Skilled nursing facility · CMS certification number 155353
HICKORY CREEK AT GREENSBURG
GREENSBURG, Indiana · Medicare and Medicaid
Certified beds, as filed in Care Compare: 36
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: 0 · Fines: 0 · Fines, total amount: $0.00 · Payment denials: 0. 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 August 28, 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,010,804 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$344,118 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,354,922 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,541,308 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$186,386 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $30,118 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$156,268 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$156,268 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 13,176 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 227 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 9,051 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 1,057 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 10,335 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 1 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 36 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 10 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 47 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 227 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 251.42 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 219.89 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1433567, 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 September 25, 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,849,328 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$269,997 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,119,325 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,113,794 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $5,531 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $13,285 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $18,816 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $18,816 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,443 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 59 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 119 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 192.55 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 177 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1395790, 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 July 19, 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,218,330 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$476,277 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,694,607 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,042,463 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$347,856 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $121,122 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$226,734 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$226,734 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 9,381 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 110 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 31.07 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 110.15 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 85.28 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1389779, 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 September 28, 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,180,681 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$252,175 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,432,856 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,746,959 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$314,103 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $41,260 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$272,843 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$272,843 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 8,730 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 24 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 139.5 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 381.78 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 363.75 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1334365, 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 September 28, 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,236,179 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$345,260 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,581,439 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,789,901 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$208,462 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $125,875 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$82,587 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$82,587 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,948 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 23 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 36.25 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 476 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1301225, 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 August 11, 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,370,237 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$433,949 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,804,186 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,865,607 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$61,421 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $9,247 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$52,174 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$52,174 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 11,080 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 25 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 102.2 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 443.2 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1292856, 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 July 10, 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,155,245 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$276,259 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,431,504 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,646,175 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$214,671 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $8,019 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$206,652 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$206,652 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 9,135 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 26 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 71 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 351.35 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1236249, 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 July 27, 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,266,834 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$427,872 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,694,706 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,594,377 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $100,329 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $5,112 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $105,441 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $105,441 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,512 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 48 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 52.88 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 219 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1203411, 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 June 29, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,472,985 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$279,638 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,752,623 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,581,850 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $170,773 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $7,367 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $178,140 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $178,140 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 11,840 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 22 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 65.43 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 538.18 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1167234, 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 July 25, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,389,487 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$305,808 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,695,295 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,470,017 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $225,278 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $4,535 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $229,813 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $229,813 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 12,420 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 27 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 70.2 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 460 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1135246, 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 July 25, 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,246,273 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$115,166 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,361,439 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,318,237 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $43,202 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $5,685 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $48,887 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $48,887 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,760 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 30 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 61 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 358.67 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1105360, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended December 31, 2013
Cost report for August 1, 2013 to December 31, 2013 — a reporting period of 152 days, not a full year, on form CMS-2540-10, settled, processed by CMS on June 5, 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $762,440 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $19,434 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $743,006 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $951,427 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$208,421 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $2,406 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$206,015 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$206,015 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 3,758 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 10 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 110 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 375.8 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1062224, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended December 31, 2012
Cost report for May 1, 2012 to December 31, 2012 — a reporting period of 244 days, not a full year, on form CMS-2540-10, settled, processed by CMS on August 7, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $1,247,030 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $39,651 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,207,379 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,233,289 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$25,910 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $4,724 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$21,186 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$21,186 (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 | 36 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 7,047 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 26 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 71 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 271.04 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1045806, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended April 30, 2011
Cost report for May 1, 2010 to April 30, 2011 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on September 20, 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,693,643 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,716,138 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$22,495 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,371 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$16,124 (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 | 36 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 9,770 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 34 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 60.89 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 287.35 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 432299, read from the public cost report file SNFFY2010.zip.
Fiscal year 2010, ended April 30, 2010
Cost report for May 1, 2009 to April 30, 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on September 27, 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,826,860 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,770,787 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $56,073 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $3,146 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $59,219 (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 | 38 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 10,894 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 38 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 50.94 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 286.68 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 418413, read from the public cost report file SNFFY2009.zip.
