Worksheet A-6
- Return to Cost Report Summary
- Form A600
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV 2
GAINESVILLE HEALTH & REHAB CENTER
GAINESVILLE, VA 20155
GAINESVILLE, VA 20155
Medicare Provider Number: 495388
Cost report status: Settled Without Audit
[Record Code 1368360 - 2010]
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RECLASSIFICATIONS | Provider CCN: 495388 | PERIOD: FROM 01/01/2022 TO 12/31/2022 |
WORKSHEET A-6 | ||||||||
- Select other programs and provider types available | |||||||||||
EXPLANATION OF RECLASSIFICATION(S) | CODE (1) |
INCREASE | DECREASE | ||||||||
COST CENTER | LN NO. | SALARY | NON SALARY | COST CENTER | LN NO. | SALARY | NON SALARY | ||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||
1 | 1 | ||||||||||
2 | 2 | ||||||||||
3 | 3 | ||||||||||
4 | 4 | ||||||||||
5 | 5 | ||||||||||
6 | 6 | ||||||||||
7 | 7 | ||||||||||
8 | 8 | ||||||||||
9 | 9 | ||||||||||
10 | 10 | ||||||||||
11 | 11 | ||||||||||
12 | 12 | ||||||||||
13 | 13 | ||||||||||
14 | 14 | ||||||||||
15 | 15 | ||||||||||
16 | 16 | ||||||||||
17 | 17 | ||||||||||
18 | 18 | ||||||||||
19 | 19 | ||||||||||
20 | 20 | ||||||||||
21 | 21 | ||||||||||
22 | 22 | ||||||||||
23 | 23 | ||||||||||
24 | 24 | ||||||||||
25 | 25 | ||||||||||
26 | 26 | ||||||||||
27 | 27 | ||||||||||
28 | 28 | ||||||||||
29 | 29 | ||||||||||
30 | 30 | ||||||||||
31 | 31 | ||||||||||
32 | 32 | ||||||||||
33 | 33 | ||||||||||
34 | 34 | ||||||||||
35 | 35 | ||||||||||
100 | TOTAL RECLASSIFICATIONS (Sum of columns 4 and 5 must equal sum of columns 8 and 9 (2) | ### | ### | 100 | |||||||
(1) A letter (A, B, etc.) must be entered on each line to identify each reclassification entry. (2) Transfer the amounts in columns 4, 5, 8 and 9 to Worksheet A, column 4, lines as appropriate. |
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FORM CMS-2540-10 (09/2011) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4114) | |||||||||||
41-318 | Rev. 2 |