Skilled nursing facility · CMS certification number 265632
HICKORY MANOR
LICKING, Missouri · Medicare and Medicaid
Certified beds, as filed in Care Compare: 60
Finances, as filed
From this facility’s Medicare cost reports on form CMS-2540, each figure with the worksheet, line and column it was read from.
Cost report for 1 January 2024 to 31 December 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 28 August 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,241,757 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,134,033 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,107,724 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,308,700 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$200,976 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $18,948 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$182,028 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$182,028 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 21,960 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,098 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 9,640 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 3,288 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 14,026 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 20 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 71 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 109 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 200 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 54.9 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 135.77 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 70.13 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1434574, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended 31 December 2023
Cost report for 1 January 2023 to 31 December 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 19 September 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,618,008 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $664,726 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,953,282 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,954,008 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$726 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $16,943 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $16,217 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $16,217 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 13,027 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 97 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 46.91 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 424.36 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 134.3 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1395186, read from the public cost report file SNF10FY2023.zip.
Fiscal year 2022, ended 31 December 2022
Cost report for 1 January 2022 to 31 December 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 3 August 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,217,428 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $645,395 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,572,033 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,640,745 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$68,712 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $30,109 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$38,603 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$38,603 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 12,934 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 77 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 72.27 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 409.36 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 167.97 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1360846, read from the public cost report file SNF10FY2022.zip.
Fiscal year 2021, ended 31 December 2021
Cost report for 1 January 2021 to 31 December 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 15 August 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,753,306 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $486,863 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,266,443 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,437,934 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$171,491 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $147,094 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$24,397 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$24,397 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 11,002 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 90 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 33.76 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 404.42 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 122.24 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1329747, read from the public cost report file SNF10FY2021.zip.
Fiscal year 2020, ended 31 December 2020
Cost report for 1 January 2020 to 31 December 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 17 September 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,429,953 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $106,733 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,323,220 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,586,589 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$263,369 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $729,064 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $465,695 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $465,697 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 11,808 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 99 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 44.34 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 230.97 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 119.27 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1300481, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended 31 December 2019
Cost report for 1 January 2019 to 31 December 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 7 August 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,580,021 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $331,002 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,249,019 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,544,942 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$295,923 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,668 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$293,255 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$293,257 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 12,122 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 111 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 61.65 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 119.19 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 109.21 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1262924, read from the public cost report file SNF10FY2019.zip.
Fiscal year 2018, ended 31 December 2018
Cost report for 1 January 2018 to 31 December 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 26 July 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,775,091 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $381,304 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,393,787 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,715,645 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$321,858 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $7,602 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$314,256 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$314,257 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 12,675 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 103 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 44.03 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 156.27 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 123.06 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1238465, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended 31 December 2017
Cost report for 1 August 2017 to 31 December 2017 — a reporting period of 152 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 19 July 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $1,280,378 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $165,421 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,114,957 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,154,876 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$39,919 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,123 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$38,796 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$38,797 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 5,836 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 43 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 57.36 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 190.47 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 135.72 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1200465, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended 30 November 2016
Cost report for 1 December 2015 to 30 November 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 17 May 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $11,572,454 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $9,406,428 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,166,026 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,623,388 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$457,362 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,951 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$454,411 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$454,411 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 13,074 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 76 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 45.58 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 462.33 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 172.03 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1157429, read from the public cost report file SNF10FY2016.zip.
