Skilled nursing facility · CMS certification number 345314
Fair Haven of Forest City, LLC
Forest City, North Carolina · Medicare and Medicaid
Certified beds, as filed in Care Compare: 100
Finances, as filed
From this facility’s Medicare cost reports on form CMS-2540, each figure with the worksheet, line and column it was read from.
Cost report for 1 October 2023 to 30 September 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 6 March 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $14,934,317 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,653,008 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,281,309 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,187,491 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $93,818 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $164,667 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $258,485 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $258,485 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 46,848 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 2,315 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 21,055 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 15,347 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 38,717 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 101 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 36 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 147 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 284 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 22.92 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 584.86 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 136.33 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1404783, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended 30 September 2023
Cost report for 1 October 2022 to 30 September 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 13 March 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $14,363,129 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,052,317 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,310,812 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $10,731,572 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $579,240 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,789,726 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $2,368,966 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $2,368,966 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 38,475 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 220 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 29.57 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 580.55 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 174.89 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1374882, read from the public cost report file SNF10FY2023.zip.
Fiscal year 2022, ended 30 September 2022
Cost report for 1 October 2021 to 30 September 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 16 February 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,617,200 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,926,898 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,690,302 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,680,996 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $9,306 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $40,322 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $49,628 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $49,628 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 34,708 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 207 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 22.52 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 626.06 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 167.67 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1342574, read from the public cost report file SNF10FY2022.zip.
Fiscal year 2021, ended 30 September 2021
Cost report for 1 October 2020 to 30 September 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 24 May 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $10,572,370 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$428,145 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,000,515 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,411,259 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $1,589,256 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $187,533 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,776,789 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,776,789 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 33,703 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 105 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 53.04 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,045.45 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 320.98 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1348249, read from the public cost report file SNF10FY2021.zip.
Fiscal year 2020, ended 30 September 2020
Cost report for 1 October 2019 to 30 September 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 4 August 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,166,795 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,849,411 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $9,317,384 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,134,816 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $182,568 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $671,182 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $853,750 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $853,750 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 39,924 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 175 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 56.42 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 526.51 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 228.14 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1328918, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended 30 September 2019
Cost report for 1 October 2018 to 30 September 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 25 June 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $12,123,075 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,215,884 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $8,907,191 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,476,378 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $430,813 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $6,347 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $437,160 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $437,160 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 40,884 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 241 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 43.16 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 391.68 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 169.64 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1287626, read from the public cost report file SNF10FY2019.zip.
Fiscal year 2018, ended 30 September 2018
Cost report for 1 October 2017 to 30 September 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 30 July 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $10,692,853 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,415,751 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $8,277,102 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,360,921 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$83,819 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $7,312 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$76,507 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$76,507 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 39,482 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 246 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 41.33 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 460.12 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 160.5 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1262041, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended 30 September 2017
Cost report for 1 October 2016 to 30 September 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 27 June 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $10,210,922 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,013,098 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $8,197,824 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,725,252 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $472,572 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $7,630 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $480,202 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $480,202 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 40,363 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 241 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 44.13 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 382.89 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 167.48 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1233473, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended 30 September 2016
Cost report for 1 December 2015 to 30 September 2016 — a reporting period of 304 days, on form CMS-2540-10, reopened, processed by CMS on 16 January 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,897,029 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,878,052 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,018,977 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,051,596 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$32,619 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $6,289 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$26,330 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$26,330 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 32,658 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 194 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 42.17 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 339.25 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 168.34 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1249483, read from the public cost report file SNF10FY2016.zip.
