Skilled nursing facility · CMS certification number 245491
MOOSE LAKE VILLAGE
MOOSE LAKE, Minnesota · Medicare and Medicaid
Certified beds, as filed in Care Compare: 60
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 | $9,182,165 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $840,406 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $8,341,759 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,641,024 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$299,265 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $633,997 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $334,732 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $334,732 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 26,352 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,596 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 10,522 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 7,185 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 19,303 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 44 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 19 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 55 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 118 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 36.27 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 553.79 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 163.58 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1434445, 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 August 6, 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,272,005 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $977,809 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $8,294,196 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,880,157 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $414,039 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $7,765 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $421,804 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $421,804 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 18,989 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 144 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 37.18 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 312.23 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 131.87 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1391209, 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 June 13, 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,654,209 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $764,736 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,889,473 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,250,190 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$360,717 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $161,057 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$199,660 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$348,310 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 18,256 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 126 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 51.54 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 352.88 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 144.89 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1351085, 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 August 11, 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,984,541 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $582,749 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,401,792 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,619,009 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,217,217 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,048,582 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$168,635 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$206,162 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 19,861 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 112 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 49.18 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 351.59 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 177.33 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1329526, 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 | $7,012,759 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $436,636 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,576,123 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $7,351,312 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$775,189 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $792,679 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $17,490 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $17,490 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 20,536 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 112 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 47.44 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,161.67 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 183.36 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1301261, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended December 31, 2019
Cost report for October 1, 2019 to December 31, 2019 — a reporting period of 91 days, not a full year, on form CMS-2540-10, settled, processed by CMS on November 23, 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $1,735,256 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $53,143 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,682,113 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,702,433 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$20,320 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $5,238 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$15,082 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$15,082 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 5,764 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 28 | 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, Medicaid, in days | 1,601 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 205.86 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1274232, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2018, ended September 30, 2018
Cost report for October 1, 2017 to September 30, 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on June 27, 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,126,790 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $541,592 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,585,198 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,704,980 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$119,782 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $21,151 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$98,631 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$98,631 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 23,109 | 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 | 34.46 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 272.07 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 101.36 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1233395, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended September 30, 2017
Cost report for October 1, 2016 to September 30, 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on May 2, 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,873,529 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $512,480 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,361,049 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,803,062 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$442,013 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $430,710 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$11,303 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$11,303 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 24,965 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 125 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 42.05 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 799.47 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 199.72 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1187689, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended September 30, 2016
Cost report for October 1, 2015 to September 30, 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on May 2, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,450,410 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $434,353 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $6,016,057 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,522,945 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$506,888 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $965,180 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $458,292 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $458,292 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 24,066 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 239 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 28.67 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 368.56 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 100.69 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1156604, read from the public cost report file SNF10FY2016.zip.
Fiscal year 2015, ended September 30, 2015
Cost report for October 1, 2014 to September 30, 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on May 6, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,989,986 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $386,846 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,603,140 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,765,453 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$162,313 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $553,926 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $391,613 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $391,613 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 24,700 | 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 | 37.36 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 491.58 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 119.9 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1123447, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended September 30, 2014
Cost report for October 1, 2013 to September 30, 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on February 25, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,715,417 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $355,950 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,359,467 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,252,101 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $107,366 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $622,676 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $730,042 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $730,042 (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 | 72 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 23,705 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 221 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 34.36 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 465.13 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 107.26 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1119583, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended September 30, 2013
Cost report for October 1, 2012 to September 30, 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on April 30, 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,448,900 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $247,349 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,201,551 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,168,463 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $33,088 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $488,963 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $522,051 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $522,051 (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 | 80 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 23,975 | 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 | 32.04 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 447.15 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 116.95 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1059066, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended September 30, 2012
Cost report for October 1, 2011 to September 30, 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on September 19, 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,650,858 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $341,894 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,308,964 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,208,754 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $100,210 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $404,547 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $504,757 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $504,757 (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 | 80 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 25,329 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 214 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 29.98 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 434.1 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 118.36 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1078219, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended September 30, 2011
Cost report for September 1, 2010 to September 30, 2011 — a reporting period of 394 days, on form CMS-2540-96, settled, processed by CMS on May 21, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $6,189,137 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $5,840,648 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $348,489 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $3,361,370 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $200 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: $3,709,659 (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 | 80 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 28,984 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 243 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 36.83 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 467.42 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 119.28 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 434671, read from the public cost report file SNFFY2010.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 |
|---|---|---|---|---|
| CASSIA | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | since 01/01/2018 |
| DAHL, ROBERT | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2018 |
| KERN, MATTHEW | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2018 |
| STADTHERR, SEELOCHANI | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2018 |
| YOUNGQUIST, KATHRYN | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2018 |
| MACKAY, MARSHALL | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2018 |
| NYE, GERALD | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2018 |
| PARKS, CHARLES | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2018 |
| RAMSDALE, SCOTT | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2018 |
| WILKERSON, GARY | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2018 |
| CASSIA | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 01/01/2018 |
| SMITH, SHAWNA | W-2 MANAGING EMPLOYEE | Individual | NOT APPLICABLE | since 01/01/2018 |
Medicare enrollment
As filed in the CMS file dated August 1, 2026 (Medicare enrollment ownership), under the enrollment of AUGUSTANA MERCY CARE CENTER LLC (enrollment ID O20101019000790).
