September 1997 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 23 February 1999.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,673,878 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,607,691 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $66,187 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $137,450 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $203,637 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,960 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 112 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 118.18 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 665.2 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 383.57 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 28826, read from the public cost report file SNFFY1997.zip.
Fiscal year 1996, ended 30 September 1996
Cost report for 1 October 1995 to 30 September 1996 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 20 July 1998.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,482,782 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,494,038 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$11,256 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $164,278 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $153,022 (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 | 118 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 43,067 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 105 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 124 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 811.76 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 410.16 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 28824, 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.
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 |
|---|---|---|---|---|
| COUNTY OF ITASCA | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | since 01/13/2015 |
| EBENEZER MANAGEMENT SERVICES INC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 01/30/2025 |
| OLIVERIUS, MAGGIE | ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/21/2025 |
| YOUNGDAHL-PALECEK, ANTOINETTE | ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/21/2025 |
| JOHNSON, JOHN | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2025 |
| ROHLING, AUSTIN | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2025 |
| SMITH, CORY | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2025 |
| SNYDER, TERRY | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2012 |
| TRUNT, LEO | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2010 |
| VENEMA, MATTHEW | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2025 |
| BELL, BRITTANY | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 10/01/2023 |
| EBENEZER MANAGEMENT SERVICES INC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 10/01/2023 |
| OLIVERIUS, MAGGIE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 10/01/2023 |
| WILLETT, TODD | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 10/01/2023 |
| YOUNGDAHL-PALECEK, ANTOINETTE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 10/01/2023 |
Medicare enrollment
As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of ITASCA NURSING HOME (enrollment ID O20080605000824).
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| COUNTY OF ITASCA | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100 | 1/13/2015 | Private equity company: No Real estate investment trust: No Holding company: No |
| ANTOINETTE L YOUNGDAHL-PALECEK | 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. | 4/21/2025 | 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. |
| EBENEZER MANAGEMENT SERVICES INC | 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. | 1/30/2025 | Private equity company: No Real estate investment trust: No Holding company: No |
| MAGGIE OLIVERIUS | 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. | 4/21/2025 | 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. |
| AUSTIN ROHLING | Individual | CORPORATE DIRECTOR | 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. | 1/1/2025 | 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. |
| CORY SMITH | Individual | CORPORATE DIRECTOR | 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. | 1/1/2025 | 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. |
| JOHN JOHNSON | Individual | CORPORATE DIRECTOR | 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. | 1/1/2025 | 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. |
| LEO TRUNT | Individual | CORPORATE DIRECTOR | 0 | 1/1/2010 | 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. |
| MATTHEW VENEMA | Individual | CORPORATE DIRECTOR | 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. | 1/1/2025 | 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. |
| TERRY SNYDER | Individual | CORPORATE DIRECTOR | 0 | 1/1/2012 | 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. |
| ANTOINETTE L YOUNGDAHL-PALECEK | 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. | 10/1/2023 | 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. |
| BRITTANY BELL | 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. | 10/1/2023 | 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. |
| EBENEZER MANAGEMENT SERVICES INC | Organization | OPERATIONAL/MANAGERIAL CONTROL | 100 | 10/1/2023 | Private equity company: No Real estate investment trust: No Holding company: No |
| MAGGIE OLIVERIUS | 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. | 10/1/2023 | 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. |
| TODD WILLETT | 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. | 10/1/2023 | 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. |
Changes in ownership
- 1 July 2026: ANTOINETTE L YOUNGDAHL-PALECEK 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: ANTOINETTE L YOUNGDAHL-PALECEK 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: ANTOINETTE L YOUNGDAHL-PALECEK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: ANTOINETTE L YOUNGDAHL-PALECEK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 March 2026: DAVIN TINQUIST no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: AIMEE JOHNSON no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MAGGIE OLIVERIUS no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: BRITTANY BELL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: AUSTIN ROHLING appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MATTHEW VENEMA appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: EBENEZER MANAGEMENT SERVICES INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: JOHN JOHNSON appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: CORY SMITH appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MAGGIE OLIVERIUS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MAGGIE OLIVERIUS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: ANTOINETTE L YOUNGDAHL-PALECEK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: ANTOINETTE L YOUNGDAHL-PALECEK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 December 2024: MICHAEL IVES no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-12-01.csv
