Skilled nursing facility · CMS certification number 366026
COUNTRY CLUB CENTER V, INC
DELAWARE, Ohio · Medicare and Medicaid
Certified beds, as filed in Care Compare: 50
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 December 12, 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $9,913,894 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,931,778 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $7,982,116 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $6,188,342 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $1,793,774 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $46,380 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $1,840,154 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $1,840,154 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 18,300 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,606 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 11,007 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 4,580 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 17,193 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 32 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 73 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 13 | 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 | 50.19 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 150.78 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 145.7 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1444460, 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 January 16, 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $6,936,048 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,860,206 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $5,075,842 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,945,150 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $130,692 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $269,660 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $400,352 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $400,352 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,062 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 191 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.49 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 135.16 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 84.09 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1402357, 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 May 12, 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $7,034,012 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,257,750 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,776,262 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,902,778 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$126,516 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $716,673 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $590,157 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $590,157 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,292 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 188 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 34.47 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 90.85 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 86.66 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1347202, 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 July 22, 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,408,513 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $757,032 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $4,651,481 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,472,703 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $178,778 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $726,631 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $905,409 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $905,409 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,397 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 273 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 48.8 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 94.42 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 60.06 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1327276, 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 July 15, 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,642,434 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $654,157 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,988,277 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,237,712 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$249,435 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $770,249 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $520,814 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $520,814 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,202 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 161 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 46.25 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 76.97 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 100.63 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1288113, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended December 31, 2019
Cost report for January 1, 2019 to December 31, 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on April 14, 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,119,383 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,178,392 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,940,991 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,134,577 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$193,586 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $176,998 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$16,588 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$16,588 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 16,326 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 211 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 41.4 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 136.12 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 77.37 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1281940, 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 June 20, 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,425,969 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $623,303 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,802,666 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,964,152 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$161,486 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $285,152 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $123,666 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $123,666 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 15,789 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 163 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 47.85 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 148.3 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 96.87 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1230806, 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 September 27, 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,265,282 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $546,216 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,719,066 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,676,715 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $42,351 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $308,387 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $350,738 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $350,738 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 15,610 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 219 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 37.89 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 107.9 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 71.28 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1212374, read from the public cost report file SNF10FY2017.zip.
Fiscal year 2016, ended December 31, 2016
Cost report for January 1, 2016 to December 31, 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on August 17, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $4,493,901 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $584,269 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,909,632 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,647,939 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $261,693 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $142,038 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $403,731 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $403,731 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 15,008 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 250 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 34.96 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 106.65 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 60.03 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1173554, 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 30, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,393,430 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $588,120 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,805,310 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,887,342 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$82,032 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $122,219 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $40,187 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $40,187 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 12,984 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 123 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 34.39 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 221.37 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 105.56 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1155355, read from the public cost report file SNF10FY2015.zip.
Fiscal year 2014, ended December 31, 2014
Cost report for January 1, 2014 to December 31, 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on May 5, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,179,603 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $502,382 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,677,221 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,454,095 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $223,126 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $50,938 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $274,064 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $274,064 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 11,977 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 66 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 42.48 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 288.1 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 181.47 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1123361, read from the public cost report file SNF10FY2014.zip.
Fiscal year 2013, ended October 10, 2013
Cost report for January 1, 2013 to October 10, 2013 — a reporting period of 282 days, not a full year, on form CMS-2540-10, settled, processed by CMS on February 20, 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,222,027 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $331,441 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,890,586 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,215,521 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$324,935 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $835,074 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $510,139 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $510,139 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 10,157 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 85 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.6 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 327.91 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 119.49 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1086122, 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 November 8, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,302,096 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $265,866 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,036,230 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,153,913 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$117,683 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Net income after other income | −$117,683 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$117,683 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 15,788 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 71 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 34.42 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 687.5 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 222.37 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1050485, 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 March 14, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,405,435 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $244,326 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,161,109 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,162,284 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$1,175 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Net income after other income | −$1,175 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$1,175 (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 | 50 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 15,194 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 90 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 23.04 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 423.24 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 168.82 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1025828, 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 January 18, 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,191,729 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,169,159 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $22,570 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $1 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $22,571 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 15,492 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 57 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 30.73 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 781.87 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 271.79 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 423107, 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 April 20, 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,056,398 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,198,574 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$142,176 | CMS-2540-96 worksheet G300000 line 500 column 100 |
Net income: −$142,176 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 15,487 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 42 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 31 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,135.73 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 368.74 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 397237, read from the public cost report file SNFFY2009.zip.
