234x Filetype XLS File size 0.92 MB Source: myersandstauffer.com
Data Schedule Line Column Description 0 Facility Description 1 Number Medicaid Provider Number 0 Facility Description 2 Name Name of Facility 0 Facility Description 3 Street Street Address 0 Facility Description 3 City City 0 Facility Description 3 Zip Zip Code 0 Facility Description 3 County County 0 Facility Description 3 Phone Phone 0 Facility Description 4 FEIN Federal Employer Identification No. 0 Facility Description 5 Contact Person to contact for questions 0 Facility Description 6 Phone Phone 12/30/1899 Facility Description 7 Begin Fiscal Year Begin 12/30/1899 Facility Description 8 End Fiscal Year End 0 Facility Description 9 Yes Change in Ownership During Year-Yes 0 Facility Description 9 No Change in Ownership During Year-No 0 Facility Description 10 Seller If yes, this Cost Report, For-Seller 0 Facility Description 10 Buyer If yes, this Cost Report, For-Buyer 0 Facility Description 11 Indiv Type of Ownership-Individual 0 Facility Description 11 Partner Type of Ownership-Partnership 0 Facility Description 11 Corp Type of Ownership-Corporation 0 Facility Description 11 Church Type of Ownership-Church 0 Facility Description 11 Other Type of Ownership-Other (specify) 0 Facility Description 11 Specify Type of Ownership-Other (specify)-description 0 Facility Description 11 State Type of Ownership-State 0 Facility Description 11 County Type of Ownership-County 0 Facility Description 11 City Type of Ownership-City 0 Facility Description 13 Yes Constructed with Tax Exempt Financing?-Yes 0 Facility Description 13 No Constructed with Tax Exempt Financing?-No 0 Index 3 Yes Occupancy and Rate Data-Yes 0 Index 4 Yes Certification of Provider-Yes 0 Index 4 Yes Statement of Operations-Yes 0 Index 5 Yes Supporting Schedules-Revenues-Yes 0 Index 6 Yes Supporting Schedules-Allowances-Yes 0 Index 7 Yes Supporting Schedules-Nursing Care-Yes 0 Index 8 Yes Supporting Schedules-Other Patient Care-Yes 0 Index 9 Yes Supporting Schedules-Routine-Yes 0 Index 10 Yes Supporting Schedules-Administrative-Yes 0 Index 11 Yes Supporting Schedules-Capital/Property-Yes 0 Index 12 Yes Supporting Schedules-Non-operating Revenues-Yes 0 Index 13 Yes Adjustments to Expenses-Yes 0 Index 16 Yes Detailed Analysis-Owner and Administrator-Yes 0 Index 17 Yes Detailed Analysis-Employee Benefits-Yes 0 Index 18 Yes Detailed Analysis-Central Office Overhead-Yes 0 Index 19 Yes Detailed Analysis-Allocation of Indirect Expenses-Yes 0 Index 21 Yes Detailed Analysis-Services From Related Parties-Yes 0 Index 22 Yes Analysis of Capital-Yes 0 Index 23 Yes Analysis of Fund Balances-Yes 0 Index 24 Yes Balance Sheet-Proprietary Facilities-Yes 0 Index 26 Yes Balance Sheet-Voluntary Facilities-Yes 0 Index 29 Yes Detailed Analysis-Fixed Assets-Yes 0 Index 30 Yes Detailed Analysis-Depreciation-Yes 0 Index 31 Yes Detailed Analysis-Interest and Loans-Yes 0 Index 32 Yes Detailed Analysis-Leases-Yes 0 Index 33 Yes Patient Trust Funds-Yes 0 Index 34 Yes Questionnaire & Checklist-Yes 0 Index 3 No Occupancy and Rate Data-No 0 Index 4 No Certification of Provider-No 0 Index 4 No Statement of Operations-No 0 Index 5 No Supporting Schedules-Revenues-No 0 Index 6 No Supporting Schedules-Allowances-No 0 Index 7 No Supporting Schedules-Nursing Care-No 0 Index 8 No Supporting Schedules-Other Patient Care-No 0 Index 9 No Supporting Schedules-Routine-No 0 Index 10 No Supporting Schedules-Administrative-No 0 Index 11 No Supporting Schedules-Capital/Property-No 0 Index 12 No Supporting Schedules-Non-operating Revenues-No 0 Index 13 No Adjustments to Expenses-No 0 Index 16 No Detailed Analysis-Owner and Administrator-No 0 Index 17 No Detailed Analysis-Employee Benefits-No 0 Index 18 No Detailed Analysis-Central Office Overhead-No 0 Index 19 No Detailed Analysis-Allocation of Indirect Expenses-No 0 Index 21 No Detailed Analysis-Services From Related Parties-No 0 Index 22 No Analysis of Capital-No 0 Index 23 No Analysis of Fund Balances-No 0 Index 24 No Balance Sheet-Proprietary Facilities-No 0 Index 26 No Balance Sheet-Voluntary Facilities-No 0 Index 29 No Detailed Analysis-Fixed Assets-No 0 Index 30 No Detailed Analysis-Depreciation-No 0 Index 31 No Detailed Analysis-Interest and Loans-No 0 Index 32 No Detailed Analysis-Leases-No 0 Index 33 No Patient Trust Funds-No 0 Index 34 No Questionnaire & Checklist-No 0 Occupancy 1 Month Inpatient Days by Class of License Month 0 Occupancy 2 Month Inpatient Days by Class of License Month 0 Occupancy 3 Month Inpatient Days by Class of License Month 0 Occupancy 4 Month Inpatient Days by Class of License Month 0 Occupancy 5 Month Inpatient Days by Class of License Month 0 Occupancy 6 Month Inpatient Days by Class of License Month 0 Occupancy 7 Month Inpatient Days by Class of License Month 0 Occupancy 8 Month Inpatient Days by Class of License Month 0 Occupancy 9 Month Inpatient Days by Class of License Month 0 Occupancy 10 Month Inpatient Days by Class of License Month 0 Occupancy 11 Month Inpatient Days by Class of License Month 0 Occupancy 12 Month Inpatient Days by Class of License Month 0 Occupancy 12a Month Inpatient Days by Class of License Month 0 Occupancy 12b Month Inpatient Days by Class of License Month Other (SpeciOccupancy 23 Month Daily Minimum Semi-Private Rate-Other (Specify) Description 0 Occupancy 24 Month Daily Minimum Semi-Private Rate-Other (Specify) Description 0 Occupancy 1 1 Inpatient Days-Comprehensive-Private 0 Occupancy 2 1 Inpatient Days-Comprehensive-Private 0 Occupancy 3 1 Inpatient Days-Comprehensive-Private 0 Occupancy 4 1 Inpatient Days-Comprehensive-Private 0 Occupancy 5 1 Inpatient Days-Comprehensive-Private 0 Occupancy 6 1 Inpatient Days-Comprehensive-Private 0 Occupancy 7 1 Inpatient Days-Comprehensive-Private 0 Occupancy 8 1 Inpatient Days-Comprehensive-Private 0 