SNFData - 676019 - 12/2011

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Form S700
INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV

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LAMPSTAND HLTH & REHAB OF BRYAN LLC
BRYAN, TX 77802

Medicare Provider Number: 676019

Cost report status: Settled Without Audit

[Record Code 1014925 - 2010]

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PROSPECTIVE PAYMENT FOR SNF STATISTICAL DATA		Provider CCN: 676019	PERIOD: FROM 01/01/2011 TO 12/31/2011	WORKSHEET S-7
	RUGS GROUPS (Through September 30, 2019)			Days
	1			2
1	RUX				1
2	RUL			###	2
3	RVX				3
4	RVL			###	4
5	RHX				5
6	RHL			###	6
7	RMX			###	7
8	RML				8
9	RLX				9
10	RUC			###	10
11	RUB			###	11
12	RUA			###	12
13	RVC			###	13
14	RVB			###	14
15	RVA			###	15
16	RHC			###	16
17	RHB			###	17
18	RHA			###	18
19	RMC			###	19
20	RMB			###	20
21	RMA			###	21
22	RLB				22
23	RLA			###	23
24	ES3				24
25	ES2			###	25
26	ES1				26
27	HE2			###	27
28	HE1				28
29	HD2			###	29
30	HD1			###	30
31	HC2			###	31
32	HC1			###	32
33	HB2			###	33
34	HB1			###	34
35	LE2			###	35
36	LE1				36
37	LD2			###	37
38	LD1			###	38
39	LC2			###	39
40	LC1			###	40
41	LB2				41
42	LB1			###	42
43	CE2			###	43
44	CE1			###	44
45	CD2			###	45
46	CD1			###	46
47	CC2			###	47
48	CC1			###	48
49	CB2				49
50	CB1			###	50
51	CA2			###	51
52	CA1			###	52
53	SE3				53
54	SE2				54
55	SE1				55
56	SSC				56
57	SSB				57
58	SSA				58
59	IB2				59
60	IB1				60
61	IA2				61
62	IA1				62
63	BB2			###	63
64	BB1			###	64
65	BA2			###	65
66	BA1			###	66
67	PE2				67
68	PE1				68
69	PD2			###	69
70	PD1			###	70
71	PC2			###	71
72	PC1			###	72
73	PB2				73
74	PB1			###	74
75	PA2			###	75
76	PA1			###	76
99	AAA			###	99
100	Total			###	100
A notice published in the "Federal Register" Vol. 68, No. 149 August 4, 2003 provided for an increase in the RUG payments beginning 10/01/2003 Congress expected this increase to be used for direct patient care and related expenses. For lines 101 through 106: Enter in column 1 the amount of expense for each category. Enter in column 2 the percentage of total expenses for each category to total SNF revenue from Worksheet G-2, Part I line 1 column 3. Indicate in column 3 "Y" for yes or "N" for no if the spending reflects increases associated with direct patient care and related expenses for each category. (If column 2 is zero, enter N/A in column 3) (see instructions)
		Expenses	Percentage	Y/N
		1	2	3
101	Staffing	###	###	###	101
102	Recruitment			###	102
103	Retention of employees			###	103
104	Training			###	104
105	Other (Specify)			###	105
106	Total SNF revenue (Wkst. G-2, Pt. I, line 1, col. 3)		###		106

FORM CMS-2540-10 (11/2019) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTIONS 4109 - 4109.1)
41-314				Rev. 9

Worksheet S-7