Skilled nursing facility · CMS certification number 365699
COUNTRY CLUB RETIREMENT CTR IV
BELLAIRE, Ohio · Medicare and Medicaid
Certified beds, as filed in Care Compare: 62
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 22 May 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,100,949 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,256,703 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,844,246 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,280,314 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,436,068 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,660,693 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $224,625 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $224,625 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 22,692 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 945 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 11,339 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 7,438 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 19,722 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 43 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 69 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 26 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 138 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 21.98 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 164.33 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 142.91 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1424279, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended 31 December 2023
Cost report for 1 January 2023 to 31 December 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 16 January 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,876,805 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,165,861 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,710,944 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,747,416 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,036,472 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,182,832 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $146,360 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $146,360 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,176 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 215 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 30.81 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 127.98 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 79.89 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1402355, 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 2 February 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,999,814 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,308,789 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,691,025 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,904,862 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,213,837 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,243,169 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $29,332 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $29,332 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,306 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 245 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 26.6 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 95.1 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 70.64 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1372917, read from the public cost report file SNF10FY2022.zip.
Fiscal year 2021, ended 31 December 2021
Cost report for 1 January 2021 to 31 December 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 7 November 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,846,655 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,326,468 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,520,187 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,681,075 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$160,888 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,539,135 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,378,247 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,378,247 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,343 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 209 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 46.66 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 143.75 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 78.2 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1367523, read from the public cost report file SNF10FY2021.zip.
Fiscal year 2020, ended 31 December 2020
Cost report for 1 January 2020 to 31 December 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 29 April 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,714,931 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,190,741 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,524,190 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,041,163 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$516,973 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $926,718 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $409,745 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $409,745 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 18,197 | 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 | 35.94 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 334.12 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 87.91 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1315039, 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 14 April 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,753,482 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,189,582 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,563,900 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,516,999 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $46,901 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $26,183 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $73,084 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $73,084 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 18,169 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 162 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 43.32 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 183.33 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 112.15 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1282177, 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 6 February 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,475,792 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,452,696 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,023,096 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,642,542 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $380,554 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $41,489 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $422,043 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $422,043 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 20,509 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 217 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 45.94 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 260.03 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 94.51 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1250589, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended 31 December 2017
Cost report for 1 January 2017 to 31 December 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 8 November 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,776,453 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,454,761 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,321,692 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,379,262 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$57,570 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $46,084 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$11,486 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$11,486 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 18,005 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 149 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 49.61 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 273 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 120.84 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1213740, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended 31 December 2016
Cost report for 1 January 2016 to 31 December 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 27 July 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,198,391 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,591,667 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,606,724 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,559,971 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $46,753 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $41,514 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $88,267 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $88,267 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 19,363 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 231 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 42.88 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 175.18 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 83.82 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1170882, read from the public cost report file SNF10FY2016.zip.
Fiscal year 2015, ended 31 December 2015
Cost report for 1 January 2015 to 31 December 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 30 March 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,448,972 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,476,323 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,972,649 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,666,009 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $306,640 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $27,606 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $334,246 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $334,246 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,485 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 271 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 46.07 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 88.64 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 64.52 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1155351, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended 31 December 2014
Cost report for 1 January 2014 to 31 December 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 19 May 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,103,197 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,391,110 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,712,087 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,693,187 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $18,900 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $26,889 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $45,789 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $45,789 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,486 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 178 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 40.11 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 212.56 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 98.24 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1124156, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended 31 December 2013
Cost report for 1 January 2013 to 31 December 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 5 November 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,492,246 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,275,740 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,216,506 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,525,268 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $691,238 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $41,270 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $732,508 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $732,508 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,569 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 166 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 52.88 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 205.72 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 105.84 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1112285, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended 31 December 2012
Cost report for 1 January 2012 to 31 December 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 8 November 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,587,261 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,384,818 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,202,443 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,712,152 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $490,291 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $15,773 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $506,064 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $506,064 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 18,911 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 189 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 28.88 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 236.86 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 100.06 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1050483, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended 31 December 2011
Cost report for 1 January 2011 to 31 December 2011 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 24 January 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,131,287 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,680,013 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,451,274 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,127,808 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $323,466 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $36,849 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $360,315 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $360,315 (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 | 62 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 19,976 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 203 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 40.23 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 278.83 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 98.4 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1023280, read from the public cost report file SNF10FY2011.zip.