Fiscal year 2015, ended 30 November 2015
Cost report for 1 December 2014 to 30 November 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 8 June 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $11,945,027 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $9,663,604 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,281,423 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,659,258 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$377,835 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $7,215 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$370,620 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$370,620 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 13,451 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 89 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 42.13 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 272.38 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 151.13 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1126514, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended 30 November 2014
Cost report for 1 December 2013 to 30 November 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 11 May 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $13,637,966 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $11,054,129 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,583,837 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,713,607 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$129,770 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,625 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$127,145 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$127,145 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 15,350 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 77 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 41.12 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 474.91 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 199.35 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1090162, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended 30 November 2013
Cost report for 1 December 2012 to 30 November 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 12 May 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $15,579,541 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $12,747,106 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,832,435 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,980,044 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$147,609 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $11,556 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$136,053 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$136,053 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,508 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 89 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 44.52 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 501.91 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 196.72 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1059742, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended 30 November 2012
Cost report for 1 December 2011 to 30 November 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 13 May 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $17,074,325 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $14,043,718 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,030,607 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,917,936 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $112,671 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $15,906 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $128,577 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $128,577 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 19,305 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 74 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 33.72 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 529 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 260.88 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1029073, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended 30 November 2011
Cost report for 1 December 2010 to 30 November 2011 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 26 October 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $17,359,416 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $14,332,523 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,026,893 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,735,980 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $290,913 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $21,260 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $312,173 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $312,173 (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 | 60 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 19,670 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 74 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 54.52 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 549.05 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 265.81 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1013989, read from the public cost report file SNF10FY2011.zip.
Fiscal year 2010, ended 30 November 2010
Cost report for 1 December 2009 to 30 November 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 29 April 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,539,516 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,451,391 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $88,125 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $28,304 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $116,429 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 17,008 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 76 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 42.77 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 912.45 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 223.79 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 398219, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended 30 November 2009
Cost report for 1 December 2008 to 30 November 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 29 April 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,210,503 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,529,952 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$319,449 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $17,864 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$301,585 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 15,683 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 93 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 40.28 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 398.15 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 168.63 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 368466, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended 30 November 2008
Cost report for 1 December 2007 to 30 November 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 29 April 2009.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,700,672 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,650,245 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $50,427 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $5,381 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $55,808 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 18,495 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 120 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 41.38 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 245.94 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 154.13 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 337895, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended 30 November 2007
Cost report for 1 June 2007 to 30 November 2007 — a reporting period of 182 days, not a full year, on form CMS-2540-96, settled, processed by CMS on 18 June 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,394,156 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,379,509 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $14,647 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $33 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $14,680 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 9,911 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 67 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 50.6 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 305.24 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 147.93 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 315578, read from the public cost report file SNFFY2007.zip.
Fiscal year 2006, ended 31 May 2006
Cost report for 1 June 2005 to 31 May 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 13 December 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,592,171 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,570,657 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $21,514 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,539 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $28,053 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 20,824 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 127 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 79.39 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 291.64 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 163.97 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 268639, read from the public cost report file SNFFY2005.zip.
Fiscal year 2005, ended 31 May 2005
Cost report for 1 June 2004 to 31 May 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 9 February 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,466,241 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,521,427 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$55,186 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $11,332 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$43,854 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 20,627 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 147 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 56.69 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 291.83 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 140.32 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 242663, read from the public cost report file SNFFY2004.zip.
Fiscal year 2004, ended 31 May 2004
Cost report for 1 June 2003 to 31 May 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 8 December 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,380,013 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,355,469 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $24,544 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $9,619 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $34,163 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 20,575 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 124 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 80.29 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 274.79 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 165.93 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 238494, read from the public cost report file SNFFY2003.zip.
Fiscal year 2003, ended 31 May 2003
Cost report for 1 June 2002 to 31 May 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 15 November 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,195,790 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,200,133 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$4,343 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $8,770 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $4,427 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 19,626 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 127 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 87.16 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 233.9 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 154.54 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 236889, read from the public cost report file SNFFY2002.zip.
Fiscal year 2002, ended 31 May 2002
Cost report for 1 June 2001 to 31 May 2002 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 17 November 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,200,774 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,133,287 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $67,487 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $22,389 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $89,876 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 20,031 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 89 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 53 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 323.36 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 225.07 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 237048, read from the public cost report file SNFFY2001.zip.
Fiscal year 2000, ended 31 May 2000
Cost report for 1 June 1999 to 31 May 2000 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 16 June 2004.
None of these figures is carried on this report.
CMS report record 182463, read from the public cost report file SNFFY1999.zip.