- 1 April 2024: ECUMEN no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: TARA L JOHNSON no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: SHANNON ELLERING no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: SHANNON ELLERING no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: EBENEZER MANAGEMENT SERVICES INC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: TODD WILLETT appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: MAGGIE OLIVERIUS appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
Recent changes on this record
- 1 July 2026: ANTOINETTE L YOUNGDAHL-PALECEK 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: ANTOINETTE L YOUNGDAHL-PALECEK 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: ANTOINETTE L YOUNGDAHL-PALECEK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: ANTOINETTE L YOUNGDAHL-PALECEK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 March 2026: DAVIN TINQUIST no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: AIMEE JOHNSON no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MAGGIE OLIVERIUS no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: BRITTANY BELL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: AUSTIN ROHLING appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MATTHEW VENEMA appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: EBENEZER MANAGEMENT SERVICES INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: JOHN JOHNSON appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: CORY SMITH appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MAGGIE OLIVERIUS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MAGGIE OLIVERIUS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: ANTOINETTE L YOUNGDAHL-PALECEK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: ANTOINETTE L YOUNGDAHL-PALECEK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 15 April 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- 1 December 2024: MICHAEL IVES no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-12-01.csv
- 1 April 2024: ECUMEN no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: TARA L JOHNSON no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: SHANNON ELLERING no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: SHANNON ELLERING no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: EBENEZER MANAGEMENT SERVICES INC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: TODD WILLETT appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 1 April 2024: MAGGIE OLIVERIUS appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-04-01.csv
- 8 February 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- 21 March 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- 26 April 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- 7 June 2021: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- 15 April 2020: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- 28 March 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- 2 May 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- 18 January 2018: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- 20 April 2016: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- 25 February 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 22 September 2015: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- 27 September 2014: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- 5 November 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-96. SNFFY2011.zip
- 14 February 2012: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 7 July 2026 | 7 July 2026 | 1 | 10 |
| 2 | 21 May 2025 | 21 May 2025 | 9 | 4 |
| 3 | 29 August 2024 | 29 August 2024 | 8 | 3 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
18 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 14 May 2026 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Yes | Deficient, Provider has date of correction | 11 June 2026 |
| 21 May 2025 | 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 | 20 June 2025 |
| 21 May 2025 | Health | F 0605 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | D | No | Deficient, Provider has date of correction | 20 June 2025 |
| 21 May 2025 | Health | F 0641 | Resident Assessment and Care Planning Deficiencies | Ensure each resident receives an accurate assessment. | D | No | Deficient, Provider has date of correction | 20 June 2025 |
| 21 May 2025 | 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 | 20 June 2025 |
| 21 May 2025 | Health | F 0756 | Pharmacy Service Deficiencies | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | D | No | Deficient, Provider has date of correction | 20 June 2025 |
| 21 May 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. | F | No | Deficient, Provider has date of correction | 20 June 2025 |
| 21 May 2025 | 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 | No | Deficient, Provider has date of correction | 20 June 2025 |
| 21 May 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 20 June 2025 |
| 11 April 2025 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Yes | Deficient, Provider has date of correction | 9 May 2025 |
| 29 August 2024 | Health | F 0553 | Resident Rights Deficiencies | Allow resident to participate in the development and implementation of his or her person-centered plan of care. | D | No | Deficient, Provider has date of correction | 23 September 2024 |
| 29 August 2024 | Health | F 0554 | Resident Rights Deficiencies | Allow residents to self-administer drugs if determined clinically appropriate. | D | No | Deficient, Provider has date of correction | 23 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 | 23 September 2024 |
| 29 August 2024 | 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 | 23 September 2024 |
| 29 August 2024 | Health | F 0695 | Quality of Life and Care Deficiencies | Provide safe and appropriate respiratory care for a resident when needed. | D | No | Deficient, Provider has date of correction | 23 September 2024 |
| 29 August 2024 | Health | F 0758 | Pharmacy Service Deficiencies | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | D | No | Deficient, Provider has date of correction | 23 September 2024 |
| 31 July 2024 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Yes | Deficient, Provider has date of correction | 19 August 2024 |
| 12 September 2023 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | E | Yes | Deficient, Provider has date of correction | 27 September 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 | ITASCA NURSING HOME |
| Date First Approved to Provide Medicare and Medicaid Services | 1986-11-01 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | N |
| County/Parish | Itasca |
| Telephone Number | 2183260543 |
| 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 | 82 |
| Average Number of Residents per Day | 62.1 |
| Overall Rating | 5 |
| Health Inspection Rating | 4 |
| QM Rating | 5 |
| Long-Stay QM Rating | 4 |
| 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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