Skilled nursing facility · CMS certification number 145879
TRI-STATE VILLAGE NRSG & RHB
LANSING, Illinois · Medicare and Medicaid
Certified beds, as filed in Care Compare: 84
Download this facility’s record (CSV)
A CSV file of this facility’s record: its name and location, its Medicare cost-report finances year by year, its ownership, its inspections, deficiencies and penalties, and the Care Compare provider information — each figure with the worksheet, line and column or file it came from.
In Care Compare’s provider information: Penalties: 6 · Fines: 4 · Fines, total amount: $157,909.00 · Payment denials: 2. The most recent penalty on file: March 13, 2026, Fine, $50,915. Every penalty on file ↓
For this facility: the citable document with full history — $295 · an email when this record changes — $99/month
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 January 1, 2024 to December 31, 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on May 7, 2026.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,783,873 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $7,783,873 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $9,732,694 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,948,821 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $220,073 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,728,748 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,728,748 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 30,744 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,394 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 20,238 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 2,677 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 24,309 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 13 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 35 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 2 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 50 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 107.23 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 486.18 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1449560, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended December 31, 2023
Cost report for January 1, 2023 to December 31, 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on December 19, 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,524,791 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $7,524,791 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,675,603 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,150,812 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $364,749 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$786,063 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$786,063 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 25,061 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 76 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 67.25 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 329.75 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1444936, read from the public cost report file SNF10FY2023.zip.
Fiscal year 2022, ended December 31, 2022
Cost report for January 1, 2022 to December 31, 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on January 18, 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,795,567 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $480,498 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,315,069 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,578,302 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,263,233 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $123,860 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,139,373 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,139,373 (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%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 23,767 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 168 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 50.81 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 141.47 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1372173, read from the public cost report file SNF10FY2022.zip.
Fiscal year 2021, ended December 31, 2021
Cost report for January 1, 2021 to December 31, 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on November 7, 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,386,805 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $736,327 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,650,478 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,567,939 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$917,461 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,409,898 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,492,437 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,492,437 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 22,176 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 105 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 68.64 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 211.2 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1367473, read from the public cost report file SNF10FY2021.zip.
Fiscal year 2020, ended December 31, 2020
Cost report for January 1, 2020 to December 31, 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on January 17, 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,220,617 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $570,061 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,650,556 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,503,457 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$852,901 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $990,472 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $137,571 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $137,571 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 23,971 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 94 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 96.3 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 255.01 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1340059, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended December 31, 2019
Cost report for December 1, 2018 to December 31, 2019 — a reporting period of 395 days, on form CMS-2540-10, settled, processed by CMS on August 14, 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,496,903 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $992,361 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $8,504,542 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,371,814 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $132,728 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $6,855 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $139,583 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $139,583 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 29,958 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 137 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 65.47 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 218.67 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1263594, read from the public cost report file SNF10FY2019.zip.
Fiscal year 2018, ended November 30, 2018
Cost report for January 1, 2018 to November 30, 2018 — a reporting period of 333 days, on form CMS-2540-10, settled, processed by CMS on February 13, 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,741,136 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $658,125 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,083,011 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,853,271 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$770,260 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $4,380 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$765,880 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$765,880 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 24,876 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 120 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 108.54 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 207.3 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1250903, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended December 31, 2017
Cost report for January 1, 2017 to December 31, 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on October 25, 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,229,268 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $577,678 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,651,590 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,989,460 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$337,870 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $509,655 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $171,785 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $171,785 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 27,709 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 122 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 57.39 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 227.12 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1213240, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended December 31, 2016
Cost report for January 1, 2016 to December 31, 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on October 26, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,209,036 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $772,795 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,436,241 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,413,410 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $22,831 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $8,683 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $31,514 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $31,514 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 27,609 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 135 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 55.91 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 204.51 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1177551, read from the public cost report file SNF10FY2016.zip.
