Skilled nursing facility · CMS certification number 265820
VILLAGES OF JACKSON CREEK
INDEPENDENCE, Missouri · Medicare and Medicaid
Certified beds, as filed in Care Compare: 120
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: 1 · Fines: 1 · Fines, total amount: $29,186.00 · Payment denials: 0. The most recent penalty on file: October 31, 2024, Fine, $29,186. 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 March 1, 2024 to December 31, 2024 — a reporting period of 305 days, on form CMS-2540-10, settled, processed by CMS on March 5, 2026.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $18,751,881 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $7,963,246 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $10,788,635 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,121,346 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$332,711 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $6,350 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$326,361 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$326,361 (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 | 120 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 36,720 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 3,278 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 13,807 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 13,441 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 30,526 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 98 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 34 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 317 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 449 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 33.45 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 406.09 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 67.99 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1448310, 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 March 21, 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $15,501,319 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,369,376 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $13,131,943 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $15,166,350 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,034,407 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $56,486 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,977,921 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,977,921 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 48,279 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 655 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 24.82 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 167.28 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 73.71 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1405646, 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 February 20, 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $14,182,965 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,170,596 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,012,369 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $14,777,391 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$3,765,022 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $61,531 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$3,703,491 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$3,703,491 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 46,286 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 409 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 26.47 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 272.77 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 113.17 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1373576, 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 4, 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $13,784,307 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,957,688 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $10,826,619 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $13,857,421 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$3,030,802 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $365,788 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$2,665,014 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$2,665,014 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 48,406 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 486 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 22.15 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 257.49 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 99.6 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1328899, 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 December 7, 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $14,868,486 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,236,668 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $11,631,818 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $16,249,043 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$4,617,225 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,282,040 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$3,335,185 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$3,338,515 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 50,518 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 559 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 27.16 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 180.7 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 90.37 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1337578, 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 September 16, 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $16,575,333 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $4,161,908 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $12,413,425 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $15,393,912 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,980,487 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $29,747 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$2,950,740 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$2,950,740 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 54,849 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 859 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 18.89 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 210.88 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 63.85 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1300013, 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 August 7, 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $17,261,607 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $4,043,922 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $13,217,685 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $15,920,189 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,702,504 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $40,699 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$2,661,805 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$2,661,805 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 54,680 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 899 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 18.36 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 308.58 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 60.82 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1262932, 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 November 4, 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $17,655,803 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,791,632 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $13,864,171 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $16,627,357 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,763,186 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $17,750 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$2,745,436 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$2,745,436 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 54,629 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 920 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 21.78 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 303.22 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 59.38 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1245209, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended December 31, 2016
Cost report for January 1, 2016 to December 31, 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on October 22, 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $17,159,483 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,664,332 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $13,495,151 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $16,397,437 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,902,286 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $19,823 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$2,882,463 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$2,882,463 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 54,274 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 1,014 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 18.98 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 326.68 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 53.52 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1213120, 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 March 15, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $18,401,046 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $3,383,100 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,017,946 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $16,282,100 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,264,154 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $27,210 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$1,236,944 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,236,944 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 59,118 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 1,095 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 19.3 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 259.39 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 53.99 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1154483, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended December 31, 2014
Cost report for March 1, 2014 to December 31, 2014 — a reporting period of 305 days, on form CMS-2540-10, settled, processed by CMS on November 28, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $15,367,813 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,839,752 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $12,528,061 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $13,368,654 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$840,593 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $11,307 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$829,286 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$829,286 (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 | 182 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 50,537 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 786 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 21.95 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 831 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 64.3 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1147038, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended December 31, 2013
Cost report for January 1, 2013 to December 31, 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on December 16, 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $22,241,973 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $6,614,648 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,627,325 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $14,815,401 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $811,924 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $60,071 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $871,995 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $871,994 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 40,900 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 503 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 24.16 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 2,212.75 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 81.31 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1115121, read from the public cost report file SNF10FY2013.zip.
