Skilled nursing facility · CMS certification number 366358
OTTERBEIN NORTH SHORE
LAKESIDE, Ohio · Medicare and Medicaid
Certified beds, as filed in Care Compare: 20
Download this facility’s record (CSV)
A CSV file of this facility’s record: its name and location, its Medicare cost-report finances year by year, its ownership, its inspections, deficiencies and penalties, and the Care Compare provider information — each figure with the worksheet, line and column or file it came from.
In Care Compare’s provider information: Penalties: 0 · Fines: 0 · Fines, total amount: $0.00 · Payment denials: 0. Every penalty on file ↓
For this facility: the citable document with full history — $295 · an email when this record changes — $99/month
Finances, as filed
From this facility’s Medicare cost reports on form CMS-2540, each figure with the worksheet, line and column it was read from.
Cost report for January 1, 2024 to December 31, 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on August 28, 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,175,436 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,102,699 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,072,737 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,634,198 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$561,461 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $224,265 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$337,196 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$337,196 (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 | 20 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 7,320 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,833 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 836 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 3,680 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 6,349 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 62 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 8 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 63 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 133 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 29.56 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 104.5 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 47.74 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1435177, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2023, ended December 31, 2023
Cost report for January 1, 2023 to December 31, 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on August 13, 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,105,651 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,921,128 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,184,523 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,771,324 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$586,801 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $374,776 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$212,025 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$212,025 (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 | 20 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 6,597 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 122 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 31.69 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 117.43 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 54.07 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1392037, read from the public cost report file SNF10FY2023.zip.
Fiscal year 2022, ended December 31, 2022
Cost report for January 1, 2022 to December 31, 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on July 27, 2023.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,033,571 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $2,106,714 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,926,857 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,792,047 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$865,190 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | −$70,612 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$935,802 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$935,977 (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 | 20 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 6,573 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 165 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 31.92 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 62.47 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 39.84 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1360099, 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 23, 2022.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $5,069,954 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,996,018 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,073,936 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,545,409 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$471,473 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $369,414 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$102,059 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$102,059 (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 | 20 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 6,386 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 148 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 38.29 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 43.5 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 43.15 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1330440, 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 November 11, 2021.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,977,217 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,600,567 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,376,650 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,802,196 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$425,546 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $171,211 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$254,335 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$254,335 (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 | 20 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 4,909 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 121 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 35.63 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 48.71 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 40.57 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1304290, read from the public cost report file SNF10FY2020.zip.
Fiscal year 2019, ended December 31, 2019
Cost report for January 1, 2019 to December 31, 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on August 27, 2020.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,071,384 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,474,723 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,596,661 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,992,490 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$395,829 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $181,929 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$213,900 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$213,900 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 2,821 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 100 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.95 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 28.21 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1265242, read from the public cost report file SNF10FY2019.zip.
Fiscal year 2018, ended December 31, 2018
Cost report for January 1, 2018 to December 31, 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on July 10, 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,925,816 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,432,001 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,493,815 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,920,200 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$426,385 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | −$45,327 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$471,712 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$471,712 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 2,764 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 103 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.07 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 26.83 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1235754, read from the public cost report file SNF10FY2018.zip.