Fiscal year 2009, ended April 30, 2009
Cost report for May 1, 2008 to April 30, 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on June 17, 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,890,256 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,785,750 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $104,506 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $2,229 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $106,735 (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 | 38 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 10,654 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 42 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 50.53 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 253.67 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 375655, read from the public cost report file SNFFY2008.zip.
Fiscal year 2008, ended April 30, 2008
Cost report for May 1, 2007 to April 30, 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on July 15, 2009.
None of these figures is carried on this report.
CMS report record 350502, read from the public cost report file SNFFY2007.zip.
Fiscal year 2007, ended April 30, 2007
Cost report for May 1, 2006 to April 30, 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on September 9, 2008.
None of these figures is carried on this report.
CMS report record 325410, read from the public cost report file SNFFY2006.zip.
Fiscal year 2006, ended April 30, 2006
Cost report for May 1, 2005 to April 30, 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on May 16, 2007.
None of these figures is carried on this report.
CMS report record 278615, read from the public cost report file SNFFY2005.zip.
Fiscal year 2005, ended April 30, 2005
Cost report for May 1, 2004 to April 30, 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on February 10, 2006.
None of these figures is carried on this report.
CMS report record 242707, read from the public cost report file SNFFY2004.zip.
Fiscal year 2004, ended April 30, 2004
Cost report for May 1, 2003 to April 30, 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on March 21, 2005.
None of these figures is carried on this report.
CMS report record 211799, read from the public cost report file SNFFY2003.zip.
Fiscal year 2003, ended April 30, 2003
Cost report for May 1, 2002 to April 30, 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on April 27, 2004.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,538,294 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,526,359 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $11,935 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $730 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $12,665 (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 | 38 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 12,969 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 26 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 110 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 498.81 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 173725, read from the public cost report file SNFFY2002.zip.
Fiscal year 2002, ended April 30, 2002
Cost report for November 1, 2001 to April 30, 2002 — a reporting period of 180 days, not a full year, on form CMS-2540-96, settled, processed by CMS on May 7, 2003.
None of these figures is carried on this report.
CMS report record 142946, read from the public cost report file SNFFY2002.zip.
Fiscal year 2001, ended October 31, 2001
Cost report for January 1, 2001 to October 31, 2001 — a reporting period of 303 days, on form CMS-2540-96, settled, processed by CMS on February 13, 2003.
None of these figures is carried on this report.
CMS report record 131088, 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 11, 2003.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,269,301 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,423,162 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$153,861 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $4,801 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$149,060 (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 | 40 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 11,581 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 28 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 157.4 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 413.61 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 114438, read from the public cost report file SNFFY2000.zip.
Fiscal year 1999, ended December 31, 1999
Cost report for October 4, 1999 to December 31, 1999 — a reporting period of 88 days, not a full year, on form CMS-2540-96, as submitted, processed by CMS on March 15, 2001.
Net income: $64,962 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
CMS report record 13256, read from the public cost report file SNFFY2000.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, reopened, processed by CMS on September 20, 2001.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,295,149 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,321,817 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$26,668 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $678 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$25,990 (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 | 39 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 11,022 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 17 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 86.08 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 648.35 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 13252, 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, reopened, processed by CMS on September 19, 2001.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,226,497 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,205,683 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $20,814 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $1,984 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $22,798 (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 | 40 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 10,745 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 25 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 79.08 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 429.8 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 13249, read from the public cost report file SNFFY1997.zip.