Fiscal year 2012, ended December 31, 2012
Cost report for January 1, 2012 to December 31, 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on December 2, 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $24,228,993 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $8,623,527 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $15,605,466 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $15,810,646 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$205,180 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $38,836 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$166,344 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$166,345 (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 | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 39,823 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 852 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 25.23 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 190.66 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 46.74 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1081339, read from the public cost report file SNF10FY2012.zip.
Fiscal year 2011, ended December 31, 2011
Cost report for January 1, 2011 to December 31, 2011 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on January 28, 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $21,180,585 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $6,986,464 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $14,194,121 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $14,746,808 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$552,687 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $28,978 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$523,709 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$523,711 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 128 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 37,944 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 798 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 24.95 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 419.92 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 47.55 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1054802, read from the public cost report file SNF10FY2011.zip.
Fiscal year 2010, ended December 31, 2010
Cost report for January 1, 2010 to December 31, 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on September 8, 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $13,232,570 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $13,828,568 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$595,998 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $29,012 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$566,986 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 36,606 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 1,160 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 24.23 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 510.79 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 31.56 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 416810, read from the public cost report file SNFFY2010.zip.
Fiscal year 2009, ended December 31, 2009
Cost report for January 1, 2009 to December 31, 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on August 24, 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $7,405,212 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $11,150,027 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$3,744,815 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $2,500 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$3,742,315 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 29,178 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 250 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 50.64 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 838.73 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 116.71 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 386129, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended December 31, 2008
Cost report for February 22, 2008 to December 31, 2008 — a reporting period of 313 days, on form CMS-2540-96, settled, processed by CMS on September 21, 2009.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $7,751,912 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $8,803,930 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$1,052,018 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $1,789 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $250 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: −$1,050,479 (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 | 128 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 30,209 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 565 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 28.1 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 164.61 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 53.47 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 356960, read from the public cost report file SNFFY2008.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 |
|---|---|---|---|---|
| 3980 SOUTH JACKSON DRIVE LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 03/01/2024 |
| BUSHMAN, MATTHEW | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/25/2025 |
| ENRIQUEZ, SOL | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2024 |
| HANCOCK, MARK | ADP OF THE SNF | Individual | NOT APPLICABLE | since 03/01/2024 |
| MARTIN, DOMINIQUE | ADP OF THE SNF | Individual | NOT APPLICABLE | since 05/27/2024 |
| MURRAY, JASON | ADP OF THE SNF | Individual | NOT APPLICABLE | since 03/01/2024 |
| PACS GROUP, INC. | ADP OF THE SNF | Organization | NOT APPLICABLE | since 03/01/2024 |
| PACS HOLDINGS, LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 03/01/2024 |
| PROVIDENCE ADMINISTRATIVE CONSULTING SERVICES INC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 03/01/2024 |
| ZENZOO LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 03/01/2024 |
| MURRAY, JASON | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/01/2024 |
| JERGENSEN, JOSHUA | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2024 |
| MITCHELL, JOHN | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 01/01/2024 |
| BLUEBIRD MASTER TENANT LLC | DIRECT OWNERSHIP INTEREST | Organization | NOT APPLICABLE | since 08/02/2023 |
| MURRAY, JASON | INDIRECT OWNERSHIP INTEREST | Individual | NOT APPLICABLE | since 08/02/2023 |
| PACS GROUP, INC. | INDIRECT OWNERSHIP INTEREST | Organization | NOT APPLICABLE | since 08/02/2023 |
| PACS HOLDINGS, LLC | INDIRECT OWNERSHIP INTEREST | Organization | NOT APPLICABLE | since 08/02/2023 |
| PROVIDENCE GROUP INC | INDIRECT OWNERSHIP INTEREST | Organization | NOT APPLICABLE | since 08/02/2023 |
| BUSHMAN, MATTHEW | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/25/2025 |
| ENRIQUEZ, SOL | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2024 |
| JERGENSEN, JOSHUA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 03/01/2024 |
| LACHANCE, HARRIS | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 04/01/2024 |
| MARTIN, DOMINIQUE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 05/27/2024 |
| MITCHELL, JOHN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 03/01/2024 |
Medicare enrollment
As filed in the CMS file dated August 1, 2026 (Medicare enrollment ownership), under the enrollment of INDEPENDENCE COMMUNITY HEALTHCARE LLC (enrollment ID O20240716003544).