Fiscal year 1999, ended 31 May 1999
Cost report for 1 June 1998 to 31 May 1999 — a reporting period of 364 days, on form CMS-2540-96, as submitted, processed by CMS on 24 March 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,970,536 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,837,853 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $132,683 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $5,773 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $138,456 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 19,785 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 206 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 35.39 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 112.54 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 96.04 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 31937, read from the public cost report file SNFFY1998.zip.
Fiscal year 1998, ended 31 May 1998
Cost report for 1 June 1997 to 31 May 1998 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 8 March 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,818,776 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,913,479 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$94,703 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $5,256 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$89,447 (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 | 60 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 18,939 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 94 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 65.96 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 236.7 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 201.48 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 31935, read from the public cost report file SNFFY1997.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 |
|---|---|---|---|---|
| AGH1 LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 04/14/2025 |
| BEAIRD, TODD | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2022 |
| BEERS, JONATHAN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 09/01/2024 |
| CAUDILL, TINA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/15/2026 |
| FG LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 08/01/2017 |
| FORVIS MAZARS LLP | ADP OF THE SNF | Organization | NOT APPLICABLE | since 08/16/2021 |
| MID STATES INC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 08/01/2017 |
| SCHMITT, LINDI | ADP OF THE SNF | Individual | NOT APPLICABLE | since 11/27/2023 |
| SOVEREIGN HEALTHCARE GROUP LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 04/06/2025 |
| THE CITY OF LICKING | ADP OF THE SNF | Organization | NOT APPLICABLE | since 08/01/2017 |
| VAN DE VEN LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 08/01/2017 |
| WARNER, ANGIE | ADP OF THE SNF | Individual | NOT APPLICABLE | since 06/16/2023 |
| THE LICKING EXEMPT TRUST | DIRECT OWNERSHIP INTEREST | Organization | NOT APPLICABLE | since 05/24/2017 |
| BEDELL, BRYAN | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 05/12/2025 |
| AGH1 LLC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 08/01/2017 |
| BEAIRD, TODD | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/01/2022 |
| BEDELL, DONALD | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 05/24/2017 |
| BEERS, JONATHAN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 09/01/2024 |
| CAUDILL, TINA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/15/2026 |
| SCHMITT, LINDI | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 11/27/2023 |
| SOVEREIGN HEALTHCARE GROUP LLC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 04/23/2021 |
| WARNER, ANGIE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 06/16/2023 |
| THE LICKING EXEMPT TRUST | TRUSTEE OF THE SNF | Organization | NOT APPLICABLE | since 05/24/2017 |
Medicare enrollment
As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of LICKING NO 1 LLC (enrollment ID O20171122002453).
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| AGH1 LLC | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 4/14/2025 | Private equity company: No Real estate investment trust: No Holding company: No |
| ANGIE WARNER | Individual | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/16/2023 | 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. |
| FG LLC | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 8/1/2017 | Private equity company: No Real estate investment trust: No Holding company: No |
| FORVIS MAZARS LLP | 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. | 8/16/2021 | Private equity company: No Real estate investment trust: No Holding company: No |
| JONATHAN R BEERS | 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. | 9/1/2024 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| LINDI DIANA SCHMITT | 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. | 11/27/2023 | 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. |
| MID STATES 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. | 8/1/2017 | Private equity company: No Real estate investment trust: No Holding company: No |
| SOVEREIGN HEALTHCARE GROUP LLC | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 4/6/2025 | Private equity company: No Real estate investment trust: No Holding company: No |
| THE CITY OF LICKING | 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. | 8/1/2017 | Private equity company: No Real estate investment trust: No Holding company: No |
| TINA CAUDILL | 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. | 1/15/2026 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| TODD BEAIRD | 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. | 1/1/2022 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| VAN DE VEN LLC | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 8/1/2017 | Private equity company: No Real estate investment trust: No Holding company: No |
| CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 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. | 1/1/2000 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 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. | 1/1/2000 | 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. |
| THE LICKING EXEMPT TRUST | Organization | DIRECT OWNERSHIP INTEREST | 100 | 5/24/2017 | Private equity company: No Real estate investment trust: No Holding company: No |
| AGH1 LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 8/1/2017 | Private equity company: No Real estate investment trust: No Holding company: No |
| ANGIE WARNER | Individual | OPERATIONAL/MANAGERIAL CONTROL | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/16/2023 | 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. |
