Skilled nursing facility · CMS certification number 366026

COUNTRY CLUB CENTER V, INC

DELAWARE, Ohio · Medicare and Medicaid

Certified beds, as filed in Care Compare: 50

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 12 December 2025.

Revenue and expenses, fiscal year 2024
Figure	As filed	Where it comes from
Total patient revenue	$9,913,894	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$1,931,778	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$7,982,116	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$6,188,342	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$1,793,774	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$46,380	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$1,840,154	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $1,840,154 (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%).

Beds, days and discharges, fiscal year 2024
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Bed days available, all components	18,300	CMS-2540-10 worksheet S300001 line 800 column 200
Medicare (Title XVIII) patient days	1,606	CMS-2540-10 worksheet S300001 line 800 column 400
Medicaid (Title XIX) patient days	11,007	CMS-2540-10 worksheet S300001 line 800 column 500
Other-payer patient days	4,580	CMS-2540-10 worksheet S300001 line 800 column 600
Total patient days, all components	17,193	CMS-2540-10 worksheet S300001 line 800 column 700
Medicare discharges	32	CMS-2540-10 worksheet S300001 line 800 column 900
Medicaid discharges	73	CMS-2540-10 worksheet S300001 line 800 column 1000
Other-payer discharges	13	CMS-2540-10 worksheet S300001 line 800 column 1100
Total discharges, all components	118	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	50.19	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	150.78	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	145.7	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1444460, 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.

Revenue and expenses, fiscal year 2023
Figure	As filed	Where it comes from
Total patient revenue	$6,936,048	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$1,860,206	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$5,075,842	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$4,945,150	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$130,692	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$269,660	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$400,352	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $400,352 (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%).

Beds, days and discharges, fiscal year 2023
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	16,062	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	191	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	32.49	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	135.16	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	84.09	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1402357, 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 12 May 2023.

Revenue and expenses, fiscal year 2022
Figure	As filed	Where it comes from
Total patient revenue	$7,034,012	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$2,257,750	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$4,776,262	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$4,902,778	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$126,516	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$716,673	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$590,157	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $590,157 (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%).

Beds, days and discharges, fiscal year 2022
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	16,292	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	188	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	34.47	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	90.85	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	86.66	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1347202, 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 22 July 2022.

Revenue and expenses, fiscal year 2021
Figure	As filed	Where it comes from
Total patient revenue	$5,408,513	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$757,032	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$4,651,481	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$4,472,703	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$178,778	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$726,631	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$905,409	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $905,409 (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%).

Beds, days and discharges, fiscal year 2021
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	16,397	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	273	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	48.8	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	94.42	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	60.06	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1327276, 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 15 July 2021.

Revenue and expenses, fiscal year 2020
Figure	As filed	Where it comes from
Total patient revenue	$4,642,434	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$654,157	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,988,277	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$4,237,712	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$249,435	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$770,249	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$520,814	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $520,814 (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%).

Beds, days and discharges, fiscal year 2020
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	16,202	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	161	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	46.25	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	76.97	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	100.63	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1288113, 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.

Revenue and expenses, fiscal year 2019
Figure	As filed	Where it comes from
Total patient revenue	$5,119,383	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$1,178,392	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,940,991	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$4,134,577	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$193,586	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$176,998	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	−$16,588	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$16,588 (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%).

Beds, days and discharges, fiscal year 2019
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	16,326	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	211	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	41.4	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	136.12	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	77.37	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1281940, 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 20 June 2019.

Revenue and expenses, fiscal year 2018
Figure	As filed	Where it comes from
Total patient revenue	$4,425,969	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$623,303	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,802,666	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,964,152	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$161,486	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$285,152	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$123,666	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $123,666 (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%).

Beds, days and discharges, fiscal year 2018
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	15,789	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	163	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	47.85	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	148.3	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	96.87	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1230806, 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 27 September 2018.

Revenue and expenses, fiscal year 2017
Figure	As filed	Where it comes from
Total patient revenue	$4,265,282	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$546,216	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,719,066	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,676,715	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$42,351	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$308,387	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$350,738	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $350,738 (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%).

Beds, days and discharges, fiscal year 2017
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	15,610	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	219	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	37.89	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	107.9	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	71.28	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1212374, 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 17 August 2017.

