Skilled nursing facility · CMS certification number 525497
The Pines Post Acute and Memory Care
Clintonville, Wisconsin · 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 22 May 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,744,125 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $387,298 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,356,827 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,078,030 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $278,797 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $559 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $279,356 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $279,356 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 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 | 237 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 12,673 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 4,370 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 17,280 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 5 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 9 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 44 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 58 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 47.4 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,408.11 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 297.93 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1424735, 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 28 May 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,641,484 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,160,719 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,480,765 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,664,562 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$183,797 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $19,208 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$164,589 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$164,589 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,270 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 59 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 40 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,046 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 292.71 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1379560, 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 25 July 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,333,314 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $596,145 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,737,169 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,491,281 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $245,888 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $9,009 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $254,897 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $254,897 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 17,084 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 98 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 35.5 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,346.78 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 174.33 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1359851, 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 31 August 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,122,176 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,074,891 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,047,285 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,210,492 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$163,207 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $8,195 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$155,012 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$155,507 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,988 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 89 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 50.09 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 805.65 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 190.88 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1331010, 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 16 September 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,219,035 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,129,653 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,089,382 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,032,216 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $57,166 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $4,858 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $62,024 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $61,711 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,670 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 88 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 43.72 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 718 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 189.43 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1298976, 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 30 June 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,218,602 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,107,202 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,111,400 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,856,286 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $255,114 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $4,056 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $259,170 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $258,723 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 52 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,618 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 138 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 47.47 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 330.94 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 120.42 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1259238, 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 2 August 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,113,246 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,021,501 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,091,745 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,379,552 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$287,807 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $7,258 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$280,549 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$280,549 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 78 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 14,005 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 83 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 64.08 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 456.1 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 168.73 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1239368, 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 21 August 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,931,805 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $892,562 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,039,243 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,225,216 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$185,973 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $5,726 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$180,247 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$180,247 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 14,552 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 100 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 31.61 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 327.43 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 145.52 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1208173, 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 24 August 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,133,260 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,132,020 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,001,240 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,216,498 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$215,258 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,994 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$213,264 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$213,264 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 15,742 | 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 | 45.69 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 69.86 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 62.97 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1174877, 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 24 August 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,477,604 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,038,546 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,439,058 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,685,936 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$246,878 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $6,928 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$239,950 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$239,950 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 18,341 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 121 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.75 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 210.54 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 151.58 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1142463, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended 31 May 2014
Cost report for 1 January 2014 to 31 May 2014 — a reporting period of 150 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 23 August 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,144,843 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $447,948 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,696,895 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,937,694 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$240,799 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,987 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$238,812 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$238,813 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 9,444 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 19 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 92.25 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,654.25 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 497.05 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1142398, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended 31 December 2013
Cost report for 1 January 2013 to 31 December 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 12 August 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,902,758 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,100,072 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,802,686 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,653,364 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$850,678 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $4,941 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$845,737 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$845,736 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 22,094 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 132 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 30.78 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 816.11 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 167.38 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1075770, 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 23 July 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,631,403 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $732,415 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,898,988 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,414,527 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$515,539 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $9,593 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$505,946 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$505,942 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 22,483 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 118 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 39.68 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 367.98 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 190.53 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1072605, 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 26 November 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,873,799 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $570,790 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,303,009 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,469,711 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$166,702 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $17,318 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$149,384 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
| Total other expenses | $3 | CMS-2540-10 worksheet G300000 line 3000 column 100 |
Net income: −$149,387 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 6,970 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 58 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 55.62 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 120.17 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1020620, 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 19 July 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,033,287 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,445,034 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$411,747 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $11,267 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $5 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: −$400,485 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 22,897 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 123 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 41.46 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 632.72 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 186.15 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 410704, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended 31 December 2009
Cost report for 1 January 2009 to 31 December 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 30 June 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,079,445 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,592,891 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$513,446 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,829 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $1 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: −$506,618 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 23,706 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 117 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 39.11 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 933.94 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 202.62 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 379602, 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 14 July 2009.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,260,865 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,851,705 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$590,840 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $15,007 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$575,833 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 24,588 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 111 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 47.88 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 773.17 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 221.51 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 349594, 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 5 December 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,392,007 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,559,979 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$167,972 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $15,451 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | −$1 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: −$152,520 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 95 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 27,037 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 121 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 45.23 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 919.35 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 223.45 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 329561, 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 21 November 2007.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,300,037 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,581,611 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$281,574 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,087 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $2 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: −$275,489 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 107 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 28,290 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 106 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 38.96 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 752.39 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 266.89 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 296731, 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 19 January 2007.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,529,367 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,446,983 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $82,384 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,218 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $3 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: $88,599 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 107 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 29,557 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 54 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 101.64 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,411.56 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 547.35 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 270727, 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 24 February 2006.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,648,286 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,287,970 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $360,316 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $4,236 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | −$1 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: $364,553 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 107 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 32,660 | 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 | 69.91 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 2,029.46 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 572.98 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 243620, 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 23 December 2004.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,413,893 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,159,643 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $254,250 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $9,912 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $264,162 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 107 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 32,626 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 118 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 25.13 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 887.79 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 276.49 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 203248, 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 27 April 2004.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,991,081 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,884,667 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $106,414 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $12,999 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $119,413 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 107 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 34,439 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 118 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 17.66 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 448.19 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 291.86 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 173975, read from the public cost report file SNFFY2002.zip.