| DONALD B BEDELL | 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. | 5/24/2017 | 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. |
| JONATHAN R BEERS | 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. | 9/1/2024 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| LINDI DIANA SCHMITT | Individual | OPERATIONAL/MANAGERIAL CONTROL | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 11/27/2023 | 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. |
| SOVEREIGN HEALTHCARE GROUP LLC | Organization | 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. | 4/23/2021 | Private equity company: No Real estate investment trust: No Holding company: No |
| TINA CAUDILL | 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. | 1/15/2026 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| TODD BEAIRD | 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. | 1/1/2022 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| THE LICKING EXEMPT TRUST | Organization | TRUSTEE OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 5/24/2017 | Private equity company: No Real estate investment trust: No Holding company: No |
Changes in ownership
- 1 July 2026: A listing under ADP OF THE SNF no longer appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JONATHAN R BEERS 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: JONATHAN R BEERS 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: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JONATHAN R BEERS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JONATHAN R BEERS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 March 2026: MICHAEL GAWLAK no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MICHAEL GAWLAK no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: TINA CAUDILL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: TINA CAUDILL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 September 2025: TIFFANI ALLEN no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE LICKING EXEMPT TRUST no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: DONALD B BEDELL no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: DONALD B BEDELL no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: TODD BEAIRD no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: LINDI DIANA SCHMITT appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: LINDI DIANA SCHMITT appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE CITY OF LICKING appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: AGH1 LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: AGH1 LLC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: FORVIS MAZARS LLP appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE LICKING EXEMPT TRUST appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE LICKING EXEMPT TRUST appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: ANGIE WARNER appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: ANGIE WARNER appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: DONALD B BEDELL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: TODD BEAIRD appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: TODD BEAIRD appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: MICHAEL GAWLAK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: MICHAEL GAWLAK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: VAN DE VEN LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: MID STATES INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: FG LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: SOVEREIGN HEALTHCARE GROUP LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: SOVEREIGN HEALTHCARE GROUP LLC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: JONATHAN R BEERS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: JONATHAN R BEERS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
Recent changes on this record
- 1 July 2026: A listing under ADP OF THE SNF no longer appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JONATHAN R BEERS 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: JONATHAN R BEERS 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: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JONATHAN R BEERS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JONATHAN R BEERS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 March 2026: MICHAEL GAWLAK no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: MICHAEL GAWLAK no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: TINA CAUDILL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 March 2026: TINA CAUDILL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-03-01.csv
- 1 September 2025: TIFFANI ALLEN no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE LICKING EXEMPT TRUST no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: DONALD B BEDELL no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: DONALD B BEDELL no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: TODD BEAIRD no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: LINDI DIANA SCHMITT appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: LINDI DIANA SCHMITT appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE CITY OF LICKING appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: AGH1 LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: AGH1 LLC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: FORVIS MAZARS LLP appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE LICKING EXEMPT TRUST appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: THE LICKING EXEMPT TRUST appears as TRUSTEE OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: ANGIE WARNER appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: ANGIE WARNER appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: DONALD B BEDELL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: TODD BEAIRD appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: TODD BEAIRD appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: MICHAEL GAWLAK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: MICHAEL GAWLAK appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: VAN DE VEN LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: MID STATES INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: FG LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: SOVEREIGN HEALTHCARE GROUP LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: SOVEREIGN HEALTHCARE GROUP LLC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: JONATHAN R BEERS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 1 September 2025: JONATHAN R BEERS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- 28 August 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- 19 September 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 30 April 2026 | 30 April 2026 | 14 | 3 |