Revenue and expenses, fiscal year 2016
Figure	As filed	Where it comes from
Total patient revenue	$4,493,901	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$584,269	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,909,632	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,647,939	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$261,693	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$142,038	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$403,731	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $403,731 (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%).

Beds, days and discharges, fiscal year 2016
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	15,008	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	250	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	34.96	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	106.65	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	60.03	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1173554, 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.

Revenue and expenses, fiscal year 2015
Figure	As filed	Where it comes from
Total patient revenue	$3,393,430	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$588,120	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$2,805,310	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,887,342	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$82,032	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$122,219	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$40,187	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $40,187 (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%).

Beds, days and discharges, fiscal year 2015
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,984	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	123	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	34.39	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	221.37	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	105.56	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1155355, 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 5 May 2016.

Revenue and expenses, fiscal year 2014
Figure	As filed	Where it comes from
Total patient revenue	$3,179,603	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$502,382	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$2,677,221	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,454,095	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$223,126	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$50,938	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$274,064	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $274,064 (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%).

Beds, days and discharges, fiscal year 2014
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	11,977	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	66	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	42.48	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	288.1	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	181.47	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1123361, read from the public cost report file SNF10FY2014.zip.

Fiscal year 2013, ended 10 October 2013

Cost report for 1 January 2013 to 10 October 2013 — a reporting period of 282 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 20 February 2015.

Revenue and expenses, fiscal year 2013
Figure	As filed	Where it comes from
Total patient revenue	$2,222,027	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$331,441	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$1,890,586	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,215,521	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$324,935	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$835,074	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$510,139	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $510,139 (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%).

Beds, days and discharges, fiscal year 2013
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	10,157	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	85	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	32.6	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	327.91	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	119.49	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1086122, 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.

Revenue and expenses, fiscal year 2012
Figure	As filed	Where it comes from
Total patient revenue	$3,302,096	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$265,866	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,036,230	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,153,913	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$117,683	CMS-2540-10 worksheet G300000 line 500 column 100
Net income after other income	−$117,683	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$117,683 (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%).

Beds, days and discharges, fiscal year 2012
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	15,788	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	71	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	34.42	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	687.5	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	222.37	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1050485, 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 14 March 2013.

Revenue and expenses, fiscal year 2011
Figure	As filed	Where it comes from
Total patient revenue	$3,405,435	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$244,326	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,161,109	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,162,284	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$1,175	CMS-2540-10 worksheet G300000 line 500 column 100
Net income after other income	−$1,175	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$1,175 (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%).

Beds, days and discharges, fiscal year 2011
Figure	As filed	Where it comes from
Total facility beds, all components	50	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	15,194	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	90	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	23.04	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	423.24	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	168.82	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1025828, 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 18 January 2012.

Revenue and expenses, fiscal year 2010
Figure	As filed	Where it comes from
Net patient revenue	$3,191,729	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$3,169,159	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	$22,570	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$1	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $22,571 (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.

Beds, days and discharges, fiscal year 2010
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	15,492	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	57	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	30.73	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, Medicaid, in days	781.87	CMS-2540-96 worksheet S300001 line 900 column 1500
Average length of stay, all patients, in days	271.79	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 423107, 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 20 April 2011.

Revenue and expenses, fiscal year 2009
Figure	As filed	Where it comes from
Net patient revenue	$3,056,398	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$3,198,574	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$142,176	CMS-2540-96 worksheet G300000 line 500 column 100

Net income, stated at moderate confidence: −$142,176 (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.

Beds, days and discharges, fiscal year 2009
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	15,487	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	42	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	31	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, Medicaid, in days	1,135.73	CMS-2540-96 worksheet S300001 line 900 column 1500
Average length of stay, all patients, in days	368.74	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 397237, 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 3 June 2010.

Revenue and expenses, fiscal year 2008
Figure	As filed	Where it comes from
Net patient revenue	$3,047,058	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$3,107,589	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$60,531	CMS-2540-96 worksheet G300000 line 500 column 100

Net income, stated at moderate confidence: −$60,531 (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.

Beds, days and discharges, fiscal year 2008
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	16,983	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	38	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	24.5	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, Medicaid, in days	2,274.67	CMS-2540-96 worksheet S300001 line 900 column 1500
Average length of stay, all patients, in days	446.92	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 372181, 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 28 July 2008.

None of these figures is carried on this report.

CMS report record 321848, 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 24 January 2008.

