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Facility record report · CMS certification number 445542

JEFFERSON PARK AT WHITE PINE

WHITE PINE, Tennessee · Medicare and Medicaid

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 July 2024 to 30 June 2025 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 13 November 2025.

Revenue and expenses, fiscal year 2025
FigureAs filedWhere it comes from
Total patient revenue$2,872,101CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts−$99,668CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue$2,971,769CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses$2,987,761CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients−$15,992CMS-2540-10 worksheet G300000 line 500 column 100
Total other income$15,619CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income−$373CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$373 (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 2025
FigureAs filedWhere it comes from
Total facility beds, all components33CMS-2540-10 worksheet S300001 line 800 column 100
Bed days available, all components11,091CMS-2540-10 worksheet S300001 line 800 column 200
Medicare (Title XVIII) patient days1,546CMS-2540-10 worksheet S300001 line 800 column 400
Medicaid (Title XIX) patient days2,155CMS-2540-10 worksheet S300001 line 800 column 500
Other-payer patient days4,726CMS-2540-10 worksheet S300001 line 800 column 600
Total patient days, all components8,427CMS-2540-10 worksheet S300001 line 800 column 700
Medicare discharges43CMS-2540-10 worksheet S300001 line 800 column 900
Medicaid discharges2CMS-2540-10 worksheet S300001 line 800 column 1000
Other-payer discharges93CMS-2540-10 worksheet S300001 line 800 column 1100
Total discharges, all components138CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days35.95CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days1,077.5CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days61.07CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1442338, read from the public cost report file SNF10FY2024.zip.

Cost report for 25 October 2023 to 30 June 2024 — a reporting period of 249 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 11 December 2024.

Revenue and expenses, fiscal year 2024
FigureAs filedWhere it comes from
Total patient revenue$762,073CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts−$21,563CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue$783,636CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses$1,400,480CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients−$616,844CMS-2540-10 worksheet G300000 line 500 column 100
Total other income$6,843CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income−$610,001CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$610,001 (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
FigureAs filedWhere it comes from
Total facility beds, all components30CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components2,768CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components7CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days96.5CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, all patients, in days395.43CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1400732, read from the public cost report file SNF10FY2024.zip.

Five facilities of a similar size in Tennessee, fiscal year 2025

Chosen for having certified bed counts closest to this facility’s, listed by name. Every one filed for the same fiscal year; the day each year ends differs and is shown. Each figure is that facility’s own filing.

FacilityTotal facility bedsTotal patient daysNet patient revenueTotal operating expensesNet income from service to patientsPeriod ended
HUMPHREYS COUNTY NURSING HOME9124,974$9,063,245$10,120,963−$1,057,71830 June 2025
ISLAND HOME PARK HEALTH AND REHAB9531,156$10,153,987$9,900,933$253,05430 June 2025
JEFFERSON PARK AT WHITE PINE338,427$2,971,769$2,987,761−$15,99230 June 2025
MILLINGTON NURSING CENTER8526,205$9,006,204$8,879,926$126,27830 June 2025
OBION COUNTY NURSING HOME5617,218$5,111,294$5,838,408−$727,11430 June 2025
OCOEE COPPER BASIN HEALTH AND REHABI502,743$920,171$1,037,592−$117,42131 March 2025

Where each column comes from, on every filing in this table: Total facility beds: CMS-2540-10 worksheet S300001 line 800 column 100 · Total patient days: CMS-2540-10 worksheet S300001 line 800 column 700 · Net patient revenue: CMS-2540-10 worksheet G300000 line 300 column 100 · Total operating expenses: CMS-2540-10 worksheet G300000 line 400 column 100 · Net income from service to patients: CMS-2540-10 worksheet G300000 line 500 column 100.

Ownership, as filed with CMS

Care Compare

As filed in the CMS file dated 1 August 2026 (Care Compare ownership).

Owner or managerRoleTypeOwnership percentageAssociation
MYNATT, ROGERCORPORATE DIRECTORIndividualNOT APPLICABLEsince 01/02/1992
POTTS, MARKCORPORATE DIRECTORIndividualNOT APPLICABLEsince 08/23/2018
MYNATT, ROGERW-2 MANAGING EMPLOYEEIndividualNOT APPLICABLEsince 01/02/1992

Medicare enrollment

As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of JEFFERSON COUNTY NURSING HOME (enrollment ID O20221215000144).