| 2 | 23 January 2025 | 23 January 2025 | 10 | 2 |
| 3 | 11 January 2024 | 11 January 2024 | 14 | 2 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
38 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 30 April 2026 | Health | F 0582 | Resident Rights Deficiencies | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0584 | Resident Rights Deficiencies | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0604 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0607 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0637 | Resident Assessment and Care Planning Deficiencies | Assess the resident when there is a significant change in condition | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0641 | Resident Assessment and Care Planning Deficiencies | Ensure each resident receives an accurate assessment. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0657 | Resident Assessment and Care Planning Deficiencies | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0658 | Resident Assessment and Care Planning Deficiencies | Ensure services provided by the nursing facility meet professional standards of quality. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | 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. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0699 | Quality of Life and Care Deficiencies | Provide care or services that was trauma informed and/or culturally competent. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0741 | Quality of Life and Care Deficiencies | Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 30 April 2026 | Health | F 0925 | Environmental Deficiencies | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | D | No | Deficient, Provider has date of correction | 14 June 2026 |
| 28 May 2025 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Yes | Deficient, Provider has date of correction | 16 June 2025 |
| 23 January 2025 | Health | F 0607 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | E | No | Deficient, Provider has date of correction | 9 March 2025 |
| 23 January 2025 | Health | F 0655 | Resident Assessment and Care Planning Deficiencies | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D | No | Deficient, Provider has date of correction | 9 March 2025 |
| 23 January 2025 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | No | Deficient, Provider has date of correction | 9 March 2025 |
| 23 January 2025 | Health | F 0658 | Resident Assessment and Care Planning Deficiencies | Ensure services provided by the nursing facility meet professional standards of quality. | D | No | Deficient, Provider has date of correction | 9 March 2025 |
| 23 January 2025 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | D | No | Deficient, Provider has date of correction | 9 March 2025 |
| 23 January 2025 | Health | F 0755 | Pharmacy Service Deficiencies | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | No | Deficient, Provider has date of correction | 9 March 2025 |
| 23 January 2025 | 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 | 9 March 2025 |
| 23 January 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 9 March 2025 |
| 24 September 2024 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Yes | Deficient, Provider has date of correction | 18 October 2024 |
| 4 June 2024 | Health | F 0658 | Resident Assessment and Care Planning Deficiencies | Ensure services provided by the nursing facility meet professional standards of quality. | D | Yes | Deficient, Provider has date of correction | 19 July 2024 |
| 11 January 2024 | Health | F 0641 | Resident Assessment and Care Planning Deficiencies | Ensure each resident receives an accurate assessment. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 2024 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 2024 | Health | F 0658 | Resident Assessment and Care Planning Deficiencies | Ensure services provided by the nursing facility meet professional standards of quality. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 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 | 25 February 2024 |
| 11 January 2024 | Health | F 0700 | Quality of Life and Care Deficiencies | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 2024 | Health | F 0732 | Nursing and Physician Services Deficiencies | Post nurse staffing information every day. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 2024 | 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 | 25 February 2024 |
| 11 January 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 | 25 February 2024 |
| 11 January 2024 | Health | F 0814 | Nutrition and Dietary Deficiencies | Dispose of garbage and refuse properly. | F | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 2024 | Health | F 0883 | Infection Control Deficiencies | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 2024 | Health | F 0887 | Infection Control Deficiencies | Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 11 January 2024 | Health | F 0947 | Nursing and Physician Services Deficiencies | Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | D | No | Deficient, Provider has date of correction | 25 February 2024 |
| 30 October 2023 | 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 | Yes | Deficient, Provider has date of correction | 30 November 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 | For profit - Individual |
| Legal Business Name | LICKING NO 1 LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 1996-04-03 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | N |
| County/Parish | Texas |
| Telephone Number | 5736742111 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | Resident |
| Automatic Sprinkler Systems in All Required Areas | Data Not Available |
| Number of Certified Beds | 60 |
| Average Number of Residents per Day | 37.1 |
| Overall Rating | 2 |
| Health Inspection Rating | 3 |
| QM Rating | 1 |
| Long-Stay QM Rating | 1 |
| 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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On 1 July 2026: A listing under ADP OF THE SNF no longer appears in the Medicare enrollment ownership file, with no owner named. That is one line of the alert.
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The citable document for HICKORY MANOR
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 Missouri at the same fiscal year, listed by name; every change on the record rather than the recent ones below; the inspection and staffing history in blocks of their own; and a citation block naming every CMS file it was read from.
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