Skilled nursing facility · CMS certification number 445542
JEFFERSON PARK AT WHITE PINE
WHITE PINE, Tennessee · Medicare and Medicaid
Certified beds, as filed in Care Compare: 30
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 July 1, 2024 to June 30, 2025 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on November 13, 2025.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $2,872,101 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$99,668 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $2,971,769 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $2,987,761 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$15,992 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $15,619 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$373 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$373 (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 | 33 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 11,091 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,546 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 2,155 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 4,726 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 8,427 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 43 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 2 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 93 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 138 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 35.95 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 1,077.5 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 61.07 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1442338, read from the public cost report file SNF10FY2024.zip.
Fiscal year 2024, ended June 30, 2024
Cost report for October 25, 2023 to June 30, 2024 — a reporting period of 249 days, not a full year, on form CMS-2540-10, settled, processed by CMS on December 11, 2024.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $762,073 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$21,563 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $783,636 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $1,400,480 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$616,844 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $6,843 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$610,001 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$610,001 (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 | 30 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 2,768 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 7 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 96.5 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, all patients, in days | 395.43 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1400732, read from the public cost report file SNF10FY2024.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 |
|---|---|---|---|---|
| MYNATT, ROGER | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 01/02/1992 |
| POTTS, MARK | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | since 08/23/2018 |
| MYNATT, ROGER | W-2 MANAGING EMPLOYEE | Individual | NOT APPLICABLE | since 01/02/1992 |
Medicare enrollment
As filed in the CMS file dated August 1, 2026 (Medicare enrollment ownership), under the enrollment of JEFFERSON COUNTY NURSING HOME (enrollment ID O20221215000144).
CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; where the private equity, real estate investment trust or holding company field below has not been filed under the current cycle, it reads “Paused by CMS”.
| Owner | Individual or organization | Role | Ownership percentage | Association date | Described in the filing as |
|---|---|---|---|---|---|
| MARK POTTS | Individual | CORPORATE DIRECTOR | Not stated in the filing | 8/23/2018 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| ROGER MYNATT | Individual | CORPORATE DIRECTOR | Not stated in the filing | 1/2/1992 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
| JEFFERSON COUNTY NURSING HOME | Organization | OTHER | 100 | 12/11/2019 | Private equity company: No Real estate investment trust: No Holding company: No |
| ROGER MYNATT | Individual | W-2 MANAGING EMPLOYEE | Not stated in the filing | 1/2/1992 | Private equity company: Paused by CMS Real estate investment trust: Paused by CMS Holding company: Paused by CMS |
Changes in ownership
- July 1, 2024: ROGER MYNATT (W-2 MANAGING EMPLOYEE) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since January 2, 1992. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
- July 1, 2024: ROGER MYNATT (DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since January 2, 1992. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
- July 1, 2024: MARK POTTS (DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since August 23, 2018. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
- July 1, 2024: JEFFERSON COUNTY NURSING HOME (OTHER) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since December 11, 2019. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
Recent changes on this record
- November 13, 2025: A cost report was filed for fiscal year 2025, on form CMS-2540-10. SNF10FY2024.zip
- December 11, 2024: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
- July 1, 2024: ROGER MYNATT (W-2 MANAGING EMPLOYEE) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since January 2, 1992. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
- July 1, 2024: ROGER MYNATT (DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since January 2, 1992. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
- July 1, 2024: MARK POTTS (DIRECTOR) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since August 23, 2018. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
- July 1, 2024: JEFFERSON COUNTY NURSING HOME (OTHER) first listed in CMS’s Medicare enrollment ownership file on July 1, 2024; associated with this enrollment since December 11, 2019. Skilled_Nursing_Facility_All_Owners_:_2024-07-01.csv
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | May 28, 2026 | May 28, 2026 | 4 | 5 |
| 2 | October 24, 2023 | October 24, 2023 | 0 | 0 |
From the Care Compare inspection summary file NH_SurveySummary_Sep2026_2.csv, processed on September 1, 2026.
Deficiencies cited
4 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| May 28, 2026 | 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. | C | No | Deficient, Provider has date of correction | June 30, 2026 |
| May 28, 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 | June 30, 2026 |
| May 28, 2026 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Yes | Deficient, Provider has date of correction | June 30, 2026 |
| May 28, 2026 | 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. | B | No | Deficient, Provider has date of correction | June 30, 2026 |
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 | Government - County |
| Legal Business Name | JEFFERSON COUNTY NURSING HOME |
| Date First Approved to Provide Medicare and Medicaid Services | 2023-10-25 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | Y |
| County/Parish | Jefferson |
| Telephone Number | 8653274100 |
| 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 | 30 |
| Average Number of Residents per Day | 28.2 |
| Overall Rating | 4 |
| Health Inspection Rating | 4 |
| QM Rating | 2 |
| Long-Stay QM Rating | 2 |
| Short-Stay QM Rating | 1 |
| Processing Date | 2026-09-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Sep2026_3.csv, processed on September 1, 2026.
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One email a day naming what moved on JEFFERSON PARK AT WHITE PINE: 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 November 13, 2025: A cost report was filed for fiscal year 2025, on form CMS-2540-10. That is one line of the alert.
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The citable document for JEFFERSON PARK AT WHITE PINE
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 Tennessee 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 445542.