PICKERSGILL INC.
TOWSON, MD  21204

Medicare Provider Number: 215259
Cost report status: As Submitted
[Record Code 404528 - 1996]

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STATEMENT OF PATIENT REVENUES AND OPERATING EXPENSES PART I - PATIENT REVENUES
PROVIDER NO:
215259
PERIOD:
FROM 01/01/2010
TO 12/31/2010
WORKSHEET G2 PART I
PART I - PATIENT REVENUES  
Revenue Center INPATIENT OUTPATIENT TOTAL
1 2 3
GENERAL INPATIENT ROUTINE CARE SERVICES
1 Skilled Nursing Facility ### ### 1
2       2
3 Nursing facility   3
4 Other long term care ###   ### 4
5 Total general inpatient care services (Sum of lines 1 - 4) ###   ### 5
All Other Care Service
6 Ancillary services ### ### 6
7 Clinic 7
8 Home health agency   8
9         9
10 Ambulance 10
11 Hospice 11
12 Outpatient Rehabilitation Provider 12
13   13
14 Total Patient Revenues (Sum of lines 5 - 13; Transfer column 3 to Worksheet G-3, Line 1) ### ### 14
PART II - OPERATING EXPENSES 1 2  
1 Operating Expenses (Per Worksheet A, Col. 3, Line 75) ### 1
2 Add (Specify)     2
3       3
4       4
5       5
6       6
7       7
8 Total Additions (Sum of lines 2 - 7) 8
9 Deduct (Specify)     9
10       10
11       11
12       12
13       13
14 Total Deductions (Sum of lines 9 - 13) 14
15 Total Operating Expenses (Sum of lines 1 and 8, minus line 14) (Transfer to Worksheet G-3, Line 4) ### 15