Fiscal year 1996, ended December 31, 1996
Cost report for February 1, 1996 to December 31, 1996 — a reporting period of 334 days, on form CMS-2540-96, reopened, processed by CMS on January 18, 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $998,658 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $938,997 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $59,661 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $1,358 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $61,019 (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 | 40 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 9,540 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 25 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 56.15 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, all patients, in days | 381.6 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 423485, 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 |
|---|---|---|---|---|
| HENRY COUNTY MEMORIAL HOSPITAL | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | since 08/01/2013 |
| AMERICAN SENIOR COMMUNITIES LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 03/24/2025 |
| DICE, MARK | ADP OF THE SNF | Individual | NOT APPLICABLE | since 06/01/2023 |
| SHANE, ANDREW | ADP OF THE SNF | Individual | NOT APPLICABLE | since 02/01/2023 |
| THIES, BROOKE | ADP OF THE SNF | Individual | NOT APPLICABLE | since 03/24/2025 |
| VAN CAMP, STEVEN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 06/01/2023 |
| WOLFRAM, DONALD | ADP OF THE SNF | Individual | NOT APPLICABLE | since 05/26/2026 |
| CROSBY, FRANCIS | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 08/01/2013 |
| RING, BRIAN | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 08/01/2022 |
| CHIES, STEVEN | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 03/01/2021 |
| DYNES, SHELDON | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2013 |
| JACKSON, BLAKE | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 03/01/2021 |
| JACKSON, ETHAN | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 03/01/2021 |
| JACKSON, MARK | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 03/01/2021 |
| JACKSON, MICHAEL | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 05/14/2024 |
| JACKSON, WESSLEY | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 03/01/2021 |
| JUSTICE, DAVID | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 03/01/2021 |
| KELSEY, DONNA | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 07/18/2024 |
| PIDGEON, JOHN | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2013 |
| SHORE, MARION | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2013 |
| STITLE, STEPHEN | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 03/01/2021 |
| WARE, DEBORAH | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 08/27/2021 |
| WRIGHT, THERESSA | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 05/21/2021 |
| AMERICAN SENIOR COMMUNITIES LLC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 03/01/2021 |
| CROSBY, FRANCIS | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 08/01/2013 |
| DICE, MARK | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 06/01/2023 |
| GROW, BRIANNA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 07/16/2024 |
| RING, BRIAN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 08/01/2022 |
| SHANE, ANDREW | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 02/01/2023 |
| THIES, BROOKE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/28/2022 |
| VAN CAMP, STEVEN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 06/01/2023 |
| WOLFRAM, DONALD | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 05/01/2026 |
| DYNES, SHELDON | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2013 |
| PIDGEON, JOHN | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2013 |
| SHORE, MARION | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2013 |
| WARE, DEBORAH | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 08/27/2021 |
Medicare enrollment
As filed in the CMS file dated August 1, 2026 (Medicare enrollment ownership), under the enrollment of HENRY COUNTY MEMORIAL HOSPITAL (enrollment ID O20131009000273).
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 |
|---|---|---|---|---|---|
| HENRY COUNTY MEMORIAL HOSPITAL | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100 | 8/1/2013 | Private equity company: No Real estate investment trust: No Holding company: No |
| AMERICAN SENIOR COMMUNITIES LLC | Organization | ADP OF THE SNF | Not stated in the filing | 3/24/2025 | Private equity company: No Real estate investment trust: No Holding company: No |
| ANDREW SHANE | Individual | ADP OF THE SNF | Not stated in the filing | 2/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BROOKE THIES | Individual | ADP OF THE SNF | Not stated in the filing | 3/24/2025 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DONALD WOLFRAM | Individual | ADP OF THE SNF | Not stated in the filing | 5/26/2026 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MARK DICE | Individual | ADP OF THE SNF | Not stated in the filing | 6/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| STEVEN VAN CAMP | Individual | ADP OF THE SNF | Not stated in the filing | 6/1/2023 | 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 | 3/1/2021 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| No owner named in the filing | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2021 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| No owner named in the filing | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2021 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| No owner named in the filing | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2021 | Private equity company: No Real estate investment trust: No Holding company: No |
| BRIAN RING | Individual | CORPORATE OFFICER | 0 | 8/1/2022 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| FRANCIS J CROSBY | Individual | CORPORATE OFFICER | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BLAKE JACKSON | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 3/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DAVID JUSTICE | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 3/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DEBORAH WARE | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 8/27/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DONNA KELSEY | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 7/18/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ETHAN I JACKSON | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 3/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN D PIDGEON | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 1/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MARION E SHORE | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 1/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MARK JACKSON | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 3/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MICHAEL L JACKSON | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 5/14/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| SHELDON L DYNES | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 1/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| STEPHEN STITLE | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 3/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| STEVEN CHIES | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 3/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| THERESSA WRIGHT | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 5/21/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| WESSLEY JACKSON | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 3/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| AMERICAN SENIOR COMMUNITIES LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL | 100 | 3/1/2021 | Private equity company: No Real estate investment trust: No Holding company: No |
| ANDREW SHANE | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 2/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BRIAN RING | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 8/1/2022 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BRIANNA GROW | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 7/16/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BROOKE THIES | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/28/2022 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DONALD WOLFRAM | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 5/1/2026 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| FRANCIS J CROSBY | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MARK DICE | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 6/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| STEVEN VAN CAMP | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 6/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DEBORAH WARE | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 8/27/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN D PIDGEON | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 1/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MARION E SHORE | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 1/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| SHELDON L DYNES | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 1/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
Changes in ownership
