Skilled nursing facility · CMS certification number 146074
MASON POINT
SULLIVAN, Illinois
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.
This certification number is not in CMS’s current Care Compare Provider Information file, processed on August 1, 2026. Its Medicare enrollment, PETERSEN HEALTH CARE VII LLC (enrollment ID O20090305000509), is not listed in the CMS enrollment file dated August 1, 2026.
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, 2022 to August 9, 2022 — a reporting period of 220 days, not a full year, on form CMS-2540-10, settled, processed by CMS on May 19, 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,121,787 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $170,801 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,950,986 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,977,299 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,026,313 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $175,501 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$850,812 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$850,812 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 37,570 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,217 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 7,004 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 2,711 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 10,932 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 18 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 15 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 3 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 36 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 67.61 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 466.93 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 303.67 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1347674, 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 February 16, 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,895,566 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $464,701 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,430,865 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,031,494 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,600,629 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,881,257 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $280,628 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $280,628 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 21,458 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 85 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 52.74 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 437.5 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 252.45 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1342532, 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 August 24, 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,591,989 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $556,647 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,035,342 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,157,655 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,122,313 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $3,805,866 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,683,553 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,683,553 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 26,094 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 114 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 52.45 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 384.78 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 228.89 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1330509, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended December 31, 2019
Cost report for January 1, 2019 to December 31, 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on April 14, 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,176,250 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $754,614 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,421,636 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,632,847 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,211,211 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $241,527 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$969,684 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$969,684 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 32,524 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 174 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 45.39 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 186.92 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1282377, read from the public cost report file SNF10FY2019.zip.
Fiscal year 2018, ended December 31, 2018
Cost report for January 1, 2018 to December 31, 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on January 28, 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,353,753 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $536,192 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,817,561 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,024,386 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,206,825 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $288,406 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$918,419 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$918,419 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 31,991 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 188 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 34.97 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 170.16 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1249973, 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 April 17, 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,963,014 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $392,454 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,570,560 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,091,749 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,521,189 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $280,384 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,240,805 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,240,805 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 32,160 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 205 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 27.23 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 156.88 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1222568, 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 August 14, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,319,207 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $391,500 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,927,707 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,474,328 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$546,621 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $280,590 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$266,031 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$266,031 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 38,260 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 206 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 29.94 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 185.73 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1173086, 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 June 6, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,083,425 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $536,221 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,547,204 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,645,482 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$98,278 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $271,301 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $173,023 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $173,023 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 36,777 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 228 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 36.73 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 161.3 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1159525, 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 19, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,023,329 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $708,191 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,315,138 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,825,451 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$510,313 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $612,456 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $102,143 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $102,143 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 38,021 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 262 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.8 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 145.12 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1144652, 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 July 25, 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,680,131 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $496,198 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,183,933 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,908,130 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$724,197 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $755,785 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $31,588 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $31,588 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 36,916 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 248 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 30.33 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 148.85 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1104445, 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 October 23, 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $8,386,633 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $517,696 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,868,937 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,819,120 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $49,817 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $408,116 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $457,933 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $457,933 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 53,965 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 248 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 33.88 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 217.6 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1079364, 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 December 10, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,483,850 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $170,128 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,313,722 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,809,233 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$495,511 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $544,814 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $49,303 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $49,303 (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 | 170 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 35,380 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 204 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 22.98 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 173.43 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1051900, 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 May 30, 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,261,918 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,693,960 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$432,042 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $697,607 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $265,565 (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 | 170 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 38,651 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 229 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 31.32 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 297.53 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 168.78 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 429648, 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 June 3, 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $4,671,140 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,371,209 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$1,700,069 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $1,663,180 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$36,889 (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 | 170 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 36,895 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 247 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 29.2 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 262.41 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 149.37 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 401931, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended December 31, 2008
Cost report for September 1, 2008 to December 31, 2008 — a reporting period of 121 days, not a full year, on form CMS-2540-96, settled, processed by CMS on January 13, 2010.
None of these figures is carried on this report.
CMS report record 361987, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended August 31, 2007
Cost report for September 1, 2006 to August 31, 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on October 22, 2009.
None of these figures is carried on this report.
CMS report record 358183, read from the public cost report file SNFFY2006.zip.
Fiscal year 2006, ended August 31, 2006
Cost report for September 1, 2005 to August 31, 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on September 24, 2007.
None of these figures is carried on this report.
CMS report record 294152, read from the public cost report file SNFFY2005.zip.
Fiscal year 2005, ended August 31, 2005
Cost report for January 12, 2005 to August 31, 2005 — a reporting period of 231 days, not a full year, on form CMS-2540-96, settled, processed by CMS on June 7, 2006.
None of these figures is carried on this report.
CMS report record 251890, read from the public cost report file SNFFY2005.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
Not listed in CMS’s Care Compare data.
Medicare enrollment
No owner listed for this facility in CMS’s Medicare enrollment ownership data.
Changes in ownership
- October 31, 2022: DARIN WALL no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2022-10-31.csv
- October 31, 2022: MARK B PETERSEN no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2022-10-31.csv
Recent changes on this record
- May 19, 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- February 16, 2023: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- October 31, 2022: DARIN WALL no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2022-10-31.csv
- October 31, 2022: MARK B PETERSEN no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2022-10-31.csv
- August 24, 2022: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- April 14, 2021: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- January 28, 2020: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- April 17, 2019: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- August 14, 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- June 6, 2017: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- October 19, 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- July 25, 2015: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- October 23, 2014: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- December 10, 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-10. SNF10FY2011.zip
- May 30, 2012: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- June 3, 2011: A cost report was filed for fiscal year 2009, on form CMS-2540-96. SNFFY2009.zip
- January 13, 2010: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2008.zip
- October 23, 2009: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2007.zip
- October 22, 2009: A cost report was filed for fiscal year 2007, on form CMS-2540-96. SNFFY2006.zip
- September 24, 2007: A cost report was filed for fiscal year 2006, on form CMS-2540-96. SNFFY2005.zip
- June 7, 2006: A cost report was filed for fiscal year 2005, on form CMS-2540-96. SNFFY2005.zip
Inspections
Not listed in CMS’s Care Compare data.
Deficiencies cited
Not listed in CMS’s Care Compare data.
Penalties
Not listed in CMS’s Care Compare data.
Care Compare provider information
Not listed in CMS’s Care Compare data.
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