Fiscal year 2015, ended December 31, 2015
Cost report for January 1, 2015 to December 31, 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on January 19, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,714,319 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,089,657 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,624,662 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,879,307 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$254,645 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $6,419 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$248,226 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$248,226 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 26,990 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 128 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 57.01 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 210.86 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1151569, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended December 31, 2014
Cost report for January 1, 2014 to December 31, 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on October 24, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,957,687 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,064,139 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,893,548 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,849,373 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $44,175 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $29,475 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $73,650 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $73,650 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 27,462 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 202 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 47.57 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 135.95 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1145341, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended December 31, 2013
Cost report for January 1, 2013 to December 31, 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on November 30, 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,293,994 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,364,259 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,929,735 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,912,919 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $16,816 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $55,685 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $72,501 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $72,501 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 27,810 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 213 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 41.99 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 130.56 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1113423, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended December 31, 2012
Cost report for January 1, 2012 to December 31, 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on April 18, 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,293,327 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,487,412 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,805,915 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,969,405 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$163,490 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $33,896 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$129,594 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$129,594 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 26,506 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 186 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 47.99 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 142.51 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1058235, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended December 31, 2011
Cost report for January 1, 2011 to December 31, 2011 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on June 13, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,002,616 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $6,002,616 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,378,276 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$375,660 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $514 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$375,146 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$375,146 (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 | 84 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 25,736 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 201 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 35.02 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 128.04 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1034574, read from the public cost report file SNF10FY2011.zip.
Fiscal year 2010, ended December 31, 2010
Cost report for January 1, 2010 to December 31, 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on September 24, 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,509,375 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,824,384 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$315,009 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $66,117 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$248,892 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 27,035 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 200 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 40.23 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 430.34 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 135.18 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 432500, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended December 31, 2009
Cost report for January 1, 2009 to December 31, 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on February 25, 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,994,761 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,732,650 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $262,111 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $18,480 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $280,591 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 27,420 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 243 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 42.23 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 351.17 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 112.84 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 394569, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended December 31, 2008
Cost report for January 1, 2008 to December 31, 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on June 25, 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $5,313,979 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,641,044 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$327,065 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $13,870 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$313,195 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 28,402 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 226 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 40.5 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 308.55 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 125.67 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 378147, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended December 31, 2007
Cost report for January 1, 2007 to December 31, 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on June 17, 2009.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,356,106 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,909,491 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$553,385 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $29,430 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$523,955 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 27,719 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 182 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 36.98 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 393.55 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 152.3 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 345323, read from the public cost report file SNFFY2007.zip.
Fiscal year 2006, ended December 31, 2006
Cost report for January 1, 2006 to December 31, 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on January 25, 2008.
None of these figures is carried on this report.
CMS report record 301141, read from the public cost report file SNFFY2006.zip.
Fiscal year 2005, ended December 31, 2005
Cost report for January 1, 2005 to December 31, 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on January 31, 2007.
None of these figures is carried on this report.
CMS report record 271456, read from the public cost report file SNFFY2005.zip.
Fiscal year 2004, ended December 31, 2004
Cost report for January 1, 2004 to December 31, 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on February 28, 2006.
None of these figures is carried on this report.
CMS report record 243763, read from the public cost report file SNFFY2004.zip.
Fiscal year 2003, ended December 31, 2003
Cost report for January 1, 2003 to December 31, 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on February 10, 2005.
None of these figures is carried on this report.
CMS report record 206933, read from the public cost report file SNFFY2003.zip.
Fiscal year 2002, ended December 31, 2002
Cost report for January 1, 2002 to December 31, 2002 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on October 28, 2003.
None of these figures is carried on this report.
CMS report record 162219, read from the public cost report file SNFFY2002.zip.
Fiscal year 2001, ended December 31, 2001
Cost report for January 1, 2001 to December 31, 2001 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on April 7, 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,771,069 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,643,159 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $127,910 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $1,200 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $129,110 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 28,946 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 143 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 67.76 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 247.27 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 202.42 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 141870, read from the public cost report file SNFFY2001.zip.
Fiscal year 2000, ended December 31, 2000
Cost report for January 1, 2000 to December 31, 2000 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on February 21, 2002.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,536,056 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,526,426 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $9,630 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $4,019 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $13,649 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 29,203 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 127 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 79.05 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 284.68 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 229.94 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 20335, read from the public cost report file SNFFY2000.zip.
Fiscal year 1999, ended December 31, 1999
Cost report for January 1, 1999 to December 31, 1999 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on August 9, 2001.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,478,319 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,094,355 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $383,964 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,694 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $390,658 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 29,515 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 162 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 35.92 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 182.19 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 20333, read from the public cost report file SNFFY1999.zip.