- July 1, 2026: CHARLES M JANSSENS no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- July 1, 2026: CHARLES M JANSSENS no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- July 1, 2026: DONALD WOLFRAM appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- July 1, 2026: DONALD WOLFRAM appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- November 1, 2025: KEVIN D NEESE no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- November 1, 2025: KEVIN D NEESE no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- November 1, 2025: CHARLES M JANSSENS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- November 1, 2025: CHARLES M JANSSENS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- August 1, 2025: SHELDON L DYNES no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DEBORAH WARE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: GREGORY SCHIAVONE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DONNA G KELSEY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARION E SHORE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: FRANCIS J CROSBY no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: LINDA YOUNG no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN D PIDGEON no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SHELDON L DYNES (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SHELDON L DYNES (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DAVID JUSTICE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: AMERICAN SENIOR COMMUNITIES LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 24, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BRIANNA GROW (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since July 16, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ANDREW E SHANE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since February 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ANDREW E SHANE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since February 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEVIN D NEESE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 24, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEVIN D NEESE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since April 28, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEVEN E CHIES (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DEBORAH WARE (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 27, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DEBORAH WARE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 27, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: THERESSA WRIGHT (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since May 21, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEPHEN STITLE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ETHAN JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARK E DICE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since June 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARK E DICE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since June 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEVEN A VAN CAMP (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since June 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: WESSLEY JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BROOKE THIES (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 24, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BROOKE THIES (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 28, 2022. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DONNA G KELSEY (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since July 18, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BLAKE JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BRIAN RING (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 1, 2022. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARION E SHORE (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARION E SHORE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MICHAEL JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since May 14, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARK A. JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: FRANCIS J CROSBY (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: A listing under ADP OF THE SNF, with no owner named, first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN D PIDGEON (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN D PIDGEON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- February 15, 2023: PAUL F JANSSEN no longer appears as OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv
- February 15, 2023: NATALIE BERGMAN no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv
- February 15, 2023: CHRISTINA RUSSELL no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv
- February 15, 2023: GREGORY SCHIAVONE (W-2 MANAGING EMPLOYEE) first listed in CMS’s Medicare enrollment ownership file on February 15, 2023; associated with this enrollment since September 24, 2022. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv
- February 15, 2023: BRIAN RING (OFFICER) first listed in CMS’s Medicare enrollment ownership file on February 15, 2023; associated with this enrollment since August 1, 2022. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv
- February 15, 2023: LINDA YOUNG (W-2 MANAGING EMPLOYEE) first listed in CMS’s Medicare enrollment ownership file on February 15, 2023; associated with this enrollment since March 18, 2022. Skilled_Nursing_Facility_All_Owners_:_2023-02-15.csv
Recent changes on this record
- July 1, 2026: CHARLES M JANSSENS no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- July 1, 2026: CHARLES M JANSSENS no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- July 1, 2026: DONALD WOLFRAM appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- July 1, 2026: DONALD WOLFRAM appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
- November 1, 2025: KEVIN D NEESE no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- November 1, 2025: KEVIN D NEESE no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- November 1, 2025: CHARLES M JANSSENS appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- November 1, 2025: CHARLES M JANSSENS appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-11-01.csv
- August 28, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- August 1, 2025: SHELDON L DYNES no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DEBORAH WARE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: GREGORY SCHIAVONE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DONNA G KELSEY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARION E SHORE no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: FRANCIS J CROSBY no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: LINDA YOUNG no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN D PIDGEON no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SHELDON L DYNES (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SHELDON L DYNES (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DAVID JUSTICE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: AMERICAN SENIOR COMMUNITIES LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 24, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BRIANNA GROW (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since July 16, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ANDREW E SHANE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since February 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ANDREW E SHANE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since February 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEVIN D NEESE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 24, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEVIN D NEESE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since April 28, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEVEN E CHIES (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DEBORAH WARE (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 27, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DEBORAH WARE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 27, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: THERESSA WRIGHT (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since May 21, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEPHEN STITLE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ETHAN JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARK E DICE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since June 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARK E DICE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since June 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEVEN A VAN CAMP (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since June 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: WESSLEY JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BROOKE THIES (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 24, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BROOKE THIES (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 28, 2022. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DONNA G KELSEY (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since July 18, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BLAKE JACKSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since March 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | September 22, 2025 | September 22, 2025 | 5 | 5 |
| 2 | October 11, 2024 | October 11, 2024 | 4 | 2 |
| 3 | August 10, 2023 | August 10, 2023 | 9 | 6 |
From the Care Compare inspection summary file NH_SurveySummary_Sep2026_2.csv, processed on September 1, 2026.