Fiscal year 2010, ended 31 December 2010
Cost report for 1 January 2010 to 31 December 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 29 May 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,128,551 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,926,330 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $202,221 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $31,083 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $233,304 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 20,238 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 189 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 41.42 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 243.83 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 107.08 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 429519, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended 31 December 2009
Cost report for 1 January 2009 to 31 December 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 30 September 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,987,685 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,039,261 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$51,576 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $21,134 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$30,442 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,183 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 181 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 28.42 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 307.26 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 117.03 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 388265, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended 31 December 2008
Cost report for 1 January 2008 to 31 December 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 12 May 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,013,641 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,730,604 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $283,037 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $23,998 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $307,035 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,525 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 162 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 40.88 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 315.71 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 132.87 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 369498, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended 31 December 2007
Cost report for 1 January 2007 to 31 December 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 24 November 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,759,200 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,647,980 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $111,220 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $19,746 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $130,966 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,665 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 160 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 47.43 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 329.74 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 135.41 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 328717, read from the public cost report file SNFFY2007.zip.
Fiscal year 2006, ended 31 December 2006
Cost report for 1 January 2006 to 31 December 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 27 February 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,580,540 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,707,339 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$126,799 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $7,507 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$119,292 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 16,500 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 154 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 25.94 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 355.96 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 107.14 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 303131, read from the public cost report file SNFFY2006.zip.
Fiscal year 2005, ended 31 December 2005
Cost report for 1 January 2005 to 31 December 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 21 December 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,615,345 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,517,593 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $97,752 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $1,867 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $99,619 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,663 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 107 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 50.62 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 403.65 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 202.46 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 269461, read from the public cost report file SNFFY2005.zip.
Fiscal year 2004, ended 31 December 2004
Cost report for 1 January 2004 to 31 December 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 23 January 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,642,355 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,318,539 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $323,816 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $2,940 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $326,756 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,557 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 142 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 77.92 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 237.14 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 151.81 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 241051, read from the public cost report file SNFFY2004.zip.
Fiscal year 2003, ended 31 December 2003
Cost report for 1 January 2003 to 31 December 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 2 February 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,343,288 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,035,570 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $307,718 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $10,761 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $318,479 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,629 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 193 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 31.81 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 190.5 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 112.07 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 206260, read from the public cost report file SNFFY2003.zip.
Fiscal year 2002, ended 31 December 2002
Cost report for 1 January 2002 to 31 December 2002 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 15 March 2004.
None of these figures is carried on this report.
CMS report record 171021, read from the public cost report file SNFFY2002.zip.
Fiscal year 2001, ended 31 December 2001
Cost report for 1 January 2001 to 31 December 2001 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 7 April 2003.
None of these figures is carried on this report.
CMS report record 138259, read from the public cost report file SNFFY2001.zip.
Fiscal year 2000, ended 31 December 2000
Cost report for 1 January 2000 to 31 December 2000 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 8 January 2002.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,538,115 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,430,134 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $107,981 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $11,003 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $118,984 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 20,990 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 101 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 28.98 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 2,267.4 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 207.82 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 47367, read from the public cost report file SNFFY2000.zip.
Fiscal year 1999, ended 31 December 1999
Cost report for 1 January 1999 to 31 December 1999 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 9 May 2001.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,412,129 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,255,259 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $156,870 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $12,902 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $169,772 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 20,598 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 114 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 36.73 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 312.53 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 180.68 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 47365, read from the public cost report file SNFFY1999.zip.
Fiscal year 1998, ended 31 December 1998
Cost report for 1 January 1998 to 31 December 1998 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 18 January 2000.
Net income, stated at moderate confidence: $156,240 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
CMS report record 47363, read from the public cost report file SNFFY1998.zip.
Fiscal year 1997, ended 31 December 1997
Cost report for 1 January 1997 to 31 December 1997 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 23 February 1999.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,157,524 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,061,798 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $95,726 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $9,035 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $104,761 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,026 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 90 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 26.61 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 946.62 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 233.62 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 47361, read from the public cost report file SNFFY1997.zip.