Fiscal year 2015, ended 30 November 2015
Cost report for 1 July 2015 to 30 November 2015 — a reporting period of 152 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 2 May 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $10,317,083 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $7,188,949 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,128,134 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,189,507 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$61,373 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $697 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$60,676 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$60,676 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,348 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 79 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 35.02 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 879.92 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 206.94 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1188065, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended 30 April 2014
Cost report for 1 October 2013 to 30 April 2014 — a reporting period of 211 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 25 August 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,954,986 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,088,974 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,866,012 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,340,227 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$474,215 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $71,233 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$402,982 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$402,982 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 22,841 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 303 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 38.05 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 88.7 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 75.38 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1108736, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended 30 September 2013
Cost report for 1 October 2012 to 30 September 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 14 October 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,185,480 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,122,144 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,063,336 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,609,798 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$546,462 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $192,334 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$354,128 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$354,128 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 41,510 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 378 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 36.96 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 145.31 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 109.81 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1078735, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended 30 September 2012
Cost report for 1 October 2011 to 30 September 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 25 July 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,959,023 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,870,305 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,088,718 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,715,757 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$627,039 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $215,622 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$411,417 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$411,417 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 41,478 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 376 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 33.86 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 151.46 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 110.31 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1043739, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended 30 September 2011
Cost report for 1 October 2010 to 30 September 2011 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 28 March 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $7,205,745 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,543,812 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$338,067 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $197,032 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$141,035 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 40,989 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 355 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 39.8 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 157.35 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 115.46 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 434378, read from the public cost report file SNFFY2011.zip.
Fiscal year 2010, ended 30 September 2010
Cost report for 1 October 2009 to 30 September 2010 — a reporting period of 364 days, on form CMS-2540-96, settled with audit, processed by CMS on 10 November 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $7,177,389 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,415,292 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$237,903 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $194,635 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$43,268 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,012 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 250 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 39.38 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 282.32 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 168.05 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 420150, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended 30 September 2009
Cost report for 1 October 2008 to 30 September 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 15 March 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,852,418 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,187,267 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$334,849 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $174,100 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$160,749 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 40,609 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 68.17 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 284.92 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 232.05 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 395482, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended 30 September 2008
Cost report for 1 October 2007 to 30 September 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 27 August 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,810,462 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,891,290 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$80,828 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $201,652 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $120,824 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,376 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 68.85 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 295.92 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 242.15 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 386461, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended 30 September 2007
Cost report for 1 October 2006 to 30 September 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 15 October 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,394,104 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,649,486 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$255,382 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $201,263 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$54,119 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,263 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 80.45 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 295.48 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 241.5 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 326606, read from the public cost report file SNFFY2007.zip.
Fiscal year 2006, ended 30 September 2006
Cost report for 1 October 2005 to 30 September 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 12 June 2007.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,299,739 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,545,057 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$245,318 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $185,113 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$60,205 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 41,872 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 90.44 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 285.11 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 239.27 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 282857, read from the public cost report file SNFFY2006.zip.
Fiscal year 2005, ended 30 September 2005
Cost report for 1 October 2004 to 30 September 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 8 November 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,984,385 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,360,755 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$376,370 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $154,672 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$221,698 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 40,261 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 82.33 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 278.67 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 230.06 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 265889, read from the public cost report file SNFFY2005.zip.
Fiscal year 2004, ended 30 September 2004
Cost report for 1 October 2003 to 30 September 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 1 February 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,284,525 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,518,753 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$234,228 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $177,521 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$56,707 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 42,624 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 91.7 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 270.35 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 243.57 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 242051, read from the public cost report file SNFFY2004.zip.
Fiscal year 2003, ended 30 September 2003
Cost report for 1 October 2002 to 30 September 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 25 April 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,839,907 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,897,720 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$57,813 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $150,732 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $92,919 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 41,441 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 76.27 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 273.03 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 236.81 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 214979, read from the public cost report file SNFFY2003.zip.
Fiscal year 2002, ended 30 September 2002
Cost report for 1 October 2001 to 30 September 2002 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 1 September 2004.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,512,645 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,638,804 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$126,159 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $133,792 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $7,633 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 40,081 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 65.82 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 286.19 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 229.03 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 192755, read from the public cost report file SNFFY2002.zip.
Fiscal year 2001, ended 30 September 2001
Cost report for 1 October 2000 to 30 September 2001 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 13 February 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,952,946 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,190,560 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$237,614 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $95,827 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$141,787 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 41,514 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 175 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 45.06 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 332.35 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 237.22 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 130160, read from the public cost report file SNFFY2001.zip.
Fiscal year 2000, ended 30 September 2000
Cost report for 1 October 1999 to 30 September 2000 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 12 February 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,372,482 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,686,981 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$314,499 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $104,098 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$210,401 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 40,337 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 116 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 55.41 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 473.34 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 347.73 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 123942, read from the public cost report file SNFFY2000.zip.