Fiscal year 2001, ended 31 December 2001
Cost report for 1 January 2001 to 31 December 2001 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 7 April 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,618,514 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,460,657 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $157,857 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $15,016 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $172,873 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 104 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 32,772 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 54 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 26.6 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,622.53 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 606.89 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 142385, read from the public cost report file SNFFY2001.zip.
Fiscal year 2000, ended 31 October 2000
Cost report for 1 January 2000 to 31 October 2000 — a reporting period of 304 days, on form CMS-2540-96, settled, processed by CMS on 12 February 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,707,754 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,838,721 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$130,967 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $18,175 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$112,792 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 108 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 26,359 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 96 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 27.86 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 274.57 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 125117, 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 20 July 2001.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,457,477 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,527,054 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | −$69,577 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $9,608 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$59,969 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 108 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 33,745 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 97 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 34.12 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 858.36 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 347.89 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 72160, 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 19 September 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,662,048 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,541,020 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $121,028 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $2,222 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $123,250 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 101 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 32,364 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 91 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 42.86 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 623.24 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 355.65 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 72158, read from the public cost report file SNFFY1998.zip.
Fiscal year 1997, ended 31 December 1997
Cost report for 1 February 1997 to 31 December 1997 — a reporting period of 333 days, on form CMS-2540-96, settled, processed by CMS on 3 January 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,336,105 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,224,964 | CMS-2540-96 worksheet G200002 line 1500 column 100 |
| Net income from service to patients | $111,141 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | −$10,553 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $100,588 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 101 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 30,582 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 76 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 42 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 402.39 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 72156, read from the public cost report file SNFFY1997.zip.
Nurse staffing
Nurse staffing hours from the Payroll-Based Journal, quarter by quarter, are on this facility’s staffing page, each quarter with the file it came from.
Ownership, as filed with CMS
Care Compare
As filed in the CMS file dated 1 August 2026 (Care Compare ownership).
| Owner or manager | Role | Type | Ownership percentage | Association |
|---|---|---|---|---|
| BELL, CODY | ADP OF THE SNF | Individual | NOT APPLICABLE | since 06/01/2014 |
| ENSIGN SERVICES INC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 12/20/2013 |
| KAMIN, SHAYNA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 11/01/2024 |
| LEGEND LAKE HEALTH HOLDINGS LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 06/01/2014 |
| STANDARD BEARER HEALTHCARE OP, LP | ADP OF THE SNF | Organization | NOT APPLICABLE | since 06/01/2014 |
| THE ENSIGN GROUP INC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 06/01/2014 |
| BURNAM, SOON | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 12/20/2013 |
| JORGENSEN, DAVID | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 09/09/2024 |
| KEETCH, CHAD | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 03/01/2011 |
| GATEWAY HEALTHCARE LLC | DIRECT OWNERSHIP INTEREST | Organization | NOT APPLICABLE | since 02/01/2014 |
| THE ENSIGN GROUP INC | INDIRECT OWNERSHIP INTEREST | Organization | NOT APPLICABLE | since 05/23/2011 |
| PORT, BARRY | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 10/15/2025 |
| BELL, CODY | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 06/01/2014 |
| KAMIN, SHAYNA | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 11/01/2024 |
| BELL, CODY | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 06/01/2014 |
| J THOMPSON STAFFING INC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 06/01/2014 |
| KAMIN, SHAYNA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 11/01/2024 |
| KELSTAR LLC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 06/01/2014 |
| PRN HEALTH SERVICES, INC. | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 06/01/2014 |
Medicare enrollment
As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of CLOVERLEAF HEALTHCARE LLC (enrollment ID O20141203000073).