Fiscal year 1998, ended December 31, 1998
Cost report for January 1, 1998 to December 31, 1998 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on October 26, 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,331,487 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,148,999 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $182,488 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,768 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $189,256 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 29,738 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 172 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 29 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 172.9 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 20331, read from the public cost report file SNFFY1998.zip.
Fiscal year 1997, ended December 31, 1997
Cost report for January 1, 1997 to December 31, 1997 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on November 26, 1999.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,314,453 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,967,927 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $346,526 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $10,937 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $45,990 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: $311,473 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 29,506 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 129 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 74.95 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 228.73 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 20329, read from the public cost report file SNFFY1997.zip.
Fiscal year 1996, ended December 31, 1996
Cost report for May 1, 1996 to December 31, 1996 — a reporting period of 244 days, not a full year, on form CMS-2540-96, settled, processed by CMS on October 2, 1998.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,646,747 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,718,219 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$71,472 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $18,927 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$52,545 (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 | 84 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 17,419 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 81 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 91.88 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 138.17 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 215.05 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 20328, read from the public cost report file SNFFY1996.zip.
Nurse staffing
Nurse staffing hours from the Payroll-Based Journal, quarter by quarter, are on this facility’s staffing page, each quarter with the file it came from.
Ownership, as filed with CMS
Care Compare
As filed in the CMS file dated September 1, 2026 (Care Compare ownership).
| Owner or manager | Role | Type | Ownership percentage | Association |
|---|---|---|---|---|
| GEMINO HEALTHCARE FINANCE LLC | 5% OR GREATER SECURITY INTEREST | Organization | NOT APPLICABLE | since 03/31/2023 |
| ASADULLAH, KHAJA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2018 |
| MASHIACH, YEHOSHUA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2018 |
| ASADULLAH, KHAJA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2018 |
| MASHIACH, YAACOV | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2018 |
| MASHIACH, YECHIEL | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2018 |
| MASHIACH, YEHOSHUA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2018 |
Medicare enrollment
As filed in the CMS file dated August 1, 2026 (Medicare enrollment ownership), under the enrollment of TRI-STATE VILLAGE NURSING AND REHABILITATION CENTER LLC (enrollment ID O20190206000066).
CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; where the private equity, real estate investment trust or holding company field below has not been filed under the current cycle, it reads “Paused by CMS”.
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| ATIED ASSOCIATES LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| RHONDA MASHIACH | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| RITA LIPSHITZ | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| YAACOV MASHIACH | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| YECHIEL MASHIACH | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 20 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| GEMINO HEALTHCARE FINANCE LLC | Organization | 5% OR GREATER SECURITY INTEREST | Not stated in the filing | 3/31/2023 | Private equity company: No Real estate investment trust: No Holding company: No |
| KHAJA ASADULLAH | Individual | ADP OF THE SNF | Not stated in the filing | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| YEHOSHUA ARYEH MASHIACH | Individual | ADP OF THE SNF | Not stated in the filing | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Individual | ADP OF THE SNF | Not stated in the filing | 1/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Organization | ADP OF THE SNF | Not stated in the filing | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | ADP OF THE SNF | Not stated in the filing | 4/11/2025 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | ADP OF THE SNF | Not stated in the filing | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | ADP OF THE SNF | Not stated in the filing | 4/11/2025 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Individual | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Individual | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Individual | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Individual | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 3 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Individual | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Organization | INDIRECT OWNERSHIP INTEREST | 3 | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| No owner named in the filing | Individual | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| No owner named in the filing | Individual | INDIRECT OWNERSHIP INTEREST | 1 | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| KHAJA ASADULLAH | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| YAACOV MASHIACH | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| YECHIEL MASHIACH | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| YEHOSHUA ARYEH MASHIACH | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
