MCCREARY COUNTY HEALTH & REHABILITAT
PINE KNOT, KY  42635

Medicare Provider Number: 185211
Cost report status: Settled Without Audit
[Record Code 1023305 - 2010]

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ANALYSIS OF CHANGES IN CAPITAL ASSET BALANCES Provider CCN: 185211
PERIOD:
FROM 01/01/2011
TO 12/31/2011
WORKSHEET A-7
Description Beginning Balances Acquisitions Disposals and Retirements Ending Balance Fully Depreciated Assets  
Purchases Donation Total
1 2 3 4 5 6 7
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 Subtotal (sum of lines 1-6) ### ### ### ### 7
8 Reconciling Items 8
9 Total (line 7 minus line 8) ### ### ### ### 9
FORM CMS-2540-10 (05/2011) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4115)
Rev. 1   41-319