Fiscal year 2017, ended December 31, 2017
Cost report for January 1, 2017 to December 31, 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on July 19, 2018.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,869,401 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,424,067 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,445,334 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,659,296 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$213,962 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $115,113 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$98,849 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$98,849 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 2,741 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 100 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 27.8 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 54.75 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 27.41 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1200041, 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 July 17, 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,019,265 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,497,818 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,521,447 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,731,160 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$209,713 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $87,333 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$122,380 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$122,380 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 3,006 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 91 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 30.77 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 33.03 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1169353, 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 August 18, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,830,497 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,298,677 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,531,820 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,789,480 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$257,660 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | −$10,900 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$268,560 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$268,560 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 3,016 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 106 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.16 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 28.45 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1141740, 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 September 30, 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,821,144 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,306,494 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,514,650 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,671,720 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$157,070 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $1,785 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$155,285 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$155,285 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 3,086 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 103 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 32.1 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 209 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 29.96 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1143807, 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 November 12, 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,596,217 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $1,149,707 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,446,510 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,565,930 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$119,420 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $104,731 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$14,689 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$14,689 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 2,997 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 88 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 31.05 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 137 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 34.06 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1112589, 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, as submitted, processed by CMS on July 23, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,146,569 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $974,703 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,171,866 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,419,934 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$248,068 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $116,092 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$131,976 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$131,976 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 2,827 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 107 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 24.18 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 134 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 26.42 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1042635, 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 May 31, 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,030,352 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $704,917 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $1,325,435 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,400,184 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$74,749 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $9,951 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$64,798 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$64,798 (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 | 10 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 2,773 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 91 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 28.31 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 150 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 30.47 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1031185, 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 October 26, 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,214,690 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,298,056 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$83,366 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $64,593 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | −$6,551 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: −$12,222 (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 | 10 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 2,588 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 89 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 24.83 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 206 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 29.08 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 433117, 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 May 6, 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,519,673 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,450,388 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $69,285 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $148,659 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $1,476 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: $216,468 (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 | 10 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 3,164 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 78 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 35.88 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 202.5 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 40.56 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 398904, 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 July 29, 2009.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $1,077,647 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,069,363 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $8,284 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $66,412 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $222,029 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income: −$147,333 (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 | 10 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 3,286 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 64 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 31.67 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 78.7 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 51.34 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 353204, read from the public cost report file SNFFY2008.zip.
Fiscal year 2007, ended December 31, 2007
Cost report for October 10, 2007 to December 31, 2007 — a reporting period of 82 days, not a full year, on form CMS-2540-96, settled, processed by CMS on September 12, 2008.
None of these figures is carried on this report.
CMS report record 325771, 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 |
|---|---|---|---|---|
| OTTERBEIN LSC, LLC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | since 01/01/2016 |
| OTTERBEIN HOME | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Organization | 100% | since 12/01/2021 |
| FUNCTIONAL PATHWAYS OF TENNESSEE LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 04/04/2025 |
| LENTHE, JENNIFER | ADP OF THE SNF | Individual | NOT APPLICABLE | since 08/10/2012 |
| OTTERBEIN HOME | ADP OF THE SNF | Organization | NOT APPLICABLE | since 12/01/2021 |
| PIERCE, JOHN | ADP OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2021 |
| POLARIS PHARMACY SERVICES OF OHIO LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | since 12/01/2018 |
| APP, LYNN | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 07/01/2014 |
| GREEN, JAMES | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 11/21/2005 |
| MILLER, JASON | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 07/24/2014 |
| WILSON, JILL | CORPORATE OFFICER | Individual | NOT APPLICABLE | since 05/01/2009 |
| BAKER, STEVE | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/04/2025 |
| GALBUT, ABRAHAM | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/04/2025 |
| GALBUT, DANIEL | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/06/2025 |
| GALBUT, DAVID | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/04/2025 |
| GALBUT, ERIC | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/06/2025 |
| GALBUT, ROBERT | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/04/2025 |
| PARITZKY, JONATHAN | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/04/2025 |
| ROMBRO, DAVID | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/04/2025 |
| ZISEK, TODD | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | Individual | NOT APPLICABLE | since 04/04/2025 |
| BELL, KEB | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2024 |
| FARIS, MARILYN | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2020 |
| JOHNSON, BECKY | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2023 |
| OCKE, SCOT | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2024 |
| PALMER, ROBYN | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2023 |
| PYTLIK, CAROLYN | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 01/01/2024 |
| SIBBRING, ELIZABETH | MANAGING CONTROL - GOVERNING BODY | Individual | NOT APPLICABLE | since 12/01/2021 |
| APP, LYNN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| BARTLETT, VICTORIA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| BAYLIFF, BECKY | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| BROWNSON, WILLIAM | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| BURKE, DANIEL | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| COLEMAN, ROBERT | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| FRALEY, RALPH | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| FUNCTIONAL PATHWAYS OF TENNESSEE LLC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 12/01/2018 |
| GLOSSER, HEIDI | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| GREEN, JAMES | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| HAWKINS, RITA | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 01/16/2006 |
| HAZELBAKER, TOMAS | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| LENTHE, JENNIFER | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 08/10/2012 |
| OTTERBEIN HOME | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | since 12/01/2021 |
| PIERCE, JOHN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| VONDERHAAR, STEVE | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | since 12/01/2021 |
| BELL, KEB | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2024 |
| FARIS, MARILYN | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2020 |
| JOHNSON, BECKY | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2023 |
| OCKE, SCOT | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2024 |
| PALMER, ROBYN | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2023 |
| PYTLIK, CAROLYN | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 01/01/2024 |
| SIBBRING, ELIZABETH | TRUSTEE OF THE SNF | Individual | NOT APPLICABLE | since 12/01/2021 |
Medicare enrollment
As filed in the CMS file dated August 1, 2026 (Medicare enrollment ownership), under the enrollment of NORTH SHORE RETIREMENT COMMUNITY (enrollment ID O20070620000184).