Fiscal year 1996, ended 31 December 1996
Cost report for 1 January 1996 to 31 December 1996 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 12 August 1998.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,208,453 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,054,564 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $153,889 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,598 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $160,487 (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 | 62 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 21,347 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 149 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 27.95 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,503.44 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 143.27 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 47360, 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 |
|---|---|---|---|---|
| HOLLAND GROUP II, LTD | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 58% | since 01/23/2012 |
| HOLLAND, JOHN | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Individual | 22% | since 01/23/2012 |
| GRESOCK, JOSHUA | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 8% | since 01/01/2006 |
| HOLLAND-GRESOCK, ADAM | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 8% | since 01/01/2006 |
| HOLLAND-GRESOCK, PATRICIA | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 8% | since 01/01/2006 |
| HOLLAND, BENJAMIN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 8% | since 01/01/2006 |
| HOLLAND, NICHOLAS | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 8% | since 01/01/2006 |
| HOLLAND, NOAH | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 8% | since 01/01/2006 |
| MUIRDEN-HOLLAND, JOHN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 8% | since 01/01/2006 |
| GRESOCK, JOSHUA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HARRIS, JANET | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND GROUP II, LTD | ADP OF THE SNF | Organization | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND-GRESCOCK, TERESA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND-GRESOCK, ADAM | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND-GRESOCK, PATRICIA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND, BENJAMIN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND, JOHN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND, NICHOLAS | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HOLLAND, NOAH | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| KUREISHY, ZAVEEN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2008 |
| MARONI, ANTHONY | ADP OF THE SNF | Individual | NOT APPLICABLE | since 06/20/2025 |
| MUIRDEN-HOLLAND, JOHN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2012 |
| HARRIS, JANET | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2008 |
| HARRIS, JANET | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/01/2008 |
| KUREISHY, ZAVEEN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/01/2008 |
| MARONI, ANTHONY | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/01/2008 |
Medicare enrollment
As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of COUNTRY CLUB RETIREMENT CENTER IV, INC (enrollment ID O20120413000525).
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| HOLLAND GROUP II, LTD | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 58 | 1/23/2012 | Private equity company: No Real estate investment trust: No Holding company: No |
| JOHN HOLLAND | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 21.58 | 1/23/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| TERESA HOLLAND-GRESCOCK | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 21.58 | 1/23/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| ADAM HOLLAND-GRESOCK | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 8.12 | 1/1/2006 | 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. |
| BENJAMIN HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 8.12 | 1/1/2006 | 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 MUIRDEN-HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 8.12 | 1/1/2006 | 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. |
| JOSHUA GRESOCK | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 8.12 | 1/1/2006 | 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. |
| NICHOLAS HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 8.12 | 1/1/2006 | 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. |
| NOAH HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 8.12 | 1/1/2006 | 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. |
| PATRICIA HOLLAND-GRESOCK | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 8.12 | 1/1/2006 | 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. |
| ADAM HOLLAND-GRESOCK | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| ANTHONY MARONI | 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. | 6/20/2025 | 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. |
| BENJAMIN HOLLAND | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| HOLLAND GROUP II, LTD | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 1/1/2012 | Private equity company: No Real estate investment trust: No Holding company: No |
| JANET HARRIS | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| JOHN HOLLAND | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| JOHN MUIRDEN-HOLLAND | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| JOSHUA GRESOCK | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| NICHOLAS HOLLAND | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| NOAH HOLLAND | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| PATRICIA HOLLAND-GRESOCK | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| TERESA HOLLAND-GRESCOCK | 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. | 1/1/2012 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
| ZAVEEN A KUREISHY | 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. | 1/1/2008 | 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. |
| JANET HARRIS | Individual | CORPORATE OFFICER | 100 | 1/1/2008 | 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. |
| ANTHONY MARONI | 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. | 1/1/2008 | 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. |
| JANET HARRIS | 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. | 1/1/2008 | 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. |
| ZAVEEN A KUREISHY | 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. | 1/1/2008 | Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
Changes in ownership