Fiscal year 1999, ended 30 September 1999
Cost report for 1 May 1999 to 30 September 1999 — a reporting period of 152 days, not a full year, on form CMS-2540-96, settled, processed by CMS on 13 February 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,547,298 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,746,868 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$199,570 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $39,702 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$159,868 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 16,113 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 123 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 19.75 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 196.82 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 131 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 129639, read from the public cost report file SNFFY1999.zip.
Fiscal year 1998, ended 30 September 1998
Cost report for 1 October 1997 to 30 September 1998 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 7 September 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,855,269 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,013,731 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$158,462 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $11,355 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$147,107 (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 | 88 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 30,278 | 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 | 51 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 321.16 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 322.11 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 40794, read from the public cost report file SNFFY1998.zip.
Fiscal year 1997, ended 30 September 1997
Cost report for 1 October 1996 to 30 September 1997 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 1 February 1999.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,619,788 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,792,750 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$172,962 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $14,357 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$158,605 (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 | 88 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 30,973 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 87 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 119.43 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 321.86 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 356.01 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 40792, read from the public cost report file SNFFY1997.zip.
Fiscal year 1996, ended 30 September 1996
Cost report for 1 October 1995 to 30 September 1996 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 31 July 1998.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,610,711 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,610,081 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $630 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $9,817 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $10,447 (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 | 88 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 30,707 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 75 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 91.25 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 530.06 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 409.43 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 40790, read from the public cost report file SNFFY1996.zip.
Nurse staffing
Nurse staffing hours from the Payroll-Based Journal, quarter by quarter, are on this facility’s staffing page, each quarter with the file it came from.
Ownership, as filed with CMS
Care Compare
As filed in the CMS file dated 1 August 2026 (Care Compare ownership).
| Owner or manager | Role | Type | Ownership percentage | Association |
|---|---|---|---|---|
| CILONE, JOHN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, CHARLES | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, DANIEL | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, EMMETT | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2015 |
| CILONE, JOHN | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, CHARLES | DIRECT OWNERSHIP INTEREST | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, DANIEL | DIRECT OWNERSHIP INTEREST | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, EMMETT | DIRECT OWNERSHIP INTEREST | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, CHARLES | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, DANIEL | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2015 |
| MCKEITHAN, EMMETT | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2015 |
Medicare enrollment
As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of FAIR HAVEN OF FOREST CITY LLC (enrollment ID O20151211000502).
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| CHARLES MCKEITHAN | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2015 | 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. |
| DANIEL MCKEITHAN | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2015 | 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. |
| EMMETT MCKEITHAN | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2015 | 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. |
| CHARLES MCKEITHAN | 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. | 12/1/2015 | 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. |
| DANIEL MCKEITHAN | 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. | 12/1/2015 | 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. |
| EMMETT MCKEITHAN | 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. | 12/1/2015 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| JOHN CILONE | 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. | 12/1/2015 | 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. | 2/11/2025 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| 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. | 8/4/2016 | 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. | 10/1/2022 | 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. |
| JOHN CILONE | Individual | CORPORATE OFFICER | 0 | 12/1/2015 | 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. |
| CHARLES MCKEITHAN | Individual | DIRECT OWNERSHIP INTEREST | 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. | 12/1/2015 | 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. |
| DANIEL MCKEITHAN | Individual | DIRECT OWNERSHIP INTEREST | 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. | 12/1/2015 | 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. |