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| CODY BELL | Individual | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | 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. |
| ENSIGN SERVICES INC | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 12/20/2013 | Private equity company: No Real estate investment trust: No Holding company: No |
| LEGEND LAKE HEALTH HOLDINGS LLC | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| SHAYNA K KAMIN | 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. | 11/1/2024 | 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. |
| STANDARD BEARER HEALTHCARE OP, LP | 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. | 6/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| THE ENSIGN GROUP INC | Organization | ADP OF THE SNF | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 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. | 6/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| CHAD KEETCH | Individual | CORPORATE OFFICER | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 3/1/2011 | 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. |
| DAVID JORGENSEN | Individual | CORPORATE OFFICER | 0 | 9/9/2024 | 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. |
| SOON BURNAM | Individual | CORPORATE OFFICER | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 12/20/2013 | 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. |
| GATEWAY HEALTHCARE LLC | Organization | DIRECT OWNERSHIP INTEREST | 100 | 2/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| THE ENSIGN GROUP INC | Organization | INDIRECT OWNERSHIP INTEREST | 100 | 5/23/2011 | Private equity company: No Real estate investment trust: No Holding company: No |
| CODY BELL | Individual | MANAGING CONTROL - GOVERNING BODY | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | 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. |
| SHAYNA K KAMIN | Individual | MANAGING CONTROL - GOVERNING BODY | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 11/1/2024 | 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. |
| CODY BELL | Individual | OPERATIONAL/MANAGERIAL CONTROL | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | 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. |
| J THOMPSON STAFFING INC | Organization | OPERATIONAL/MANAGERIAL CONTROL | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| KELSTAR LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| PRN HEALTH SERVICES, INC. | Organization | OPERATIONAL/MANAGERIAL CONTROL | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | 6/1/2014 | Private equity company: No Real estate investment trust: No Holding company: No |
| SHAYNA K KAMIN | 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. | 11/1/2024 | 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: LEGEND LAKE HEALTH HOLDINGS LLC 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: SHAYNA K KAMIN 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: SHAYNA K KAMIN no longer appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN 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: LEGEND LAKE HEALTH HOLDINGS LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 April 2026: CODY BELL no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: GATEWAY HEALTHCARE LLC no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: THE ENSIGN GROUP INC no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: J THOMPSON STAFFING INC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CODY BELL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CODY BELL appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: STANDARD BEARER HEALTHCARE OP, LP appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CHAD A KEETCH appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: GATEWAY HEALTHCARE LLC appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: DAVID JORGENSEN appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: ENSIGN SERVICES INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: THE ENSIGN GROUP INC appears as INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: THE ENSIGN GROUP INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: PRN HEALTH SERVICES, INC. appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: KELSTAR LLC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: LEGEND LAKE HEALTH HOLDINGS LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SHAYNA K KAMIN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SHAYNA K KAMIN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SHAYNA K KAMIN appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
Recent changes on this record
- 1 July 2026: LEGEND LAKE HEALTH HOLDINGS LLC 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: SHAYNA K KAMIN 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: SHAYNA K KAMIN no longer appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN 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: LEGEND LAKE HEALTH HOLDINGS LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 July 2026: SHAYNA K KAMIN appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- 1 April 2026: CODY BELL no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: GATEWAY HEALTHCARE LLC no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: THE ENSIGN GROUP INC no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: J THOMPSON STAFFING INC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CODY BELL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CODY BELL appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: STANDARD BEARER HEALTHCARE OP, LP appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: CHAD A KEETCH appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: GATEWAY HEALTHCARE LLC appears as DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: DAVID JORGENSEN appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: ENSIGN SERVICES INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: THE ENSIGN GROUP INC appears as INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: THE ENSIGN GROUP INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: PRN HEALTH SERVICES, INC. appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: KELSTAR LLC appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: LEGEND LAKE HEALTH HOLDINGS LLC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SHAYNA K KAMIN appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SHAYNA K KAMIN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 1 April 2026: SHAYNA K KAMIN appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-04-01.csv
