Worksheet A-7
- Return to Cost Report Summary
- Form A700
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV
BENNETT HILLS CENTER
GOODING, ID 83330
GOODING, ID 83330
Medicare Provider Number: 135134
Cost report status: Settled Without Audit
[Record Code 1256366 - 2010]
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ANALYSIS OF CHANGES IN CAPITAL ASSET BALANCES | Provider CCN: 135134 | PERIOD: FROM 01/01/2018 TO 10/31/2018 |
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 |