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 |
|---|---|---|---|---|---|
| MARK D HANCOCK | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 35.2 | 9/9/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| 3980 SOUTH JACKSON DRIVE LLC | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2024 | Private equity company: No Real estate investment trust: No Holding company: No |
| DOMINIQUE MARTIN | Individual | ADP OF THE SNF | Not stated in the filing | 5/27/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JASON H MURRAY | Individual | ADP OF THE SNF | Not stated in the filing | 3/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MARK D HANCOCK | Individual | ADP OF THE SNF | Not stated in the filing | 3/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MATTHEW BUSHMAN | Individual | ADP OF THE SNF | Not stated in the filing | 1/25/2025 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| PACS GROUP, INC. | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2024 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| PACS HOLDINGS, LLC | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2024 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| PROVIDENCE ADMINISTRATIVE CONSULTING SERVICES INC | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2024 | Private equity company: No Real estate investment trust: No Holding company: No |
| SOL A ENRIQUEZ | Individual | ADP OF THE SNF | Not stated in the filing | 12/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ZENZOO LLC | Organization | ADP OF THE SNF | Not stated in the filing | 3/1/2024 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| JASON H MURRAY | Individual | CORPORATE DIRECTOR | Not stated in the filing | 1/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN T MITCHELL | Individual | CORPORATE OFFICER | Not stated in the filing | 1/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOSHUA O JERGENSEN | Individual | CORPORATE OFFICER | Not stated in the filing | 1/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BLUEBIRD MASTER TENANT LLC | Organization | DIRECT OWNERSHIP INTEREST | 100 | 8/2/2023 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| JASON H MURRAY | Individual | INDIRECT OWNERSHIP INTEREST | 35.2 | 8/2/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| PACS GROUP, INC. | Organization | INDIRECT OWNERSHIP INTEREST | 100 | 8/2/2023 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| PACS HOLDINGS, LLC | Organization | INDIRECT OWNERSHIP INTEREST | 100 | 8/2/2023 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| PROVIDENCE GROUP INC | Organization | INDIRECT OWNERSHIP INTEREST | 100 | 8/2/2023 | Private equity company: No Real estate investment trust: No Holding company: Yes |
| DOMINIQUE MARTIN | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 5/27/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| HARRIS GREGSON LACHANCE | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 4/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN T MITCHELL | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 3/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOSHUA O JERGENSEN | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 3/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| MATTHEW BUSHMAN | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 1/25/2025 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| SOL A ENRIQUEZ | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
Changes in ownership
- August 1, 2026: MARK D HANCOCK no longer appears as INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: MARK D HANCOCK no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: FREDERICK G APT no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: FREDERICK G APT no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: MARK D HANCOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on August 1, 2026; associated with this enrollment since September 9, 2024. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: PACS GROUP, INC. (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2026; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: PACS HOLDINGS, LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2026; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- May 1, 2025: NATIONAL HEALTHCARE CORPORATION no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: NHC-OP LP no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MELVIN RECTOR no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MELVIN RECTOR no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: NATIONAL HEALTH CORPORATION no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: KARIN E BORNING no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: ROBERT M USSERY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MARK D HANCOCK (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MARK D HANCOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MARK D HANCOCK (CORPORATE DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: SOL A ENRIQUEZ (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since December 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: SOL A ENRIQUEZ (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since December 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MATTHEW BUSHMAN (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 25, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MATTHEW BUSHMAN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 25, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: HARRIS GREGSON LACHANCE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since April 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: PACS GROUP, INC. (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOSHUA O JERGENSEN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOSHUA O JERGENSEN (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: PROVIDENCE ADMINISTRATIVE CONSULTING SERVICES INC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: PACS HOLDINGS, LLC (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: BLUEBIRD MASTER TENANT LLC (DIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: FREDERICK G APT (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: FREDERICK G APT (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: 3980 SOUTH JACKSON DRIVE LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOHN T MITCHELL (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOHN T MITCHELL (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JASON H MURRAY (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JASON H MURRAY (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JASON H MURRAY (CORPORATE DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: ZENZOO LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: DOMINIQUE MARTIN (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since May 27, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: DOMINIQUE MARTIN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since May 27, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: PROVIDENCE GROUP INC (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
Recent changes on this record
- August 1, 2026: MARK D HANCOCK no longer appears as INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: MARK D HANCOCK no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: FREDERICK G APT no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: FREDERICK G APT no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: MARK D HANCOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on August 1, 2026; associated with this enrollment since September 9, 2024. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: PACS GROUP, INC. (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2026; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- August 1, 2026: PACS HOLDINGS, LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2026; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2026-08-01.csv
- March 5, 2026: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- August 28, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- May 1, 2025: NATIONAL HEALTHCARE CORPORATION no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: NHC-OP LP no longer appears as 5% OR GREATER DIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MELVIN RECTOR no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MELVIN RECTOR no longer appears as CORPORATE OFFICER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: NATIONAL HEALTH CORPORATION no longer appears as 5% OR GREATER INDIRECT OWNERSHIP INTEREST in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: KARIN E BORNING no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: ROBERT M USSERY no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MARK D HANCOCK (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MARK D HANCOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MARK D HANCOCK (CORPORATE DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: SOL A ENRIQUEZ (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since December 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: SOL A ENRIQUEZ (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since December 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MATTHEW BUSHMAN (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 25, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: MATTHEW BUSHMAN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 25, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: HARRIS GREGSON LACHANCE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since April 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: PACS GROUP, INC. (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOSHUA O JERGENSEN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOSHUA O JERGENSEN (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: PROVIDENCE ADMINISTRATIVE CONSULTING SERVICES INC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: PACS HOLDINGS, LLC (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: BLUEBIRD MASTER TENANT LLC (DIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: FREDERICK G APT (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: FREDERICK G APT (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: 3980 SOUTH JACKSON DRIVE LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOHN T MITCHELL (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JOHN T MITCHELL (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JASON H MURRAY (INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since August 2, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JASON H MURRAY (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: JASON H MURRAY (CORPORATE DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: ZENZOO LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since March 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
- May 1, 2025: DOMINIQUE MARTIN (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on May 1, 2025; associated with this enrollment since May 27, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-05-01.csv
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | December 5, 2025 | December 5, 2025 | 13 | 8 |
| 2 | May 7, 2024 | May 7, 2024 | 19 | 12 |
| 3 | August 10, 2022 | August 10, 2022 | 7 | 8 |
From the Care Compare inspection summary file NH_SurveySummary_Sep2026_2.csv, processed on September 1, 2026.