- 1 July 2026: JOHN HOLLAND 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: JOHN HOLLAND no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JOHN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JOHN HOLLAND appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 August 2025: JANET HARRIS no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: HOLLAND GROUP II, LTD appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JANET HARRIS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JANET HARRIS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ADAM HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: TERESA HOLLAND-GRESCOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: BENJAMIN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: NICHOLAS HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ZAVEEN A KUREISHY appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ZAVEEN A KUREISHY appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: PATRICIA HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JOHN MUIRDEN-HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JOSHUA GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ANTHONY MARONI appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ANTHONY MARONI appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: NOAH HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JOHN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
Recent changes on this record
- 1 July 2026: JOHN HOLLAND 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: JOHN HOLLAND no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JOHN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: JOHN HOLLAND appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 August 2025: JANET HARRIS no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: HOLLAND GROUP II, LTD appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JANET HARRIS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JANET HARRIS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ADAM HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: TERESA HOLLAND-GRESCOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: BENJAMIN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: NICHOLAS HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ZAVEEN A KUREISHY appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ZAVEEN A KUREISHY appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: PATRICIA HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JOHN MUIRDEN-HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JOSHUA GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ANTHONY MARONI appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: ANTHONY MARONI appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: NOAH HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 1 August 2025: JOHN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- 22 May 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- 16 January 2025: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- 2 February 2024: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- 7 November 2023: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- 29 April 2022: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- 14 April 2021: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- 6 February 2020: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- 8 November 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- 27 July 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- 30 March 2017: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- 19 May 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 5 November 2015: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- 8 November 2013: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- 24 January 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-10. SNF10FY2011.zip
- 29 May 2012: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- 30 September 2010: A cost report was filed for fiscal year 2009, on form CMS-2540-96. SNFFY2009.zip
- 12 May 2010: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2008.zip
- 24 November 2008: A cost report was filed for fiscal year 2007, on form CMS-2540-96. SNFFY2007.zip
- 27 February 2008: A cost report was filed for fiscal year 2006, on form CMS-2540-96. SNFFY2006.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 30 September 2024 | 30 September 2024 | 30 | 3 |
| 2 | 9 November 2022 | 9 November 2022 | 7 | 5 |
| 3 | 18 December 2019 | 18 December 2019 | 8 | 3 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
45 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 17 March 2026 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | G | Yes | Deficient, Provider has date of correction | 3 April 2026 |
| 17 March 2026 | Health | F 0686 | Quality of Life and Care Deficiencies | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Yes | Deficient, Provider has date of correction | 16 April 2026 |
| 17 March 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 | Yes | Deficient, Provider has date of correction | 3 April 2026 |
| 17 March 2026 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | D | Yes | Deficient, Provider has date of correction | 3 April 2026 |
| 17 March 2026 | Health | F 0697 | Quality of Life and Care Deficiencies | Provide safe, appropriate pain management for a resident who requires such services. | G | Yes | Deficient, Provider has date of correction | 3 April 2026 |
| 17 March 2026 | Health | F 0842 | Resident Assessment and Care Planning Deficiencies | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | Yes | Deficient, Provider has date of correction | 16 April 2026 |
| 17 March 2026 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | F | Yes | Deficient, Provider has date of correction | 3 April 2026 |
| 17 March 2026 | Health | F 0881 | Infection Control Deficiencies | Implement a program that monitors antibiotic use. | D | Yes | Deficient, Provider has date of correction | 16 April 2026 |
| 17 March 2026 | Health | F 0882 | Infection Control Deficiencies | Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | F | Yes | Deficient, Provider has date of correction | 16 April 2026 |
| 17 March 2026 | Health | F 0919 | Environmental Deficiencies | Make sure that a working call system is available in each resident's bathroom and bathing area. | F | Yes | Deficient, Provider has date of correction | 3 April 2026 |
| 26 January 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 | Yes | Deficient, Provider has date of correction | 17 February 2026 |
| 25 November 2025 | Health | F 0609 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Yes | Deficient, Provider has date of correction | 18 December 2025 |
| 25 November 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. | E | Yes | Deficient, Provider has date of correction | 18 December 2025 |
