MyHealthcareSource - Heritage Healthcare At Shepherd Hills

Preparer Information (View Report Statewide)

Item Name:	Item Value:
Preparer Name	J. Sam Johnson, Cpa
Preparer City	Toccoa
Preparer Addr.	161 East Doyle Street
Preparer Firm	J. Sam Johnson, Cpa, Pc
Preparer Phone	706-886-3173
Preparer Zip	30577
Facility Accounting Costs	1,006.0

Preparer Information (View Report Statewide)

Item Name:	Item Value:
Preparer Name	J. Sam Johnson, Cpa
Preparer City	Toccoa
Preparer Addr.	161 East Doyle Street
Preparer Firm	J. Sam Johnson, Cpa, Pc
Preparer Phone	706-886-3173
Preparer Zip	30577
Facility Accounting Costs	0.025

Facility Summary (View Report Statewide)

Item Name:	Item Value:
Period Ended	6/30/08
Administrator	Sherry Solock
Legal Name	Heritage Healthcare Shepherd Hills, Llc
Admin Lic. #	4759.0
Chg. Owner	no
Owner Type	corporation
Months	12.0

Facility Summary (View Report Statewide)

Item Name:	Item Value:
Period Ended	6/30/08
Administrator	Sherry Solock
Legal Name	Heritage Healthcare Shepherd Hills, Llc
Admin Lic. #	4759.0
Chg. Owner	no
Owner Type	corporation
Months	0.000

Certifier Information (View Report Statewide)

Item Name:	Item Value:
Certifier	Neil L. Pruitt, Jr.
Date	10/30/2008
Position	officer
Title	Chairman & Ceo

Certifier Information (View Report Statewide)

Item Name:	Item Value:
Certifier	Neil L. Pruitt, Jr.
Date	10/30/2008
Position	officer
Title	Chairman & Ceo

Occupancy (View Report Statewide)

Item Name:	Item Value:
Beg. Beds	112.0
End Beds	112.0
Bed days	40,992.0
% Occ.	97.6

Occupancy (View Report Statewide)

Item Name:	Item Value:
Beg. Beds	0.003
End Beds	0.003
Bed days	1.003
% Occ.	0.002

Rate Data (View Report Statewide)

Payor	Period	Rate	Patient Days	Pay Rate Revenue
Private	7/1/07 - 6/30/08	165.1	3,593.0	593,067.6
Medicare	7/1/07 - 6/30/08	162.8	4,050.0	659,372.0
Medicaid	7/1/07 - 6/30/08	160.5	29,232.0	4,692,497.0
Other	7/1/07 - 6/30/08	160.0	3,120.0	499,181.1

Rate Data (View Report Statewide)

Payor	Period	Rate	Patient Days	Pay Rate Revenue
Private	7/1/07 - 6/30/08	0.004	0.088	14.508
Medicare	7/1/07 - 6/30/08	0.004	0.099	16.129
Medicaid	7/1/07 - 6/30/08	0.004	0.715	114.787
Other	7/1/07 - 6/30/08	0.004	0.076	12.211

Lease (View Report Statewide)

Item Name:	Item Value:
Lease Beg.	07/01/07
Lease End	06/30/10
Amount	23,481

Lease (View Report Statewide)

Item Name:	Item Value:
Lease Beg.	07/01/07
Lease End	06/30/10
Amount	23,481

Revenue (View Report Statewide)

Item Name:	Item Value:
Routine Service	6,444,118.0
Ancillary Service	1,184,063.0
Allowances and Adj.	-1,107,431.0
Net Revenue	6,520,750.0
Non-Operating Expense	0.0
Other Revenue	16,737.0
Net Income Pre-Tax	509,268.0
Income Tax Provisions	0.0
Net Income	509,268.0

Revenue (View Report Statewide)

Item Name:	Item Value:
Routine Service	157.635
Ancillary Service	28.964
Allowances and Adj.	-27.090
Net Revenue	159.510
Non-Operating Expense	0.0
Other Revenue	0.409
Net Income Pre-Tax	12.458
Income Tax Provisions	0.0
Net Income	12.458

Operating Expense (View Report Statewide)

Item Name:	Item Value:
Routine NF	2,332,828.1
Routine ICFMR	0.0
Special Services	281,714.1
Plant Oper. & Main.	373,083.2
Admin & Gen.	1,041,326.4
Property	208,039.3
Total	5,041,128.8

Operating Expense (View Report Statewide)

Item Name:	Item Value:
Routine NF	57.065
Routine ICFMR	0.0
Special Services	6.891
Plant Oper. & Main.	9.126
Admin & Gen.	25.473
Property	5.089
Total	123.315

Routine Service Revenue (View Report Statewide)

Item Name:	Item Value:
Private	593,068.0
Medicare	659,372.0
Medicaid	4,692,497.0
Other Government	0.0
Other	499,181.0
Total	6,444,118.0

Routine Service Revenue (View Report Statewide)

Item Name:	Item Value:
Private	14.508
Medicare	16.129
Medicaid	114.787
Other Government	0.0
Other	12.211
Total	157.635

Ancillary Revenue (View Report Statewide)

Item Name:	Item Value:
Physican Care	0.0
Pharmacy	222,983.0
Oxygen	659.0
Intravenous	0.0
Physical Therapy	358,300.0
Speech Therapy	200,640.0
Occupational Therapy	327,715.0
Medical Supplies	41,105.0
Tube Feeding	0.0
Other	20,064.0
Radiology	12,597.0
Total	1,184,063.0

Ancillary Revenue (View Report Statewide)

Item Name:	Item Value:
Physican Care	0.0
Pharmacy	5.455
Oxygen	0.016
Intravenous	0.0
Physical Therapy	8.765
Speech Therapy	4.908
Occupational Therapy	8.017
Medical Supplies	1.006
Tube Feeding	0.0
Other	0.491
Radiology	0.308
Total	28.964

