Worksheet G-3
- Return to Cost Report Summary
- Form G300
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, 3536, REV 1
NORTH GATE HEALTH CARE FACILITY
NORTH TONAWANDA, NY 14120
NORTH TONAWANDA, NY 14120
Medicare Provider Number: 335649
Cost report status: Settled Without Audit
[Record Code 411141 - 1996]
Print
Excel
PDF
You are not logged in or you have not purchased this report. This report has had its actual values replaced with dummy text ('###').
If you would like to become a subscriber, please look at our subscription details.
If you are already a subscriber, please login.
| STATEMENT OF REVENUES AND EXPENSES | PROVIDER NO: 335649 |
PERIOD: FROM 01/01/2010 TO 12/31/2010 |
WORKSHEET G - 3 |
||
| 1 | Total patient revenues (From Wkst. G - 2, Part I, col. 3, line 14) | ### | 1 | ||
| 2 | Less: contractual allowances and discounts on patients accounts | ### | 2 | ||
| 3 | Net patient revenues (Line 1 minus line 2) | ### | 3 | ||
| 4 | Less: total operating expenses (From Worksheet G-2, Part II, line 15) | ### | 4 | ||
| 5 | Net income from service to patients (Line 3 minus 4) | ### | 5 | ||
| 6 | Other income: | 6 | |||
| 7 | Contributions, donations, bequests, etc | 7 | |||
| 8 | Income from investments | ### | 8 | ||
| 9 | Revenues from telephone and telegraph service | 9 | |||
| 10 | Revenue from television and radio service | 10 | |||
| 11 | Purchase discounts | ### | 11 | ||
| 12 | Rebates and refunds of expenses | 12 | |||
| 13 | Parking lot receipts | 13 | |||
| 14 | Revenue from laundry and linen service | 14 | |||
| 15 | Revenue from meals sold to employees and guests | ### | 15 | ||
| 16 | Revenue from rental of living quarters | 16 | |||
| 17 | Revenue from sale of medical and surgical supplies to other than patients | 17 | |||
| 18 | Revenue from sale of drugs to other than patients | 18 | |||
| 19 | Revenue from sale of medical records and abstracts | 19 | |||
| 20 | Tuition (fees, sale of textbooks, uniforms, etc.) | 20 | |||
| 21 | Revenue from gifts, flower, coffee shops, canteen | 21 | |||
| 22 | Rental of vending machines | 22 | |||
| 23 | Rental of skilled nursing space | 23 | |||
| 24 | Governmental appropriations | 24 | |||
| 25 | 25 | ||||
| 25.01 | NURSE AIDE TRAINING | ### | 25.01 | ||
| 25.02 | VENDING MACHINE | ### | 25.02 | ||
| 25.03 | BEAUTY SHOP | ### | 25.03 | ||
| 25.04 | MISCELLANEOUS INCOME | ### | 25.04 | ||
| 25.05 | PROCEEDS ON SALE OF THERAPY SUPPLIE | ### | 25.05 | ||
| 25.06 | PROCEEDS ON SALE OF DME | ### | 25.06 | ||
| 25.07 | VAN TRANSPORTATION REVENUE | ### | 25.07 | ||
| 26 | Total other income (Sum of lines 7 - 25) | ### | 26 | ||
| 27 | Total (Line 5 plus line 26) | ### | 27 | ||
| 28 | Other expenses (specify) | 28 | |||
| 29 | 29 | ||||
| 30 | 30 | ||||
| 31 | Total other expenses (Sum of lines 28 - 30) | 31 | |||
| 32 | Net income (or loss) for the period (Line 27 minus line 31) | ### | 32 | ||