| 25 November 2025 | Health | F 0725 | Nursing and Physician Services Deficiencies | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | E | Yes | Deficient, Provider has date of correction | 18 December 2025 |
| 25 November 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. | F | Yes | Deficient, Provider has date of correction | 18 December 2025 |
| 25 November 2025 | Health | F 0842 | Resident Assessment and Care Planning Deficiencies | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | E | Yes | Deficient, Provider has date of correction | 18 December 2025 |
| 25 November 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | Yes | Deficient, Provider has date of correction | 18 December 2025 |
| 27 August 2025 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | G | Yes | Deficient, Provider has date of correction | 12 September 2025 |
| 12 March 2025 | 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 | 21 March 2025 |
| 12 March 2025 | Health | F 0695 | Quality of Life and Care Deficiencies | Provide safe and appropriate respiratory care for a resident when needed. | D | Yes | Deficient, Provider has date of correction | 21 March 2025 |
| 30 September 2024 | Health | F 0580 | Resident Rights Deficiencies | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Yes | Deficient, Provider has date of correction | 9 October 2024 |
| 30 September 2024 | 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 | 9 October 2024 |
| 30 September 2024 | Health | F 0644 | Resident Assessment and Care Planning Deficiencies | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | D | No | Deficient, Provider has date of correction | 9 October 2024 |
| 30 September 2024 | 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 | 9 October 2024 |
| 30 September 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 | 9 October 2024 |
| 30 September 2024 | Health | F 0688 | Quality of Life and Care Deficiencies | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | D | No | Deficient, Provider has date of correction | 9 October 2024 |
| 30 September 2024 | Health | F 0695 | Quality of Life and Care Deficiencies | Provide safe and appropriate respiratory care for a resident when needed. | D | No | Deficient, Provider has date of correction | 9 October 2024 |
| 30 September 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 | 9 October 2024 |
| 30 September 2024 | Health | F 0757 | Pharmacy Service Deficiencies | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | No | Deficient, Provider has date of correction | 9 October 2024 |
| 30 September 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 | 9 October 2024 |
| 30 September 2024 | Health | F 0790 | Quality of Life and Care Deficiencies | Provide routine and 24-hour emergency dental care for each resident. | D | No | Deficient, Provider has date of correction | 9 October 2024 |
| 30 September 2024 | Health | F 0881 | Infection Control Deficiencies | Implement a program that monitors antibiotic use. | D | No | Deficient, Provider has date of correction | 9 October 2024 |
| 9 November 2022 | 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 | 29 November 2022 |
| 9 November 2022 | 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 | No | Deficient, Provider has date of correction | 29 November 2022 |
| 9 November 2022 | 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 | 29 November 2022 |
| 9 November 2022 | 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 | No | Deficient, Provider has date of correction | 29 November 2022 |
| 9 November 2022 | Health | F 0725 | Nursing and Physician Services Deficiencies | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | F | No | Deficient, Provider has date of correction | 29 November 2022 |
| 18 December 2019 | Health | F 0609 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | No | Deficient, Provider has date of correction | 1 February 2020 |
| 18 December 2019 | Health | F 0676 | Quality of Life and Care Deficiencies | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | D | No | Deficient, Provider has date of correction | 1 February 2020 |
| 18 December 2019 | 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 | 1 February 2020 |
| 18 December 2019 | Health | F 0688 | Quality of Life and Care Deficiencies | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | D | No | Deficient, Provider has date of correction | 1 February 2020 |
| 18 December 2019 | 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. | J | No | Deficient, Provider has date of correction | 1 February 2020 |
| 18 December 2019 | Health | F 0791 | Quality of Life and Care Deficiencies | Provide or obtain dental services for each resident. | D | No | Deficient, Provider has date of correction | 1 February 2020 |
| 18 December 2019 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 1 February 2020 |
| 18 December 2019 | Health | F 0881 | Infection Control Deficiencies | Implement a program that monitors antibiotic use. | F | No | Deficient, Provider has date of correction | 1 February 2020 |
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 | COUNTRY CLUB RETIREMENT CENTER IV, INC |
| Date First Approved to Provide Medicare and Medicaid Services | 1987-06-23 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | Y |
| Urban | Y |
| County/Parish | Belmont |
| Telephone Number | 7406762300 |
| Chain Name | COUNTRY CLUB REHABILITATION CAMPUS |
| Chain ID | 164 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | None |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Number of Certified Beds | 62 |
| Average Number of Residents per Day | 42.6 |
| Overall Rating | 1 |
| Health Inspection Rating | 1 |
| QM Rating | 4 |
| Long-Stay QM Rating | 5 |
| Short-Stay QM Rating | 4 |
| Processing Date | 2026-08-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.
Get an email when this record changes
One email a day naming what moved on COUNTRY CLUB RETIREMENT CTR IV: the field, the value before, the value after, and the date of the file that first showed it.
The facility alert follows this one record: a cost report filed or a figure on one changed, an inspection, a deficiency or a penalty recorded, an owner added or removed. The certification number arrives filled in.
On 1 July 2026: JOHN HOLLAND no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. That is one line of the alert.
What the alerts are, and what a day of them looks like, is on the alerts page.
Following a list of facilities? The portfolio watch follows up to 100 certification numbers you name, on one subscription — on the alerts page.
The citable document for COUNTRY CLUB RETIREMENT CTR IV
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 Ohio 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 365699.