Fiscal year 2008, ended December 31, 2008
Cost report for January 1, 2008 to December 31, 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on June 3, 2010.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,047,058 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,107,589 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$60,531 | CMS-2540-96 worksheet G300000 line 500 column 100 |
Net income: −$60,531 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 16,983 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 38 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 24.5 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 2,274.67 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 446.92 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 372181, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended December 31, 2007
Cost report for January 1, 2007 to December 31, 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on July 28, 2008.
None of these figures is carried on this report.
CMS report record 321848, read from the public cost report file SNFFY2007.zip.
Fiscal year 2006, ended December 31, 2006
Cost report for January 1, 2006 to December 31, 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on January 24, 2008.
None of these figures is carried on this report.
CMS report record 300797, read from the public cost report file SNFFY2006.zip.
Fiscal year 2005, ended December 31, 2005
Cost report for January 1, 2005 to December 31, 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on March 12, 2007.
None of these figures is carried on this report.
CMS report record 274514, read from the public cost report file SNFFY2005.zip.
Fiscal year 2004, ended December 31, 2004
Cost report for January 1, 2004 to December 31, 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on December 19, 2005.
None of these figures is carried on this report.
CMS report record 239560, read from the public cost report file SNFFY2004.zip.
Fiscal year 2003, ended December 31, 2003
Cost report for January 1, 2003 to December 31, 2003 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on April 18, 2005.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $2,643,464 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,792,067 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$148,603 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $33 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$148,570 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 15,144 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 70 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 38.66 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 910.36 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 216.34 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 214447, read from the public cost report file SNFFY2003.zip.
Fiscal year 2002, ended December 31, 2002
Cost report for January 1, 2002 to December 31, 2002 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on May 12, 2004.
None of these figures is carried on this report.
CMS report record 176129, read from the public cost report file SNFFY2002.zip.
Fiscal year 2001, ended December 31, 2001
Cost report for January 1, 2001 to December 31, 2001 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on February 13, 2003.
None of these figures is carried on this report.
CMS report record 131189, read from the public cost report file SNFFY2001.zip.
Fiscal year 2000, ended December 31, 2000
Cost report for January 1, 2000 to December 31, 2000 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on October 22, 2001.
Net income: $130,053 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
CMS report record 49441, read from the public cost report file SNFFY2000.zip.
Fiscal year 1999, ended December 31, 1999
Cost report for January 1, 1999 to December 31, 1999 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on January 10, 2001.
Net income: $294,070 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
CMS report record 49439, read from the public cost report file SNFFY1999.zip.
Fiscal year 1998, ended December 31, 1998
Cost report for January 1, 1998 to December 31, 1998 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on October 3, 2000.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,860,337 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,894,757 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$34,420 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $44,981 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: $10,561 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 17,081 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 36 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 60.14 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,288.22 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 474.47 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 49437, read from the public cost report file SNFFY1998.zip.
Fiscal year 1997, ended December 31, 1997
Cost report for January 1, 1997 to December 31, 1997 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on November 30, 1998.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,702,735 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,839,669 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$136,934 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,687 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$130,247 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 16,882 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 62 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 43.21 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 603.59 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 272.29 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 49435, read from the public cost report file SNFFY1997.zip.
Fiscal year 1996, ended December 31, 1996
Cost report for January 1, 1996 to December 31, 1996 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on March 9, 1998.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,587,729 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,670,240 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$82,511 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $6,651 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income: −$75,860 (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 | 50 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 17,665 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 32 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 19.32 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,393.33 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 552.03 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 49433, read from the public cost report file SNFFY1996.zip.
Nurse staffing
Nurse staffing hours from the Payroll-Based Journal, quarter by quarter, are on this facility’s staffing page, each quarter with the file it came from.
Ownership, as filed with CMS
Care Compare
As filed in the CMS file dated September 1, 2026 (Care Compare ownership).