Changes in ownership
- September 1, 2025: DANIEL ELKAIM no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YEHOSHUA ARYEH MASHIACH (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YEHOSHUA ARYEH MASHIACH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: GEMINO HEALTHCARE FINANCE LLC (5% OR GREATER SECURITY INTEREST) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since March 31, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: KHAJA ASADULLAH (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: KHAJA ASADULLAH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YAACOV MASHIACH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: ATIED ASSOCIATES LLC (5% OR GREATER DIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YECHIEL MASHIACH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: A listing under ADP OF THE SNF, with no owner named, first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: A listing under INDIRECT OWNERSHIP INTEREST, with no owner named, first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
Recent changes on this record
- July 22, 2026: A deficiency was cited under tag F 0658, scope and severity D. NH_HealthCitations_Sep2026_2.csv
- May 7, 2026: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- December 19, 2025: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- September 1, 2025: DANIEL ELKAIM no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YEHOSHUA ARYEH MASHIACH (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YEHOSHUA ARYEH MASHIACH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: GEMINO HEALTHCARE FINANCE LLC (5% OR GREATER SECURITY INTEREST) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since March 31, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: KHAJA ASADULLAH (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: KHAJA ASADULLAH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YAACOV MASHIACH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: ATIED ASSOCIATES LLC (5% OR GREATER DIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: YECHIEL MASHIACH (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: A listing under ADP OF THE SNF, with no owner named, first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- September 1, 2025: A listing under INDIRECT OWNERSHIP INTEREST, with no owner named, first listed in CMS’s Medicare enrollment ownership file on September 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-09-01.csv
- January 18, 2024: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- November 7, 2023: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- January 17, 2023: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- August 14, 2020: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- February 13, 2020: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- October 25, 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- October 26, 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- January 19, 2017: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- October 24, 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- November 30, 2015: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- April 18, 2014: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- June 13, 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-10. SNF10FY2011.zip
- September 24, 2012: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- February 25, 2011: A cost report was filed for fiscal year 2009, on form CMS-2540-96. SNFFY2009.zip
- June 25, 2010: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2008.zip
- June 17, 2009: A cost report was filed for fiscal year 2007, on form CMS-2540-96. SNFFY2007.zip
- January 25, 2008: A cost report was filed for fiscal year 2006, on form CMS-2540-96. SNFFY2006.zip
- January 31, 2007: A cost report was filed for fiscal year 2005, on form CMS-2540-96. SNFFY2005.zip
- February 28, 2006: A cost report was filed for fiscal year 2004, on form CMS-2540-96. SNFFY2004.zip
- February 10, 2005: A cost report was filed for fiscal year 2003, on form CMS-2540-96. SNFFY2003.zip
- October 28, 2003: A cost report was filed for fiscal year 2002, on form CMS-2540-96. SNFFY2002.zip
- April 7, 2003: A cost report was filed for fiscal year 2001, on form CMS-2540-96. SNFFY2001.zip
- February 21, 2002: A cost report was filed for fiscal year 2000, on form CMS-2540-96. SNFFY2000.zip
- August 9, 2001: A cost report was filed for fiscal year 1999, on form CMS-2540-96. SNFFY1999.zip
- October 26, 2000: A cost report was filed for fiscal year 1998, on form CMS-2540-96. SNFFY1998.zip
- November 26, 1999: A cost report was filed for fiscal year 1997, on form CMS-2540-96. SNFFY1997.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | April 30, 2025 | April 30, 2025 | 18 | 12 |
| 2 | April 26, 2024 | April 26, 2024 | 12 | 11 |
| 3 | January 19, 2023 | January 19, 2023 | 25 | 13 |
From the Care Compare inspection summary file NH_SurveySummary_Sep2026_2.csv, processed on September 1, 2026.