Occupancy 9 1 Inpatient Days-Comprehensive-Private 0 Occupancy 10 1 Inpatient Days-Comprehensive-Private 0 Occupancy 11 1 Inpatient Days-Comprehensive-Private 0 Occupancy 12 1 Inpatient Days-Comprehensive-Private 0 Occupancy 12a 1 Inpatient Days-Comprehensive-Private 0 Occupancy 12b 1 Inpatient Days-Comprehensive-Private 0 Occupancy 1 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 2 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 3 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 4 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 5 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 6 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 7 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 8 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 9 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 10 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 11 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 12 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 12a 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 12b 2 Inpatient Days-Comprehensive-Maryland MA 0 Occupancy 1 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 2 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 3 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 4 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 5 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 6 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 7 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 8 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 9 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 10 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 11 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 12 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 12a 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 12b 5 Inpatient Days-Comprehensive-Other Govt. 0 Occupancy 15 5 Licensed beds at beginning of period-Comprehensive 0 Occupancy 16 5 Licensed beds at end of period-Comprehensive 0 Occupancy 17 5 Dates of change in number of certified beds-Comprehensive 0 Occupancy 18 5 Bed Days available during the period-Comprehensive 0 Occupancy 20 5 Daily Minimum Semi-Private Rate-Comprehensive 0 Occupancy 21 5 Daily Minimum Semi-Private Rate-Comprehensive 0 Occupancy 22 5 Daily Minimum Semi-Private Rate-Comprehensive 0 Occupancy 23 5 Daily Minimum Semi-Private Rate-Comprehensive 0 Occupancy 24 5 Daily Minimum Semi-Private Rate-Comprehensive 0 Occupancy 1 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 2 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 3 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 4 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 5 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 6 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 7 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 8 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 9 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 10 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 11 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 12 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 12a 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 12b 6 Inpatient Days-Non-Comprehensive-Domiciliary 0 Occupancy 15 6 Licensed beds at beginning of period-Non-Comprehensive-Domiciliary 0 Occupancy 16 6 Licensed beds at end of period-Non-Comprehensive-Domiciliary 0 Occupancy 17 6 Dates of change in number of certified beds-Non-Comprehensive-Domiciliary 0 Occupancy 18 6 Bed Days available during the period-Non-Comprehensive-Domiciliary 0 Occupancy 20 6 Daily Minimum Semi-Private Rate-Non-Comprehensive-Domiciliary 0 Occupancy 21 6 Daily Minimum Semi-Private Rate-Non-Comprehensive-Domiciliary 0 Occupancy 22 6 Daily Minimum Semi-Private Rate-Non-Comprehensive-Domiciliary 0 Occupancy 23 6 Daily Minimum Semi-Private Rate-Non-Comprehensive-Domiciliary 0 Occupancy 24 6 Daily Minimum Semi-Private Rate-Non-Comprehensive-Domiciliary 0 Occupancy Specify 7 Inpatient Days-Non-Comprehensive-Specify Description 0 Occupancy 1 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 2 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 3 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 4 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 5 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 6 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 7 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 8 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 9 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 10 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 11 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 12 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 12a 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 12b 7 Inpatient Days-Non-Comprehensive-Specify 0 Occupancy 15 7 Licensed beds at beginning of period-Non-Comprehensive-Specify 0 Occupancy 16 7 Licensed beds at end of period-Non-Comprehensive-Specify 0 Occupancy 17 7 Dates of change in number of certified beds-Non-Comprehensive-Specify 0 Occupancy 18 7 Bed Days available during the period-Non-Comprehensive-Specify 0 Occupancy 20 7 Daily Minimum Semi-Private Rate-Non-Comprehensive-Specify 0 Occupancy 21 7 Daily Minimum Semi-Private Rate-Non-Comprehensive-Specify 0 Occupancy 22 7 Daily Minimum Semi-Private Rate-Non-Comprehensive-Specify 0 Occupancy 23 7 Daily Minimum Semi-Private Rate-Non-Comprehensive-Specify 0 Occupancy 24 7 Daily Minimum Semi-Private Rate-Non-Comprehensive-Specify 0 A 16 2 Provision for Income Taxes ComprehensiB 4 Specify Comprehensive Care-Other Government (specify) Description 0 B 5 Specify Comprehensive Care Description 0 B 6 Specify Comprehensive Care Description
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