| Owner or manager | Role | Type | Ownership percentage | Association |
|---|---|---|---|---|
| HARRIS, JANET | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Individual | 30% | since 10/01/2013 |
| HOLLAND GROUP II, LTD | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 70% | since 10/01/2013 |
| GRESOCK, JOSHUA | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 10% | since 08/01/2013 |
| HOLLAND-GRESOCK, ADAM | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 10% | since 08/01/2013 |
| HOLLAND-GRESOCK, PATRICIA | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 10% | since 08/01/2013 |
| HOLLAND, BENJAMIN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 10% | since 08/01/2013 |
| HOLLAND, NICHOLAS | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 10% | since 08/01/2013 |
| HOLLAND, NOAH | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 10% | since 08/01/2013 |
| MUIRDEN-HOLLAND, JOHN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Individual | 10% | since 08/01/2013 |
| GRESOCK, JOSHUA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| HARRIS, JANET | ADP OF THE SNF | Individual | NOT APPLICABLE | since 11/18/2024 |
| HOLLAND GROUP II, LTD | ADP OF THE SNF | Organization | NOT APPLICABLE | since 12/31/2023 |
| HOLLAND-GRESCOCK, TERESA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| HOLLAND-GRESOCK, ADAM | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| HOLLAND-GRESOCK, PATRICIA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| HOLLAND, BENJAMIN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| HOLLAND, JOHN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| HOLLAND, NICHOLAS | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| HOLLAND, NOAH | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| MUIRDEN-HOLLAND, JOHN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/01/2013 |
| OLSON, LYLE | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2024 |
| ORTMAN, DIANNA | ADP OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2018 |
| HARRIS, JANET | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 12/31/2013 |
| HARRIS, JANET | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 12/31/2013 |
| HARRIS, JANET | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 11/07/2024 |
| OLSON, LYLE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/01/2024 |
| ORTMAN, DIANNA | OPERATIONAL/MANAGERIAL CONTROL | 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 COUNTRY CLUB RETIREMENT CENTER V LLC (enrollment ID O20140110000946).
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 |
|---|---|---|---|---|---|
| HOLLAND GROUP II, LTD | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 70 | 10/1/2013 | Private equity company: No Real estate investment trust: No Holding company: No |
| JANET HARRIS | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 30 | 10/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ADAM HOLLAND-GRESOCK | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 9.8 | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BENJAMIN HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 9.8 | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN MUIRDEN-HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 9.8 | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOSHUA GRESOCK | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 9.8 | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| NICHOLAS HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 9.8 | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| NOAH HOLLAND | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 9.8 | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| PATRICIA HOLLAND-GRESOCK | Individual | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 9.8 | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ADAM HOLLAND-GRESOCK | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BENJAMIN HOLLAND | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DIANNA ORTMAN | Individual | ADP OF THE SNF | 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 |
| HOLLAND GROUP II, LTD | Organization | ADP OF THE SNF | Not stated in the filing | 12/31/2023 | Private equity company: No Real estate investment trust: No Holding company: No |
| JANET HARRIS | Individual | ADP OF THE SNF | Not stated in the filing | 11/18/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN HOLLAND | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN MUIRDEN-HOLLAND | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOSHUA GRESOCK | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| LYLE TERRANCE OLSON | Individual | ADP OF THE SNF | 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 |
| NICHOLAS HOLLAND | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| NOAH HOLLAND | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| PATRICIA HOLLAND-GRESOCK | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| TERESA HOLLAND-GRESCOCK | Individual | ADP OF THE SNF | Not stated in the filing | 8/1/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JANET HARRIS | Individual | CORPORATE DIRECTOR | 30 | 12/31/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JANET HARRIS | Individual | CORPORATE OFFICER | 30 | 12/31/2013 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DIANNA ORTMAN | Individual | OPERATIONAL/MANAGERIAL CONTROL | 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 |
| JANET HARRIS | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 11/7/2024 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| LYLE TERRANCE OLSON | Individual | OPERATIONAL/MANAGERIAL CONTROL | 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 |
Changes in ownership
- June 1, 2025: JANET HARRIS no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: HOLLAND GROUP II, LTD (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since December 31, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JANET HARRIS (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since November 18, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JANET HARRIS (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since November 7, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JANET HARRIS (CORPORATE DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since December 31, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: ADAM HOLLAND-GRESOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: ADAM HOLLAND-GRESOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: DIANNA ORTMAN (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: DIANNA ORTMAN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: TERESA HOLLAND-GRESCOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: BENJAMIN HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: BENJAMIN HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NICHOLAS HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NICHOLAS HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: PATRICIA HOLLAND-GRESOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: PATRICIA HOLLAND-GRESOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOHN MUIRDEN-HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOHN MUIRDEN-HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOSHUA GRESOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOSHUA GRESOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NOAH HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NOAH HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOHN HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: LYLE TERRANCE OLSON (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: LYLE TERRANCE OLSON (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