Deficiencies cited
55 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| July 22, 2026 | Health | F 0658 | Resident Assessment and Care Planning Deficiencies | Ensure services provided by the nursing facility meet professional standards of quality. | D | Yes | Deficient, Provider has date of correction | August 6, 2026 |
| March 13, 2026 | Health | F 0686 | Quality of Life and Care Deficiencies | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G | Yes | Deficient, Provider has date of correction | March 27, 2026 |
| March 13, 2026 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Yes | Deficient, Provider has date of correction | March 27, 2026 |
| November 17, 2025 | Health | F 0686 | Quality of Life and Care Deficiencies | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G | Yes | Deficient, Provider has date of correction | December 5, 2025 |
| August 27, 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 | Yes | Deficient, Provider has date of correction | September 5, 2025 |
| August 27, 2025 | Health | F 0940 | Administration Deficiencies | Develop, implement, and/or maintain an effective training program for all new and existing staff members. | F | Yes | Deficient, Provider has date of correction | September 5, 2025 |
| April 30, 2025 | Health | F 0644 | Resident Assessment and Care Planning Deficiencies | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | D | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0686 | Quality of Life and Care Deficiencies | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 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 | May 23, 2025 |
| April 30, 2025 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | G | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0725 | Nursing and Physician Services Deficiencies | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | C | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0740 | Quality of Life and Care Deficiencies | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | D | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0755 | Pharmacy Service Deficiencies | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 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 | May 23, 2025 |
| April 30, 2025 | Health | F 0851 | Administration Deficiencies | Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | C | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0881 | Infection Control Deficiencies | Implement a program that monitors antibiotic use. | D | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0921 | Environmental Deficiencies | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | E | Yes | Deficient, Provider has date of correction | May 23, 2025 |
| April 30, 2025 | Health | F 0947 | Nursing and Physician Services Deficiencies | Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | E | No | Deficient, Provider has date of correction | May 23, 2025 |
| April 23, 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. | J | Yes | Deficient, Provider has date of correction | April 23, 2025 |
| March 13, 2025 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Yes | Deficient, Provider has date of correction | March 28, 2025 |
| November 7, 2024 | Health | F 0600 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Yes | Deficient, Provider has date of correction | November 30, 2024 |
| November 7, 2024 | Health | F 0655 | Resident Assessment and Care Planning Deficiencies | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D | Yes | Deficient, Provider has date of correction | November 30, 2024 |
| August 11, 2024 | 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 | August 29, 2024 |
| June 28, 2024 | Health | F 0558 | Resident Rights Deficiencies | Reasonably accommodate the needs and preferences of each resident. | D | Yes | Deficient, Provider has date of correction | July 25, 2024 |
| June 28, 2024 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Yes | Deficient, Provider has date of correction | July 25, 2024 |
| June 28, 2024 | 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 | July 25, 2024 |
| April 26, 2024 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | E | No | Deficient, Provider has date of correction | May 20, 2024 |
| April 26, 2024 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Yes | Deficient, Provider has date of correction | May 20, 2024 |
| April 26, 2024 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | No | Deficient, Provider has date of correction | May 20, 2024 |
| April 26, 2024 | Health | F 0693 | Quality of Life and Care Deficiencies | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | D | No | Deficient, Provider has date of correction | May 20, 2024 |
| April 26, 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. | F | No | Deficient, Provider has date of correction | May 20, 2024 |
| April 26, 2024 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | May 20, 2024 |
| February 9, 2024 | Health | F 0553 | Resident Rights Deficiencies | Allow resident to participate in the development and implementation of his or her person-centered plan of care. | C | Yes | Deficient, Provider has date of correction | March 8, 2024 |
| February 9, 2024 | Health | F 0580 | Resident Rights Deficiencies | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Yes | Deficient, Provider has date of correction | March 8, 2024 |
| February 9, 2024 | Health | F 0600 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | G | Yes | Deficient, Provider has date of correction | March 8, 2024 |
| February 9, 2024 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Yes | Deficient, Provider has date of correction | March 8, 2024 |
| February 9, 2024 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | G | Yes | Deficient, Provider has date of correction | March 8, 2024 |
| February 9, 2024 | Health | F 0686 | Quality of Life and Care Deficiencies | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Yes | Deficient, Provider has date of correction | March 8, 2024 |
| February 9, 2024 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Yes | Deficient, Provider has date of correction | March 8, 2024 |
| December 6, 2023 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Yes | Deficient, Provider has date of correction | December 30, 2023 |
| December 6, 2023 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | E | Yes | Deficient, Provider has date of correction | December 30, 2023 |
| December 6, 2023 | Health | F 0745 | Quality of Life and Care Deficiencies | Provide medically-related social services to help each resident achieve the highest possible quality of life. | G | Yes | Deficient, Provider has date of correction | December 30, 2023 |
| October 12, 2023 | Health | F 0600 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | G | Yes | Deficient, Provider has date of correction | November 6, 2023 |
| September 27, 2023 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Yes | Deficient, Provider has date of correction | October 13, 2023 |
| January 19, 2023 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | No | Deficient, Provider has date of correction | January 25, 2023 |
| January 19, 2023 | Health | F 0585 | Resident Rights Deficiencies | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | D | No | Deficient, Provider has date of correction | January 25, 2023 |
| January 19, 2023 | Health | F 0677 | Quality of Life and Care Deficiencies | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | No | Deficient, Provider has date of correction | January 25, 2023 |
| January 19, 2023 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | G | No | Deficient, Provider has date of correction | January 25, 2023 |
| January 19, 2023 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | E | No | Deficient, Provider has date of correction | January 25, 2023 |
| January 19, 2023 | Health | F 0759 | Pharmacy Service Deficiencies | Ensure medication error rates are not 5 percent or greater. | E | No | Deficient, Provider has date of correction | January 25, 2023 |
| January 19, 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. | E | No | Deficient, Provider has date of correction | February 6, 2023 |
| January 19, 2023 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | February 6, 2023 |
| January 19, 2023 | Health | F 0814 | Nutrition and Dietary Deficiencies | Dispose of garbage and refuse properly. | F | No | Deficient, Provider has date of correction | February 6, 2023 |
From the Care Compare health citations file NH_HealthCitations_Sep2026_2.csv, processed on September 1, 2026.
