CLEMMONS NURSING AND REHAB CENTER
CLEMMONS, NC  27012

Medicare Provider Number: 345131
Cost report status: Settled Without Audit
[Record Code 405665 - 1996]

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ANALYSIS OF CHANGES DURING COST REPORTING PERIOD IN CAPITAL ASSET BALANCES
PROVIDER NO:
345131
PERIOD:
FROM 10/01/2008
TO 09/30/2009
WORKSHEET A-7
  Description
Beginning
Balances
Purchases
Acquisitions
Donation
Total
Disposals
and
Retirements
Ending
Balance
 
1 2 3 4 5 6
1 Land 1
2 Land Improvements 2
3 Buildings and Fixtures 3
4 Building Improvements 4
5 Fixed Equipment ### ### ### ### 5
6 Movable Equipment ### ### ### ### 6
7 TOTAL ### ### ### ### ### 7