MANCHESTER MANOR NURSING HOME
LAKEHURST, NJ  08733

Medicare Provider Number: 315196
Cost report status: Reopened
[Record Code 167362 - 1996]

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SNF WAGE INDEX INFORMATION
PROVIDER NO:
315196
PERIOD:
FROM 01/01/2002
TO 12/31/2002
WORKSHEET S-3, Part II
PART II DIRECT SALARIES
Amount
Reported
Reclass.
of Salaries
from Wkst.
A-6
Adjusted
Salaries
(col. 1 ±
col. 2)
Paid Hours
Related
to Salary
in col. 3
Average
Hourly Wage
(col. 3 ÷
col. 4)
Data
Source
 
1 2 3 4 5 6
1 Total salary (See Instructions) ### ### ### ###   1
2 Physician salaries-Part A   2
3 Physician salaries-Part B   3
4 Interns & Residents (approved)   4
5 Home office personnel   5
6 Sum of lines 2 thru 5   6
7 Revised wages (line 1 minus line 6) ### ### ### ###   7
8 Other Long Term Care   8
9 Other Inpatient Routine Service   9
10 Interns & Residents (Not In Approved Program)   10
11 HHA   11
12 Outpatient Rehabilitation Providers   12
13 Hospice   13
14 Non-reimbursable   14
15 Total Excluded salary (Sum of lines 8 through 14)   15
16 Subtotal (line 7 minus line 15) ### ### ### ###   16
17 Contract Labor: Patient Related & Mgmt CMS 339 17
18 Home office salaries & wage related costs   18
19 Wage related costs (core) ### ###     CMS 339 19
20 Wage related costs (other)     CMS 339 20
21 Wage related costs (excluded units)     CMS 339 21
22 Subtotal (see instructions) ### ###   ###   22
23 Total (see instructions) ### ### ### ###   23
24 Contract Labor: Physician services-Part A   24
PART III - OVERHEAD COST - DIRECT SALARIES
   
Amount
Reported
Reclass.
of Salaries
from Wkst.
A-6
Adjusted
Salaries
(col. 1 ±
col. 2)
Paid Hours
Related
to Salary
in col. 3
Average
Hourly Wage
(col. 3 ÷
col. 4)
   
1 Employee Benefits   1
2 Administrative & General ### ### ### ###   2
3 Plant Operation, Maintenance & Repairs ### ### ### ###   3
4 Laundry & Linen Service   4
5 Housekeeping   5
6 Dietary ### ### ### ###   6
7 Nursing Administration ### ### ### ###   7
8 Central Services and Supply ### ### ### ###   8
9 Pharmacy   9
10 Medical Records & Library ### ### ### ###   10
11 Social Service ### ### ### ###   11
12 Interns & Residents (Apprvd Teaching Prog)   12
13 Other General Service (specify) ### ### ### ###   13
14 Total (sum lines 1 thru 13) ### ### ### ###   14