Deficiencies cited
18 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| September 22, 2025 | Health | F 0577 | Resident Rights Deficiencies | Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. | C | No | Deficient, Provider has date of correction | December 12, 2025 |
| September 22, 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 | December 12, 2025 |
| September 22, 2025 | Health | F 0711 | Nursing and Physician Services Deficiencies | Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. | D | No | Deficient, Provider has date of correction | December 12, 2025 |
| September 22, 2025 | Health | F 0770 | Administration Deficiencies | Provide timely, quality laboratory services/tests to meet the needs of residents. | D | No | Deficient, Provider has date of correction | December 12, 2025 |
| September 22, 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | December 12, 2025 |
| October 11, 2024 | Health | F 0690 | Quality of Life and Care Deficiencies | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | No | Deficient, Provider has date of correction | November 1, 2024 |
| October 11, 2024 | Health | F 0727 | Nursing and Physician Services Deficiencies | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | F | No | Waiver has been granted | November 1, 2024 |
| October 11, 2024 | Health | F 0757 | Pharmacy Service Deficiencies | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | No | Deficient, Provider has date of correction | November 1, 2024 |
| October 11, 2024 | Health | F 0759 | Pharmacy Service Deficiencies | Ensure medication error rates are not 5 percent or greater. | D | No | Deficient, Provider has date of correction | November 1, 2024 |
| September 28, 2023 | Health | F 0744 | Quality of Life and Care Deficiencies | Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | D | Yes | Deficient, Provider has date of correction | October 27, 2023 |
| August 10, 2023 | 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 | September 10, 2023 |
| August 10, 2023 | 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 | September 10, 2023 |
| August 10, 2023 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | No | Deficient, Provider has date of correction | September 10, 2023 |
| August 10, 2023 | Health | F 0690 | Quality of Life and Care Deficiencies | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | No | Deficient, Provider has date of correction | September 10, 2023 |
| August 10, 2023 | Health | F 0698 | Quality of Life and Care Deficiencies | Provide safe, appropriate dialysis care/services for a resident who requires such services. | D | No | Deficient, Provider has date of correction | September 10, 2023 |
| August 10, 2023 | Health | F 0757 | Pharmacy Service Deficiencies | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | No | Deficient, Provider has date of correction | September 10, 2023 |
| August 10, 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. | E | No | Deficient, Provider has date of correction | September 10, 2023 |
| August 10, 2023 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | September 10, 2023 |
From the Care Compare health citations file NH_HealthCitations_Sep2026_2.csv, processed on September 1, 2026.
Penalties
No penalty on file for this facility in CMS’s Care Compare penalties data.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | For profit - Corporation |
| Legal Business Name | HENRY COUNTY MEMORIAL HOSPITAL |
| Date First Approved to Provide Medicare and Medicaid Services | 1990-03-15 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | N |
| County/Parish | Decatur |
| Telephone Number | 8126637503 |
| Chain Name | AMERICAN SENIOR COMMUNITIES |
| Chain ID | 33 |
| 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 | 36 |
| Average Number of Residents per Day | 28.1 |
| Overall Rating | 5 |
| Health Inspection Rating | 4 |
| QM Rating | 5 |
| Long-Stay QM Rating | 5 |
| Processing Date | 2026-09-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Sep2026_3.csv, processed on September 1, 2026.
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On August 28, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. That is one line of the alert.
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The citable document for HICKORY CREEK AT GREENSBURG
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 Indiana 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.
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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 155353.