| EMMETT MCKEITHAN | Individual | DIRECT OWNERSHIP INTEREST | 33.34 | 12/1/2015 | 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. |
| CHARLES MCKEITHAN | 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. | 12/1/2015 | 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. |
| DANIEL MCKEITHAN | 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. | 12/1/2015 | 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. |
| EMMETT MCKEITHAN | 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. | 12/1/2015 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
Changes in ownership
- 1 April 2026: SUZANNE HENSLEY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SUZANNE HENSLEY no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: EMMETT MCKEITHAN appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: EMMETT MCKEITHAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: DANIEL MCKEITHAN appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: DANIEL MCKEITHAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CHARLES MCKEITHAN appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CHARLES MCKEITHAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 2 October 2023: FAIR HAVEN OF FOREST CITY LLC no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-10-02.csv
- 2 October 2023: FAIR HAVEN OF FOREST CITY LLC no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-10-02.csv
Recent changes on this record
- 1 April 2026: SUZANNE HENSLEY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SUZANNE HENSLEY no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: EMMETT MCKEITHAN appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: EMMETT MCKEITHAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: DANIEL MCKEITHAN appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: DANIEL MCKEITHAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CHARLES MCKEITHAN appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CHARLES MCKEITHAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: JOHN CILONE appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 6 March 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- 13 March 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- 2 October 2023: FAIR HAVEN OF FOREST CITY LLC no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-10-02.csv
- 2 October 2023: FAIR HAVEN OF FOREST CITY LLC no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-10-02.csv
- 24 May 2023: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- 16 February 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- 4 August 2022: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- 25 June 2021: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- 30 July 2020: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- 16 January 2020: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- 27 June 2019: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- 2 May 2018: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- 24 May 2017: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2014.zip
- 25 August 2015: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 7 May 2015: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 14 October 2014: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- 25 July 2013: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- 28 March 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-96. SNFFY2011.zip
- 10 November 2011: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- 15 March 2011: A cost report was filed for fiscal year 2009, on form CMS-2540-96. SNFFY2009.zip
- 27 August 2010: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2008.zip
- 15 October 2008: A cost report was filed for fiscal year 2007, on form CMS-2540-96. SNFFY2007.zip
- 12 June 2007: A cost report was filed for fiscal year 2006, on form CMS-2540-96. SNFFY2006.zip
- 8 November 2006: A cost report was filed for fiscal year 2005, on form CMS-2540-96. SNFFY2005.zip
- 1 February 2006: A cost report was filed for fiscal year 2004, on form CMS-2540-96. SNFFY2004.zip
- 25 April 2005: A cost report was filed for fiscal year 2003, on form CMS-2540-96. SNFFY2003.zip
- 1 September 2004: A cost report was filed for fiscal year 2002, on form CMS-2540-96. SNFFY2002.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 2 April 2026 | 13 February 2025 | 3 | 2 |
| 2 | 13 February 2025 | 16 November 2023 | 1 | 3 |
| 3 | 16 November 2023 | 9 June 2022 | 2 | 4 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
6 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 2 April 2026 | Health | F 0552 | Resident Rights Deficiencies | Ensure that residents are fully informed and understand their health status, care and treatments. | D | No | Deficient, Provider has date of correction | 25 April 2026 |
| 2 April 2026 | Health | F 0645 | Resident Assessment and Care Planning Deficiencies | PASARR screening for Mental disorders or Intellectual Disabilities | D | No | Deficient, Provider has date of correction | 25 April 2026 |
| 2 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 | 25 April 2026 |
| 13 February 2025 | 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 | 1 March 2025 |
| 16 November 2023 | Health | F 0690 | Quality of Life and Care Deficiencies | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | Yes | Deficient, Provider has date of correction | 11 December 2023 |
| 16 November 2023 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Yes | Deficient, Provider has date of correction | 11 December 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 - Limited Liability company |
| Legal Business Name | FAIR HAVEN OF FOREST CITY LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 1990-04-06 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | N |
| County/Parish | Rutherford |
| Telephone Number | 8282452852 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | Resident |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Number of Certified Beds | 100 |
| Average Number of Residents per Day | 84.5 |
| Overall Rating | 4 |
| Health Inspection Rating | 4 |
| QM Rating | 2 |
| Long-Stay QM Rating | 2 |
| Short-Stay QM Rating | 2 |
| 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 April 2026: SUZANNE HENSLEY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. That is one line of the alert.
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The citable document for Fair Haven of Forest City, LLC
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 North Carolina at the same fiscal year, listed by name; every change on the record rather than the recent ones below; the inspection and staffing history in blocks of their own; and a citation block naming every CMS file it was read from.
Every figure on this page is printed as it appears in the CMS file named beside it. A figure that does not match its file? Tell us on the corrections page, quoting certification number 345314.