None of these figures is carried on this report.

CMS report record 300797, 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 12 March 2007.

None of these figures is carried on this report.

CMS report record 274514, 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 19 December 2005.

None of these figures is carried on this report.

CMS report record 239560, 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 18 April 2005.

Revenue and expenses, fiscal year 2003
Figure	As filed	Where it comes from
Net patient revenue	$2,643,464	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$2,792,067	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$148,603	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$33	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: −$148,570 (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.

Beds, days and discharges, fiscal year 2003
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	15,144	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	70	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	38.66	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, Medicaid, in days	910.36	CMS-2540-96 worksheet S300001 line 900 column 1500
Average length of stay, all patients, in days	216.34	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 214447, 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 12 May 2004.

None of these figures is carried on this report.

CMS report record 176129, 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 13 February 2003.

None of these figures is carried on this report.

CMS report record 131189, 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 22 October 2001.

Net income, stated at moderate confidence: $130,053 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.

CMS report record 49441, 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 10 January 2001.

Net income, stated at moderate confidence: $294,070 (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 49439, 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 3 October 2000.

Revenue and expenses, fiscal year 1998
Figure	As filed	Where it comes from
Net patient revenue	$1,860,337	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,894,757	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$34,420	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$44,981	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: $10,561 (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.

Beds, days and discharges, fiscal year 1998
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	17,081	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	36	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	60.14	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, Medicaid, in days	1,288.22	CMS-2540-96 worksheet S300001 line 900 column 1500
Average length of stay, all patients, in days	474.47	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 49437, 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 30 November 1998.

Revenue and expenses, fiscal year 1997
Figure	As filed	Where it comes from
Net patient revenue	$1,702,735	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,839,669	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$136,934	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$6,687	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: −$130,247 (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.

Beds, days and discharges, fiscal year 1997
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	16,882	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	62	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	43.21	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, Medicaid, in days	603.59	CMS-2540-96 worksheet S300001 line 900 column 1500
Average length of stay, all patients, in days	272.29	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 49435, 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 9 March 1998.

Revenue and expenses, fiscal year 1996
Figure	As filed	Where it comes from
Net patient revenue	$1,587,729	CMS-2540-96 worksheet G300000 line 300 column 100
Total operating expenses	$1,670,240	CMS-2540-96 worksheet G200002 line 1500 column 200
Net income from service to patients	−$82,511	CMS-2540-96 worksheet G300000 line 500 column 100
Total other income	$6,651	CMS-2540-96 worksheet G300000 line 2600 column 100

Net income, stated at moderate confidence: −$75,860 (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.

Beds, days and discharges, fiscal year 1996
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	17,665	CMS-2540-96 worksheet S300001 line 900 column 700
Total discharges, all components	32	CMS-2540-96 worksheet S300001 line 900 column 1200
Average length of stay, Medicare, in days	19.32	CMS-2540-96 worksheet S300001 line 900 column 1400
Average length of stay, Medicaid, in days	1,393.33	CMS-2540-96 worksheet S300001 line 900 column 1500
Average length of stay, all patients, in days	552.03	CMS-2540-96 worksheet S300001 line 900 column 1600

CMS report record 49433, 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.