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 |
|---|---|---|---|---|---|
| CASSIA | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100 | 1/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| KATHRYN LEE YOUNGQUIST | Individual | CORPORATE DIRECTOR | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MATTHEW RAY KERN | Individual | CORPORATE DIRECTOR | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ROBERT MAHLON DAHL | Individual | CORPORATE DIRECTOR | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| SEELOCHANI NMN STADTHERR | Individual | CORPORATE DIRECTOR | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| CHARLES THOMAS PARKS | Individual | CORPORATE OFFICER | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| GARY ALBERT WILKERSON | Individual | CORPORATE OFFICER | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| GERALD THOMAS NYE | Individual | CORPORATE OFFICER | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MARSHALL ALLAN MACKAY | Individual | CORPORATE OFFICER | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| SCOTT GERALD RAMSDALE | Individual | CORPORATE OFFICER | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| CASSIA | Organization | OPERATIONAL/MANAGERIAL CONTROL | 100 | 1/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| AUGUSTANA MERCY CARE CENTER LLC | Organization | OTHER | Not stated in the filing | 9/1/2020 | Private equity company: No Real estate investment trust: No Holding company: No |
| SHAWNA RAE SMITH | Individual | W-2 MANAGING EMPLOYEE | Not stated in the filing | 1/1/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
Changes in ownership
No change in ownership appears in the CMS files on record since September 20, 2022.
Recent changes on this record
- August 28, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- August 6, 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- June 13, 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- August 11, 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- September 28, 2021: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- November 23, 2020: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2020.zip
- April 15, 2020: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- June 27, 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- May 2, 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- May 2, 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- May 6, 2016: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- February 25, 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- September 19, 2014: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- April 30, 2014: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- May 21, 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-96. SNFFY2010.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | July 9, 2026 | July 9, 2026 | 5 | 2 |
| 2 | May 15, 2025 | May 15, 2025 | 6 | 10 |
| 3 | March 14, 2024 | March 14, 2024 | 3 | 2 |
From the Care Compare inspection summary file NH_SurveySummary_Sep2026_2.csv, processed on September 1, 2026.
Deficiencies cited
14 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| July 9, 2026 | Health | F 0554 | Resident Rights Deficiencies | Allow residents to self-administer drugs if determined clinically appropriate. | D | No | Deficient, Provider has no plan of correction | |
| July 9, 2026 | 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 no plan of correction | |
| July 9, 2026 | Health | F 0761 | Pharmacy Service Deficiencies | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | E | No | Deficient, Provider has no plan of correction | |
| July 9, 2026 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has no plan of correction | |
| July 9, 2026 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | E | No | Deficient, Provider has no plan of correction | |
| May 15, 2025 | Health | F 0568 | Resident Rights Deficiencies | Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | D | No | Deficient, Provider has date of correction | June 27, 2025 |
| May 15, 2025 | Health | F 0657 | Resident Assessment and Care Planning Deficiencies | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | No | Deficient, Provider has date of correction | June 27, 2025 |
| May 15, 2025 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | E | No | Deficient, Provider has date of correction | June 27, 2025 |
| May 15, 2025 | Health | F 0699 | Quality of Life and Care Deficiencies | Provide care or services that was trauma informed and/or culturally competent. | D | No | Deficient, Provider has date of correction | June 27, 2025 |
| May 15, 2025 | Health | F 0757 | Pharmacy Service Deficiencies | Ensure each resident’s drug regimen must be free from unnecessary drugs. | E | No | Deficient, Provider has date of correction | June 27, 2025 |
| May 15, 2025 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | D | No | Deficient, Provider has date of correction | June 27, 2025 |
| March 14, 2024 | Health | F 0578 | Resident Rights Deficiencies | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | D | No | Deficient, Provider has date of correction | April 17, 2024 |
| March 14, 2024 | Health | F 0761 | Pharmacy Service Deficiencies | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | D | No | Deficient, Provider has date of correction | April 17, 2024 |
| November 9, 2023 | Health | F 0580 | Resident Rights Deficiencies | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Yes | Deficient, Provider has date of correction | January 9, 2024 |
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 | Non profit - Corporation |
| Legal Business Name | AUGUSTANA MERCY CARE CENTER LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 1987-07-01 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | Y |
| County/Parish | Carlton |
| Telephone Number | 2183519401 |
| 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 | 60 |
| Average Number of Residents per Day | 53.1 |
| Overall Rating | 4 |
| Health Inspection Rating | 3 |
| QM Rating | 3 |
| Long-Stay QM Rating | 2 |
| Short-Stay QM Rating | 3 |
| Processing Date | 2026-09-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Sep2026_3.csv, processed on September 1, 2026.
Get an email when this record changes
One email a day naming what moved on MOOSE LAKE VILLAGE: the field, the value before, the value after, and the date of the file that first showed it.
The facility alert follows this one record: a cost report filed or a figure on one changed, an inspection, a deficiency or a penalty recorded, an owner added or removed. The certification number arrives filled in.
On 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 MOOSE LAKE VILLAGE
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 Minnesota 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 245491.