Penalties
| Penalty date | Type | Fine amount | Payment denial began | Payment denial, days | Fine ID |
|---|---|---|---|---|---|
| March 13, 2026 | Fine | $50,915 | 139049 | ||
| November 17, 2025 | Fine | $30,485 | 138627 | ||
| April 23, 2025 | Payment Denial | May 14, 2025 | 16 | ||
| June 28, 2024 | Fine | $23,651 | 69979 | ||
| June 28, 2024 | Payment Denial | July 30, 2024 | 30 | ||
| February 9, 2024 | Fine | $52,858 | 69464 | ||
| September 5, 2023 | Fine | $105,486 | 68745 | ||
| September 5, 2023 | Payment Denial | November 9, 2023 | 51 |
From the Care Compare penalties file NH_Penalties_Sep2026_2.csv, processed on September 1, 2026.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | For profit - Limited Liability company |
| Legal Business Name | TRI-STATE VILLAGE NURSING AND REHABILITATION CENTER LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 1996-05-01 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | Y |
| County/Parish | Cook |
| Telephone Number | 7084747330 |
| Chain Name | ATIED ASSOCIATES |
| Chain ID | 53 |
| 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 | 84 |
| Average Number of Residents per Day | 79.4 |
| Overall Rating | 2 |
| Health Inspection Rating | 2 |
| QM Rating | 2 |
| Long-Stay QM Rating | 2 |
| Short-Stay QM Rating | 1 |
| Processing Date | 2026-09-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Sep2026_3.csv, processed on September 1, 2026.
Get an email when this record changes
One email a day naming what moved on TRI-STATE VILLAGE NRSG & RHB: the field, the value before, the value after, and the date of the file that first showed it.
The facility alert follows this one record: a cost report filed or a figure on one changed, an inspection, a deficiency or a penalty recorded, an owner added or removed. The certification number arrives filled in.
On July 22, 2026: A deficiency was cited under tag F 0658, scope and severity D. That is one line of the alert.
Following a list of facilities? The portfolio watch follows up to 100 certification numbers you name, on one subscription — on the alerts page.
The citable document for TRI-STATE VILLAGE NRSG & RHB
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 Illinois 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.
Other public records in Illinois
- NORTHERN MORAINE WW RECLAMATION DIST WWTP, ISLAND LAKE Water discharge permit
- EVANSTON CSOS, CITY OF, EVANSTON Water discharge permit
- MELROSE PARK CSOS, VILLAGE OF, MELROSE PARK Water discharge permit
- LYONS CSOS, VILLAGE OF, LYONS Water discharge permit
- MORTON GROVE CSOS, VILLAGE OF, MORTON GROVE Water discharge permit
- ARLINGTON HEIGHTS CSOS, VILLAGE OF, ARLINGTON HEIGHTS Water discharge permit
- RIVERDALE CSOS, VILLAGE OF, RIVERDALE Water discharge permit
- LAGRANGE PARK CSOS, VILLAGE OF, LA GRANGE PARK Water discharge permit
- SOLID ROCK FOUNDATIONS INC, EAST PEORIA Air emission source
- VERSA PRESS INC, EAST PEORIA Air emission source
- ROANOKE CONCRETE PRODUCTS CO, EAST PEORIA Air emission source
- BRADS AUTOBODY, ROANOKE Air emission source
- PARSONS CO INC, ROANOKE Air emission source
- EVERGREEN FS INC, ROANOKE Air emission source
- ROANOKE FARMERS ASSN, ROANOKE Air emission source
- EUREKA-GOODFIELD FIRE PROTECTION DISTRICT, EUREKA Air emission source
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 145879.