SNFData - 235224 - 12/2001 - Worksheet G-2, Part I

LENAWEE COUNTY MEDICAL CARE FACILITY
ADRIAN, MI

Medicare Provider Number: 235224

Cost report status: Settled Without Audit

[Record Code 159611 - 1996]

Excel

PDF

You are not logged in or you have not purchased this report. This report has had its actual values replaced with dummy text ('###').

If you would like to become a subscriber, please look at our subscription details.

If you are already a subscriber, please login.

STATEMENT OF PATIENT REVENUES AND OPERATING EXPENSES PART I - PATIENT REVENUES		PROVIDER NO: 235224	PERIOD: FROM 01/01/2001 TO 12/31/2001	WORKSHEET G2 PART I
PART I - PATIENT REVENUES
Revenue Center		INPATIENT	OUTPATIENT	TOTAL
Revenue Center		1	2	3
GENERAL INPATIENT ROUTINE CARE SERVICES
1	Skilled Nursing Facility	###		###	1
2					2
3	Nursing facility	###		###	3
4	Other long term care				4
5	Total general inpatient care services (Sum of lines 1 - 4)	###		###	5
All Other Care Service
6	Ancillary services				6
7	Clinic				7
8	Home health agency				8
9					9
10	Ambulance				10
11	Hospice				11
12	Outpatient Rehabilitation Provider				12
13					13
14	Total Patient Revenues (Sum of lines 5 - 13; Transfer column 3 to Worksheet G-3, Line 1)	###		###	14
PART II - OPERATING EXPENSES			1	2
1	Operating Expenses (Per Worksheet A, Col. 3, Line 75)		###		1
2	Add (Specify)				2
3					3
4					4
5					5
6					6
7					7
8	Total Additions (Sum of lines 2 - 7)				8
9	Deduct (Specify)				9
10					10
11					11
12					12
13					13
14	Total Deductions (Sum of lines 9 - 13)				14
15	Total Operating Expenses (Sum of lines 1 and 8, minus line 14) (Transfer to Worksheet G-3, Line 4)		###		15