OwnerIndividual or organizationRoleOwnership percentageAssociation dateDescribed in the filing as
MARK POTTSIndividualCORPORATE DIRECTORCMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.8/23/2018
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.
ROGER MYNATTIndividualCORPORATE DIRECTORCMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.1/2/1992
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.
JEFFERSON COUNTY NURSING HOMEOrganizationOTHER10012/11/2019
Private equity company: No
Real estate investment trust: No
Holding company: No
ROGER MYNATTIndividualW-2 MANAGING EMPLOYEECMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.1/2/1992
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

Inspections

Inspection cycleHealth inspectionFire safety inspectionHealth deficienciesFire safety deficiencies
128 May 202628 May 202645
224 October 202324 October 202300

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

Deficiencies cited

4 deficiencies on file, newest inspection first
Inspection dateInspection typeTagCategoryWhat was citedScope and severityComplaintCorrectedCorrection date
28 May 2026HealthF 0656Resident Assessment and Care Planning DeficienciesDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.CNoDeficient, Provider has date of correction30 June 2026
28 May 2026HealthF 0761Pharmacy Service DeficienciesEnsure 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.ENoDeficient, Provider has date of correction30 June 2026
28 May 2026HealthF 0812Nutrition and Dietary DeficienciesProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EYesDeficient, Provider has date of correction30 June 2026
28 May 2026HealthF 0851Administration DeficienciesElectronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.BNoDeficient, Provider has date of correction30 June 2026

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

FieldAs filed
Provider TypeMedicare and Medicaid
Ownership TypeGovernment - County
Legal Business NameJEFFERSON COUNTY NURSING HOME
Date First Approved to Provide Medicare and Medicaid Services2023-10-25
Provider Resides in HospitalN
Continuing Care Retirement CommunityN
UrbanY
County/ParishJefferson
Telephone Number8653274100
Provider Changed Ownership in Last 12 MonthsN
With a Resident and Family CouncilResident
Automatic Sprinkler Systems in All Required AreasYes
Number of Certified Beds30
Average Number of Residents per Day28.2
Overall Rating4
Health Inspection Rating4
QM Rating2
Long-Stay QM Rating2
Short-Stay QM Rating1
Processing Date2026-08-01

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

Every change on this record

How to read this report

Every figure is printed as the CMS file it came from printed it. Each cost-report figure carries the worksheet, line and column of form CMS-2540 it was read from, so a reader holding the same public file can go to that cell; each Care Compare and Medicare enrollment section names its file and the date CMS stamped on it.

A figure the filing does not carry is left out, and so is a figure whose value the filing’s own arithmetic contradicts. Net income is printed with what the form’s own arithmetic shows about it — plainly where it follows from the lines above it, and, where it does not, beside what the form’s own lines leave unaccounted for. An ownership field left empty carries the dated sentence on CMS’s pause of the expanded Form CMS-855A disclosure. A source that holds nothing for this facility says so in its section.

This report carries no percentile and no score, and it does not place this facility above or below another. The five facilities above are the one comparison it draws: the nearest certified bed counts in the same state at the same fiscal year, listed by name. Nurse staffing is printed in its own section, on its own page, apart from the cost-report figures.

How to cite this report

Velarion Records, JEFFERSON PARK AT WHITE PINE — facility record report, CMS certification number 445542. https://velarionrecords.com/facility/445542/report.

Published by VELARIONAI LLC · Andrew Richardson, founder. Corrections: hello@velarionrecords.com, quoting certification number 445542. Velarion Records publishes these records as filed.

Nurse staffing, quarter by quarter

Hours this facility reported to CMS’s Payroll-Based Journal, one row per quarter, oldest first, each with how its figures are derived and the file it came from.

Nurse staffing hours by quarter
QuarterQuarter endedDays reportedResident daysRegistered nurse hoursLicensed practical nurse hoursNurse aide hoursTotal nurse hours
2024Q230 June 2024911,0701,306.51,096.754,399.256,802.5
2024Q330 September 2024921,5581,097.251,707.256,1158,919.5
2024Q431 December 2024922,1251,804.52,212.759,051.2513,068.5
2025Q131 March 2025902,2881,628.252,409.7510,16514,203
2025Q230 June 2025912,4531,330.253,173.511,379.2515,883
2025Q330 September 2025922,3401,468.253,651.510,141.515,261.25
2025Q431 December 2025922,7171,262.54,060.510,552.2515,875.25
2026Q131 March 2026902,5401,309.253,346.259,964.7514,620.25
Nurse staffing hours per resident day by quarter
QuarterRegistered nurse hours per resident dayLicensed practical nurse hours per resident dayNurse aide hours per resident dayTotal nurse hours per resident day
2024Q21.2210281.0254.1114496.357477
2024Q30.7042681.0957963.9249045.724968
2024Q40.8491761.0412944.2594126.149882
2025Q10.7116481.0532124.4427456.207605
2025Q20.5422951.2937224.6389126.474929
2025Q30.6274571.560474.3339746.521902
2025Q40.4646671.4944793.8837875.842933
2026Q10.5154531.3174213.923135.756004

How each quarter is derived, and its file

  • 2024Q2: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-04-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-04-01.csv
  • 2024Q3: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-09-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-09-01.csv
  • 2024Q4: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-12-31.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2024-12-31.csv
  • 2025Q1: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-01-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-01-01.csv
  • 2025Q2: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-04-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-04-01.csv
  • 2025Q3: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-07-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-07-01.csv
  • 2025Q4: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-10-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-10-01.csv
  • 2026Q1: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2026-01-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. Payroll_Based_Journal_Daily_Nurse_Staffing_:_2026-01-01.csv

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