Worksheet A-7
- Return to Cost Report Summary
- Form A700
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV
QUIBURI MISSION SAMARITAN CENTER
BENSON, AZ 85302-6988
BENSON, AZ 85302-6988
Medicare Provider Number: 035214
Cost report status: Settled Without Audit
[Record Code 201532 - 1996]
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ANALYSIS OF CHANGES DURING COST REPORTING PERIOD IN CAPITAL ASSET BALANCES |
PROVIDER NO: 035214 |
PERIOD: FROM 01/01/2003 TO 12/31/2003 |
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 | ||