The staffing record →

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
HARRIS, JANET	5% OR GREATER DIRECT OWNERSHIP INTEREST	Individual	30%	since 10/01/2013
HOLLAND GROUP II, LTD	5% OR GREATER DIRECT OWNERSHIP INTEREST	Organization	70%	since 10/01/2013
GRESOCK, JOSHUA	5% OR GREATER INDIRECT OWNERSHIP INTEREST	Individual	10%	since 08/01/2013
HOLLAND-GRESOCK, ADAM	5% OR GREATER INDIRECT OWNERSHIP INTEREST	Individual	10%	since 08/01/2013
HOLLAND-GRESOCK, PATRICIA	5% OR GREATER INDIRECT OWNERSHIP INTEREST	Individual	10%	since 08/01/2013
HOLLAND, BENJAMIN	5% OR GREATER INDIRECT OWNERSHIP INTEREST	Individual	10%	since 08/01/2013
HOLLAND, NICHOLAS	5% OR GREATER INDIRECT OWNERSHIP INTEREST	Individual	10%	since 08/01/2013
HOLLAND, NOAH	5% OR GREATER INDIRECT OWNERSHIP INTEREST	Individual	10%	since 08/01/2013
MUIRDEN-HOLLAND, JOHN	5% OR GREATER INDIRECT OWNERSHIP INTEREST	Individual	10%	since 08/01/2013
GRESOCK, JOSHUA	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
HARRIS, JANET	ADP OF THE SNF	Individual	NOT APPLICABLE	since 11/18/2024
HOLLAND GROUP II, LTD	ADP OF THE SNF	Organization	NOT APPLICABLE	since 12/31/2023
HOLLAND-GRESCOCK, TERESA	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
HOLLAND-GRESOCK, ADAM	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
HOLLAND-GRESOCK, PATRICIA	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
HOLLAND, BENJAMIN	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
HOLLAND, JOHN	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
HOLLAND, NICHOLAS	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
HOLLAND, NOAH	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
MUIRDEN-HOLLAND, JOHN	ADP OF THE SNF	Individual	NOT APPLICABLE	since 08/01/2013
OLSON, LYLE	ADP OF THE SNF	Individual	NOT APPLICABLE	since 01/01/2024
ORTMAN, DIANNA	ADP OF THE SNF	Individual	NOT APPLICABLE	since 01/01/2018
HARRIS, JANET	CORPORATE DIRECTOR	Individual	NOT APPLICABLE	since 12/31/2013
HARRIS, JANET	CORPORATE OFFICER	Individual	NOT APPLICABLE	since 12/31/2013
HARRIS, JANET	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 11/07/2024
OLSON, LYLE	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 01/01/2024
ORTMAN, DIANNA	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 01/01/2018

Medicare enrollment

As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of COUNTRY CLUB RETIREMENT CENTER V LLC (enrollment ID O20140110000946).

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	70	10/1/2013	Private equity company: No Real estate investment trust: No Holding company: No
JANET HARRIS	Individual	5% OR GREATER DIRECT OWNERSHIP INTEREST	30	10/1/2013	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	9.8	8/1/2013	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	9.8	8/1/2013	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	9.8	8/1/2013	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	9.8	8/1/2013	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	9.8	8/1/2013	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	9.8	8/1/2013	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	9.8	8/1/2013	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.	8/1/2013	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.	8/1/2013	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.
DIANNA ORTMAN	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.	1/1/2018	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.	12/31/2023	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.	11/18/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
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.	8/1/2013	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.	8/1/2013	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.	8/1/2013	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.
LYLE TERRANCE OLSON	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.	1/1/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
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.	8/1/2013	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.	8/1/2013	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.	8/1/2013	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.	8/1/2013	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 DIRECTOR	30	12/31/2013	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	30	12/31/2013	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.
DIANNA ORTMAN	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.	1/1/2018	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.	11/7/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
LYLE TERRANCE OLSON	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.	1/1/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.

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: LYLE TERRANCE OLSON 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: LYLE TERRANCE OLSON no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: 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: LYLE TERRANCE OLSON appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: LYLE TERRANCE OLSON appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 June 2025: JANET HARRIS no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: HOLLAND GROUP II, LTD appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JANET HARRIS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JANET HARRIS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JANET HARRIS appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: ADAM HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: ADAM HOLLAND-GRESOCK appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: DIANNA ORTMAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: DIANNA ORTMAN appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: TERESA HOLLAND-GRESCOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: BENJAMIN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: BENJAMIN HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NICHOLAS HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NICHOLAS HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: PATRICIA HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: PATRICIA HOLLAND-GRESOCK appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOHN MUIRDEN-HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOHN MUIRDEN-HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOSHUA GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOSHUA GRESOCK appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NOAH HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NOAH HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOHN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: LYLE TERRANCE OLSON appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: LYLE TERRANCE OLSON appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.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: LYLE TERRANCE OLSON 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: LYLE TERRANCE OLSON no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: 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: LYLE TERRANCE OLSON appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: LYLE TERRANCE OLSON appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
12 December 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
1 June 2025: JANET HARRIS no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: HOLLAND GROUP II, LTD appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JANET HARRIS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JANET HARRIS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JANET HARRIS appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: ADAM HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: ADAM HOLLAND-GRESOCK appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: DIANNA ORTMAN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: DIANNA ORTMAN appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: TERESA HOLLAND-GRESCOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: BENJAMIN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: BENJAMIN HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NICHOLAS HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NICHOLAS HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: PATRICIA HOLLAND-GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: PATRICIA HOLLAND-GRESOCK appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOHN MUIRDEN-HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOHN MUIRDEN-HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOSHUA GRESOCK appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOSHUA GRESOCK appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NOAH HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: NOAH HOLLAND appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: JOHN HOLLAND appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: LYLE TERRANCE OLSON appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
1 June 2025: LYLE TERRANCE OLSON appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
16 January 2025: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
12 May 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
22 July 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
15 July 2021: 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
20 June 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
27 September 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
17 August 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip

Inspections

Inspection cycle	Health inspection	Fire safety inspection	Health deficiencies	Fire safety deficiencies
1	21 April 2026	21 April 2026	10	2
2	16 January 2025	16 January 2025	2	0
3	12 May 2022	12 May 2022	2	4

From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.

Deficiencies cited

14 deficiencies on file, newest inspection first

Inspection date	Inspection type	Tag	Category	What was cited	Scope and severity	Complaint	Corrected	Correction date
21 April 2026	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	8 May 2026
21 April 2026	Health	F 0692	Quality of Life and Care Deficiencies	Provide enough food/fluids to maintain a resident's health.	D	No	Deficient, Provider has date of correction	8 May 2026
21 April 2026	Health	F 0740	Quality of Life and Care Deficiencies	Ensure each resident must receive and the facility must provide necessary behavioral health care and services.	D	No	Deficient, Provider has date of correction	8 May 2026
21 April 2026	Health	F 0761	Pharmacy Service Deficiencies	Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.	E	No	Deficient, Provider has date of correction	8 May 2026
28 August 2025	Health	F 0558	Resident Rights Deficiencies	Reasonably accommodate the needs and preferences of each resident.	D	Yes	Deficient, Provider has date of correction	30 September 2025
28 August 2025	Health	F 0561	Resident Rights Deficiencies	Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.	D	Yes	Deficient, Provider has date of correction	30 September 2025
28 August 2025	Health	F 0757	Pharmacy Service Deficiencies	Ensure each resident’s drug regimen must be free from unnecessary drugs.	D	Yes	Deficient, Provider has date of correction	30 September 2025
28 August 2025	Health	F 0800	Nutrition and Dietary Deficiencies	Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.	D	Yes	Deficient, Provider has date of correction	30 September 2025
28 August 2025	Health	F 0805	Nutrition and Dietary Deficiencies	Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.	D	Yes	Deficient, Provider has date of correction	30 September 2025
28 August 2025	Health	F 0880	Infection Control Deficiencies	Provide and implement an infection prevention and control program.	D	Yes	Deficient, Provider has date of correction	30 September 2025
28 February 2025	Health	F 0600	Freedom from Abuse, Neglect, and Exploitation Deficiencies	Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.	D	Yes	Past Non-Compliance	31 January 2025
16 January 2025	Health	F 0580	Resident Rights Deficiencies	Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.	D	Yes	Deficient, Provider has date of correction	29 January 2025
12 May 2022	Health	F 0550	Resident Rights Deficiencies	Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.	D	No	Deficient, Provider has date of correction	27 May 2022
12 May 2022	Health	F 0759	Pharmacy Service Deficiencies	Ensure medication error rates are not 5 percent or greater.	D	No	Deficient, Provider has date of correction	27 May 2022

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 - Corporation
Legal Business Name	COUNTRY CLUB RETIREMENT CENTER V LLC
Date First Approved to Provide Medicare and Medicaid Services	1995-09-18
Provider Resides in Hospital	N
Continuing Care Retirement Community	N
Urban	Y
County/Parish	Delaware
Telephone Number	7403698741
Chain Name	COUNTRY CLUB REHABILITATION CAMPUS
Chain ID	164
Provider Changed Ownership in Last 12 Months	N
With a Resident and Family Council	Resident
Automatic Sprinkler Systems in All Required Areas	Yes
Number of Certified Beds	50
Average Number of Residents per Day	46.8
Overall Rating	5
Health Inspection Rating	4
QM Rating	5
Long-Stay QM Rating	5
Processing Date	2026-08-01

From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.

Get an email when this record changes

One email a day naming what moved on COUNTRY CLUB CENTER V, INC: 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.

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The citable document for COUNTRY CLUB CENTER V, INC

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.

Read the citable document for this facility →

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 366026.