- 22 May 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- 28 May 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- 25 July 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- 31 August 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- 16 September 2021: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- 30 June 2020: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- 2 August 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- 21 August 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- 24 August 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- 24 August 2016: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- 23 August 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 24 September 2015: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 17 July 2025 | 17 July 2025 | 6 | 5 |
| 2 | 15 May 2024 | 15 May 2024 | 9 | 7 |
| 3 | 10 May 2023 | 10 May 2023 | 3 | 2 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
18 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 17 July 2025 | Health | F 0558 | Resident Rights Deficiencies | Reasonably accommodate the needs and preferences of each resident. | D | No | Deficient, Provider has date of correction | 8 August 2025 |
| 17 July 2025 | Health | F 0628 | Resident Rights Deficiencies | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | D | No | Deficient, Provider has date of correction | 8 August 2025 |
| 17 July 2025 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | No | Deficient, Provider has date of correction | 8 August 2025 |
| 17 July 2025 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | D | No | Deficient, Provider has date of correction | 8 August 2025 |
| 17 July 2025 | 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 August 2025 |
| 17 July 2025 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | No | Deficient, Provider has date of correction | 8 August 2025 |
| 19 June 2025 | Health | F 0607 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | D | Yes | Deficient, Provider has date of correction | 4 July 2025 |
| 19 June 2025 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Yes | Deficient, Provider has date of correction | 4 July 2025 |
| 1 May 2025 | Health | F 0604 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | J | Yes | Past Non-Compliance | 2 April 2025 |
| 1 May 2025 | Health | F 0607 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | D | Yes | Deficient, Provider has date of correction | 28 May 2025 |
| 15 May 2024 | Health | F 0690 | Quality of Life and Care Deficiencies | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | No | Deficient, Provider has date of correction | 10 June 2024 |
| 15 May 2024 | Health | F 0755 | Pharmacy Service Deficiencies | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | No | Deficient, Provider has date of correction | 10 June 2024 |
| 15 May 2024 | 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 | 10 June 2024 |
| 15 May 2024 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | No | Deficient, Provider has date of correction | 10 June 2024 |
| 15 May 2024 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 10 June 2024 |
| 10 May 2023 | Health | F 0610 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Respond appropriately to all alleged violations. | D | No | Deficient, Provider has date of correction | 9 June 2023 |
| 10 May 2023 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | No | Deficient, Provider has date of correction | 9 June 2023 |
| 10 May 2023 | 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 | No | Deficient, Provider has date of correction | 9 June 2023 |
From the Care Compare health citations file NH_HealthCitations_Aug2026.csv, processed on 1 August 2026.
Penalties
| Penalty date | Type | Fine amount | Payment denial began | Payment denial, days | Fine ID |
|---|---|---|---|---|---|
| 19 June 2025 | Fine | $11,960 | 135694 |
From the Care Compare penalties file NH_Penalties_Aug2026.csv, processed on 1 August 2026.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | For profit - Corporation |
| Legal Business Name | CLOVERLEAF HEALTHCARE LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 1992-11-01 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | N |
| County/Parish | Waupaca |
| Telephone Number | 7158233135 |
| Chain Name | THE ENSIGN GROUP |
| Chain ID | 507 |
| 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 | 44.9 |
| Overall Rating | 4 |
| Health Inspection Rating | 3 |
| 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.
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On 1 July 2026: LEGEND LAKE HEALTH HOLDINGS LLC 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 The Pines Post Acute and Memory Care
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 Wisconsin at the same fiscal year, listed by name; every change on the record rather than the recent ones below; the inspection and staffing history in blocks of their own; and a citation block naming every CMS file it was read from.
Every figure on this page is printed as it appears in the CMS file named beside it. A figure that does not match its file? Tell us on the corrections page, quoting certification number 525497.