Deficiencies cited
39 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| January 22, 2026 | 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 | Past Non-Compliance | |
| December 5, 2025 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0584 | Resident Rights Deficiencies | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | E | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0688 | Quality of Life and Care Deficiencies | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | D | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | 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 | January 12, 2026 |
| December 5, 2025 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | D | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0693 | Quality of Life and Care Deficiencies | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | D | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0756 | Pharmacy Service Deficiencies | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | D | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0804 | Nutrition and Dietary Deficiencies | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | D | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 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. | F | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0849 | Administration Deficiencies | Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. | E | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | E | No | Deficient, Provider has date of correction | January 12, 2026 |
| December 5, 2025 | Health | F 0921 | Environmental Deficiencies | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | E | No | Deficient, Provider has date of correction | January 12, 2026 |
| April 10, 2025 | 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 | May 29, 2025 |
| April 10, 2025 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Yes | Deficient, Provider has date of correction | May 29, 2025 |
| April 10, 2025 | Health | F 0698 | Quality of Life and Care Deficiencies | Provide safe, appropriate dialysis care/services for a resident who requires such services. | D | Yes | Deficient, Provider has date of correction | May 29, 2025 |
| April 10, 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | Yes | Deficient, Provider has date of correction | May 29, 2025 |
| October 31, 2024 | Health | F 0580 | Resident Rights Deficiencies | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Yes | Deficient, Provider has date of correction | December 3, 2024 |
| October 31, 2024 | Health | F 0698 | Quality of Life and Care Deficiencies | Provide safe, appropriate dialysis care/services for a resident who requires such services. | J | Yes | Deficient, Provider has date of correction | December 3, 2024 |
| May 7, 2024 | Health | F 0584 | Resident Rights Deficiencies | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | E | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0645 | Resident Assessment and Care Planning Deficiencies | PASARR screening for Mental disorders or Intellectual Disabilities | D | Yes | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0658 | Resident Assessment and Care Planning Deficiencies | Ensure services provided by the nursing facility meet professional standards of quality. | E | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0679 | Quality of Life and Care Deficiencies | Provide activities to meet all resident's needs. | D | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Yes | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | 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 | June 15, 2024 |
| May 7, 2024 | 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 15, 2024 |
| May 7, 2024 | Health | F 0700 | Quality of Life and Care Deficiencies | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | D | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0804 | Nutrition and Dietary Deficiencies | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | E | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0813 | Nutrition and Dietary Deficiencies | Have a policy regarding use and storage of foods brought to residents by family and other visitors. | E | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | E | No | Deficient, Provider has date of correction | June 15, 2024 |
| May 7, 2024 | Health | F 0909 | Environmental Deficiencies | Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. | D | No | Deficient, Provider has date of correction | June 15, 2024 |
| August 10, 2022 | Health | F 0658 | Resident Assessment and Care Planning Deficiencies | Ensure services provided by the nursing facility meet professional standards of quality. | D | No | Deficient, Provider has date of correction | September 23, 2022 |
| August 10, 2022 | 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 23, 2022 |
| August 10, 2022 | Health | F 0756 | Pharmacy Service Deficiencies | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | E | No | Deficient, Provider has date of correction | September 23, 2022 |
| August 10, 2022 | 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 | September 23, 2022 |
| August 10, 2022 | Health | F 0758 | Pharmacy Service Deficiencies | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | D | No | Deficient, Provider has date of correction | September 23, 2022 |
| August 10, 2022 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | September 23, 2022 |
| August 10, 2022 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | E | No | Deficient, Provider has date of correction | September 14, 2022 |
From the Care Compare health citations file NH_HealthCitations_Sep2026_2.csv, processed on September 1, 2026.
Penalties
| Penalty date | Type | Fine amount | Payment denial began | Payment denial, days | Fine ID |
|---|---|---|---|---|---|
| October 31, 2024 | Fine | $29,186 | 90662 |
From the Care Compare penalties file NH_Penalties_Sep2026_2.csv, processed on September 1, 2026.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | For profit - Limited Liability company |
| Legal Business Name | INDEPENDENCE COMMUNITY HEALTHCARE LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 2008-02-22 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | Y |
| County/Parish | Jackson |
| Telephone Number | 8167951433 |
| Chain Name | PACS GROUP |
| Chain ID | 690 |
| 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 | 120 |
| Average Number of Residents per Day | 106.6 |
| Overall Rating | 2 |
| Health Inspection Rating | 2 |
| QM Rating | 4 |
| Long-Stay QM Rating | 4 |
| Short-Stay QM Rating | 4 |
| Processing Date | 2026-08-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on August 1, 2026.
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On March 5, 2026: 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 VILLAGES OF JACKSON CREEK
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 Missouri 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 265820.