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 |
|---|---|---|---|---|---|
| OTTERBEIN LSC, LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100 | 1/1/2016 | Private equity company: No Real estate investment trust: No Holding company: No |
| OTTERBEIN HOME | Organization | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 100 | 12/1/2021 | Private equity company: No Real estate investment trust: No Holding company: No |
| FUNCTIONAL PATHWAYS OF TENNESSEE LLC | Organization | ADP OF THE SNF | Not stated in the filing | 4/4/2025 | Private equity company: No Real estate investment trust: No Holding company: No |
| JENNIFER LENTHE | Individual | ADP OF THE SNF | Not stated in the filing | 8/10/2012 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN E PIERCE | Individual | ADP OF THE SNF | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| OTTERBEIN HOME | Organization | ADP OF THE SNF | Not stated in the filing | 12/1/2021 | Private equity company: No Real estate investment trust: No Holding company: No |
| POLARIS PHARMACY SERVICES OF OHIO LLC | Organization | ADP OF THE SNF | Not stated in the filing | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| LYNN APP | Individual | CORPORATE DIRECTOR | Not stated in the filing | 7/1/2014 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JAMES CHRISTOPHER GREEN | Individual | CORPORATE OFFICER | Not stated in the filing | 11/21/2005 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JASON E MILLER | Individual | CORPORATE OFFICER | Not stated in the filing | 7/24/2014 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JILL WILSON | Individual | CORPORATE OFFICER | Not stated in the filing | 5/1/2009 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BECKY JOHNSON | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 1/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| CAROLYN PYTLIK | Individual | MANAGING CONTROL - GOVERNING BODY | 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 |
| ELIZABETH SIBBRING | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| KEB BELL | Individual | MANAGING CONTROL - GOVERNING BODY | 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 |
| MARILYN FARIS | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 1/1/2020 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ROBYN PALMER | Individual | MANAGING CONTROL - GOVERNING BODY | Not stated in the filing | 1/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| SCOT OCKE | Individual | MANAGING CONTROL - GOVERNING BODY | 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 |
| BECKY BAYLIFF | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| DANIEL BURKE | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| FUNCTIONAL PATHWAYS OF TENNESSEE LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2018 | Private equity company: No Real estate investment trust: No Holding company: No |
| HEIDI GLOSSER | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JAMES CHRISTOPHER GREEN | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JENNIFER LENTHE | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 8/10/2012 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JOHN E PIERCE | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| LYNN APP | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| OTTERBEIN HOME | Organization | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: No Real estate investment trust: No Holding company: No |
| RALPH REED FRALEY | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| RITA C HAWKINS | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 1/16/2006 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ROBERT COLEMAN | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| STEVE VONDERHAAR | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| TOMAS HAZELBAKER | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| VICTORIA BARTLETT | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| WILLIAM BROWNSON | Individual | OPERATIONAL/MANAGERIAL CONTROL | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| BECKY JOHNSON | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 1/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| CAROLYN PYTLIK | Individual | TRUSTEE 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 |
| ELIZABETH SIBBRING | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 12/1/2021 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| KEB BELL | Individual | TRUSTEE 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 |
| MARILYN FARIS | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 1/1/2020 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ROBYN PALMER | Individual | TRUSTEE OF THE SNF | Not stated in the filing | 1/1/2023 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| SCOT OCKE | Individual | TRUSTEE 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 |
Changes in ownership
- August 1, 2025: CAROL MORGAN no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: RALPH METHENY no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: HELEN J ROFKAR no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JASON E MILLER no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: VERNON L SHEPHERD no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JENNIFER LENTHE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEVE VONDERHAAR (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: LYNN APP (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DANIEL BURKE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: CAROLYN PYTLIK (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: CAROLYN PYTLIK (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ROBERT COLEMAN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JAMES CHRISTOPHER GREEN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: OTTERBEIN HOMES (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: OTTERBEIN HOMES (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SCOT OCKE (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SCOT OCKE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ROBYN PALMER (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ROBYN PALMER (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN E PIERCE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN E PIERCE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BECKY JOHNSON (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BECKY JOHNSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: FUNCTIONAL PATHWAYS OF TENNESSEE LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since April 4, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: FUNCTIONAL PATHWAYS OF TENNESSEE LLC (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: OTTERBEIN LSC, LLC (5% OR GREATER DIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2016. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: RALPH REED FRALEY (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: TOMAS HAZELBAKER (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARILYN FARIS (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2020. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARILYN FARIS (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2020. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEB BELL (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEB BELL (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: WILLIAM BROWNSON (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: VICTORIA BARTLETT (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: HEIDI GLOSSER (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JASON E MILLER (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since July 24, 2014. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: POLARIS PHARMACY SERVICES OF OHIO LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ELIZABETH SIBBRING (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ELIZABETH SIBBRING (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BECKY BAYLIFF (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JENNIFER LENTHE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 10, 2012. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JENNIFER LENTHE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since August 10, 2012. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
Recent changes on this record
- August 28, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- August 1, 2025: CAROL MORGAN no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: RALPH METHENY no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: HELEN J ROFKAR no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JASON E MILLER no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: VERNON L SHEPHERD no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JENNIFER LENTHE no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: STEVE VONDERHAAR (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: LYNN APP (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: DANIEL BURKE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: CAROLYN PYTLIK (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: CAROLYN PYTLIK (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ROBERT COLEMAN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JAMES CHRISTOPHER GREEN (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: OTTERBEIN HOMES (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: OTTERBEIN HOMES (5% OR GREATER INDIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SCOT OCKE (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: SCOT OCKE (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ROBYN PALMER (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ROBYN PALMER (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN E PIERCE (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JOHN E PIERCE (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BECKY JOHNSON (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: BECKY JOHNSON (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2023. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: FUNCTIONAL PATHWAYS OF TENNESSEE LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since April 4, 2025. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: FUNCTIONAL PATHWAYS OF TENNESSEE LLC (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: OTTERBEIN LSC, LLC (5% OR GREATER DIRECT OWNERSHIP INTEREST) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2016. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: RALPH REED FRALEY (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: TOMAS HAZELBAKER (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARILYN FARIS (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2020. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: MARILYN FARIS (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2020. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEB BELL (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: KEB BELL (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since January 1, 2024. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: WILLIAM BROWNSON (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: VICTORIA BARTLETT (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: HEIDI GLOSSER (OPERATIONAL/MANAGERIAL CONTROL) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: JASON E MILLER (CORPORATE OFFICER) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since July 24, 2014. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: POLARIS PHARMACY SERVICES OF OHIO LLC (ADP OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2018. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ELIZABETH SIBBRING (TRUSTEE OF THE SNF) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
- August 1, 2025: ELIZABETH SIBBRING (MANAGING CONTROL - GOVERNING BODY) first listed in CMS’s Medicare enrollment ownership file on August 1, 2025; associated with this enrollment since December 1, 2021. Skilled_Nursing_Facility_All_Owners_:_2025-08-01.csv
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | March 27, 2026 | March 27, 2026 | 8 | 1 |
| 2 | April 17, 2025 | April 17, 2025 | 8 | 10 |
| 3 | March 23, 2023 | March 23, 2023 | 5 | 6 |
From the Care Compare inspection summary file NH_SurveySummary_Sep2026_2.csv, processed on September 1, 2026.