Recent changes on this record
- December 12, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- June 1, 2025: JANET HARRIS no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: HOLLAND GROUP II, LTD (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since December 31, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JANET HARRIS (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since November 18, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JANET HARRIS (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since November 7, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JANET HARRIS (CORPORATE DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since December 31, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: ADAM HOLLAND-GRESOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: ADAM HOLLAND-GRESOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: DIANNA ORTMAN (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: DIANNA ORTMAN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: TERESA HOLLAND-GRESCOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: BENJAMIN HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: BENJAMIN HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NICHOLAS HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NICHOLAS HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: PATRICIA HOLLAND-GRESOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: PATRICIA HOLLAND-GRESOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOHN MUIRDEN-HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOHN MUIRDEN-HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOSHUA GRESOCK (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOSHUA GRESOCK (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NOAH HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: NOAH HOLLAND (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: JOHN HOLLAND (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since August 1, 2013. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: LYLE TERRANCE OLSON (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- June 1, 2025: LYLE TERRANCE OLSON (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on June 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-06-01.csv
- January 16, 2025: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
- May 12, 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
- July 22, 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
- July 15, 2021: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip
- April 14, 2021: A cost report was filed for fiscal year 2019, on form CMS-2540-10. SNF10FY2019.zip
- June 20, 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- September 27, 2018: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- August 17, 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- March 30, 2017: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- May 5, 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- February 20, 2015: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- July 24, 2014: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2014.zip
- November 8, 2013: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- March 14, 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-10. SNF10FY2011.zip
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | April 21, 2026 | April 21, 2026 | 4 | 2 |
| 2 | January 16, 2025 | January 16, 2025 | 8 | 0 |
| 3 | May 12, 2022 | May 12, 2022 | 2 | 4 |
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 |
|---|---|---|---|---|---|---|---|---|
| April 21, 2026 | Health | F 0609 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | No | Deficient, Provider has date of correction | May 8, 2026 |
| April 21, 2026 | 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 | May 8, 2026 |
| April 21, 2026 | Health | F 0740 | Quality of Life and Care Deficiencies | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | D | No | Deficient, Provider has date of correction | May 8, 2026 |
| April 21, 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 date of correction | May 8, 2026 |
| August 28, 2025 | Health | F 0558 | Resident Rights Deficiencies | Reasonably accommodate the needs and preferences of each resident. | D | Yes | Deficient, Provider has date of correction | September 30, 2025 |
| August 28, 2025 | Health | F 0561 | Resident Rights Deficiencies | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | D | Yes | Deficient, Provider has date of correction | September 30, 2025 |
| August 28, 2025 | Health | F 0757 | Pharmacy Service Deficiencies | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | Yes | Deficient, Provider has date of correction | September 30, 2025 |
| August 28, 2025 | Health | F 0800 | Nutrition and Dietary Deficiencies | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | D | Yes | Deficient, Provider has date of correction | September 30, 2025 |
| August 28, 2025 | Health | F 0805 | Nutrition and Dietary Deficiencies | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | D | Yes | Deficient, Provider has date of correction | September 30, 2025 |
| August 28, 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | Yes | Deficient, Provider has date of correction | September 30, 2025 |
| February 28, 2025 | Health | F 0600 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Yes | Past Non-Compliance | January 31, 2025 |
| January 16, 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 | January 29, 2025 |
| May 12, 2022 | 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 | May 27, 2022 |
| May 12, 2022 | Health | F 0759 | Pharmacy Service Deficiencies | Ensure medication error rates are not 5 percent or greater. | D | No | Deficient, Provider has date of correction | May 27, 2022 |
From the Care Compare health citations file NH_HealthCitations_Sep2026_2.csv, processed on September 1, 2026.
Penalties
No penalty on file for this facility in CMS’s Care Compare penalties data.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | For profit - Corporation |
| Legal Business Name | COUNTRY CLUB RETIREMENT CENTER V LLC |
| Date First Approved to Provide Medicare and Medicaid Services | 1995-09-18 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | Y |
| County/Parish | Delaware |
| Telephone Number | 7403698741 |
| Chain Name | COUNTRY CLUB REHABILITATION CAMPUS |
| Chain ID | 164 |
| 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 | 50 |
| Average Number of Residents per Day | 46.8 |
| Overall Rating | 5 |
| Health Inspection Rating | 4 |
| QM Rating | 5 |
| Long-Stay QM Rating | 5 |
| Processing Date | 2026-09-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Sep2026_3.csv, processed on September 1, 2026.
Get an email when this record changes
One email a day naming what moved on COUNTRY CLUB CENTER V, INC: 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 December 12, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. That is one line of the alert.
Following a list of facilities? The portfolio watch follows up to 100 certification numbers you name, on one subscription — on the alerts page.
The citable document for COUNTRY CLUB CENTER V, INC
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 Ohio 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 366026.