Deficiencies cited
21 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| March 27, 2026 | Health | F 0578 | Resident Rights Deficiencies | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | D | No | Deficient, Provider has date of correction | April 16, 2026 |
| March 27, 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 | Deficient, Provider has date of correction | April 16, 2026 |
| March 27, 2026 | Health | F 0686 | Quality of Life and Care Deficiencies | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | No | Deficient, Provider has date of correction | April 16, 2026 |
| March 27, 2026 | Health | F 0692 | Quality of Life and Care Deficiencies | Provide enough food/fluids to maintain a resident's health. | D | Yes | Deficient, Provider has date of correction | April 16, 2026 |
| March 27, 2026 | Health | F 0755 | Pharmacy Service Deficiencies | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Yes | Deficient, Provider has date of correction | April 16, 2026 |
| March 27, 2026 | Health | F 0760 | Pharmacy Service Deficiencies | Ensure that residents are free from significant medication errors. | D | Yes | Deficient, Provider has date of correction | April 16, 2026 |
| March 27, 2026 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | April 16, 2026 |
| September 22, 2025 | Health | F 0689 | Quality of Life and Care Deficiencies | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Yes | Deficient, Provider has date of correction | November 3, 2025 |
| April 17, 2025 | Health | F 0558 | Resident Rights Deficiencies | Reasonably accommodate the needs and preferences of each resident. | D | No | Deficient, Provider has date of correction | May 30, 2025 |
| April 17, 2025 | Health | F 0575 | Resident Rights Deficiencies | Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency. | B | No | Deficient, Provider has plan of correction | April 30, 2025 |
| April 17, 2025 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | No | Deficient, Provider has date of correction | May 30, 2025 |
| April 17, 2025 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | No | Deficient, Provider has date of correction | May 30, 2025 |
| April 17, 2025 | Health | F 0732 | Nursing and Physician Services Deficiencies | Post nurse staffing information every day. | B | No | Deficient, Provider has plan of correction | April 30, 2025 |
| April 17, 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 | May 30, 2025 |
| April 17, 2025 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | May 30, 2025 |
| April 17, 2025 | Health | F 0883 | Infection Control Deficiencies | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | No | Deficient, Provider has date of correction | May 30, 2025 |
| June 17, 2024 | Health | F 0607 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | D | Yes | Deficient, Provider has date of correction | July 1, 2024 |
| June 17, 2024 | Health | F 0851 | Administration Deficiencies | Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | F | Yes | Deficient, Provider has date of correction | July 1, 2024 |
| March 23, 2023 | 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 | April 27, 2023 |
| March 23, 2023 | Health | F 0868 | Administration Deficiencies | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | C | No | Deficient, Provider has plan of correction | April 18, 2023 |
| March 23, 2023 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | E | No | Deficient, Provider has date of correction | April 27, 2023 |
From the Care Compare health citations file NH_HealthCitations_Sep2026_2.csv, processed on September 1, 2026.
Penalties
No penalty on file for this facility in CMS’s Care Compare penalties data.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | Non profit - Corporation |
| Legal Business Name | NORTH SHORE RETIREMENT COMMUNITY |
| Date First Approved to Provide Medicare and Medicaid Services | 2007-10-10 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | Y |
| Urban | Y |
| County/Parish | Ottawa |
| Telephone Number | 4197988203 |
| Chain Name | OTTERBEIN SENIORLIFE |
| Chain ID | 389 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | None |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Number of Certified Beds | 20 |
| Average Number of Residents per Day | 19.1 |
| Overall Rating | 5 |
| Health Inspection Rating | 4 |
| QM Rating | 4 |
| Long-Stay QM Rating | 4 |
| Short-Stay QM Rating | 4 |
| 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 OTTERBEIN NORTH SHORE: the field, the value before, the value after, and the date of the file that first showed it.
The facility alert follows this one record: a cost report filed or a figure on one changed, an inspection, a deficiency or a penalty recorded, an owner added or removed. The certification number arrives filled in.
On August 28, 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. That is one line of the alert.
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 OTTERBEIN NORTH SHORE
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 366358.