Plant Operation and Maintenance (View Report Statewide)

Item Name:	Item Value:
Salaries	62,472.0
Benefits	16,814.0
Supplies	22,164.0
Repairs	28,089.0
Contract	33,783.0
Utilities	101,373.0
Other	40,199.0
Total	373,083.2

Plant Operation and Maintenance (View Report Statewide)

Item Name:	Item Value:
Salaries	1.528
Benefits	0.411
Supplies	0.542
Repairs	0.687
Contract	0.826
Utilities	2.480
Other	0.983
Total	9.126

Administrative and General 1 (View Report Statewide)

Item Name:	Item Value:
Salaries	199,578.0
Benefits	34,608.0
Director Fees	0.0
Supplies	27,397.0
Contract	12,191.0
Legal	0.0
Audit & Accounting	1,006.0
Amortization	844.0
Other	10,409.0

Administrative and General 1 (View Report Statewide)

Item Name:	Item Value:
Salaries	4.882
Benefits	0.847
Director Fees	0.0
Supplies	0.670
Contract	0.298
Legal	0.0
Audit & Accounting	0.025
Amortization	0.021
Other	0.255

Property (View Report Statewide)

Item Name:	Item Value:
Deprec. and Amort.	16,643.0
Lease	15,667.0
Taxes	14,187.0
Insurance	6,987.0
Interest	6,324.0
Total	208,039.3

Property (View Report Statewide)

Item Name:	Item Value:
Deprec. and Amort.	0.407
Lease	0.383
Taxes	0.347
Insurance	0.171
Interest	0.155
Total	5.089

Administrative and General 2 (View Report Statewide)

Item Name:	Item Value:
Dues & Subs.	6,831.0
Travel & Educ.	16,337.0
Communication	22,182.0
Advertising	4,248.0
Tax & Licenses	668.0
Insurance	-71,288.0
Interest	5,183.0
Home Office Alloc.	290,427.7
Nurse Training	0.0
Provider Fee	433,782.0
Total	560,621.7

Administrative and General 2 (View Report Statewide)

Item Name:	Item Value:
Dues & Subs.	0.167
Travel & Educ.	0.400
Communication	0.543
Advertising	0.104
Tax & Licenses	0.016
Insurance	-1.744
Interest	0.127
Home Office Alloc.	7.104
Nurse Training	0.0
Provider Fee	10.611
Total	13.714

Rent Expense (View Report Statewide)

Lessor	Description	Related Party Cost	Non-Related Party Cost
Shepherd Hills Health Prop/Gemsa	Nursing Facility	281,771.0	0.0
Various	Equipment	0.0	15,667.0
United Medical	Equipment	41,882.0	0.0

Rent Expense (View Report Statewide)

Lessor	Description	Related Party Cost	Non-Related Party Cost
Shepherd Hills Health Prop/Gemsa	Nursing Facility	6.893	0.0
Various	Equipment	0.0	0.383
United Medical	Equipment	1.025	0.0

Routine Service (View Report Statewide)

Item Name:	Item Value:
Salaries	1,766,739.0
Benefits	400,480.0
Supplies	11,052.0
Contract	8,565.0
Other	0.0
Related Party	153,653.1
Total	2,332,828.1

Routine Service (View Report Statewide)

Item Name:	Item Value:
Salaries	43.218
Benefits	9.796
Supplies	0.270
Contract	0.210
Other	0.0
Related Party	3.759
Total	57.065

Physician Care (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	600.0
Other	0.0
Related Party	0.0
Total	600.0

Physician Care (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.015
Other	0.0
Related Party	0.0
Total	0.015

Physical Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	221.0
Contract	0.0
Other	-126,734.6
Related	128,179.6
Total	1,666.0

Physical Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.005
Contract	0.0
Other	-3.100
Related	3.136
Total	0.041

Pharmacy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	72.0
Related	71,427.0
Total	71,499.0

Pharmacy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.002
Related	1.747
Total	1.749

Speech Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	-59,385.0
Related	61,019.0
Total	1,634.0

Speech Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	-1.453
Related	1.493
Total	0.040

Oxygen Therapy (View Report Statewide)

Item Name:	Item Value:
Benefits	0.0
Benefits	0.0
Supplies	0.0
Contract	1,140.0
Other	0.0
Related	0.0
Total	1,140.0

Oxygen Therapy (View Report Statewide)

Item Name:	Item Value:
Benefits	0.0
Benefits	0.0
Supplies	0.0
Contract	0.028
Other	0.0
Related	0.0
Total	0.028

Occupational Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	-106,546.3
Related	106,733.3
Total	187.0

Occupational Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	-2.606
Related	2.611
Total	0.005

Medical Supplies (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	-12,928.9
Related	42,794.9
Total	29,866.0

Medical Supplies (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	-0.316
Related	1.047
Total	0.731

Recreational Activities (View Report Statewide)

Item Name:	Item Value:
Salaries	113,662.0
Benefits	30,641.0
Supplies	2,446.0
Contract	360.0
Other	145.0
Related	484.1
Total	147,738.1

Recreational Activities (View Report Statewide)

Item Name:	Item Value:
Salaries	2.780
Benefits	0.750
Supplies	0.060
Contract	0.009
Other	0.004
Related	0.012
Total	3.614

Other Services (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Related	484.1
Total	0.0

Other Services (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Related	0.012
Total	0.0

Radiology (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	8,567.0
Related	0.0
Other	-5,183.0
Total	3,384.0

Radiology (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.210
Related	0.0
Other	-0.127
Total	0.083

Medical Director (View Report Statewide)

Item Name:	Item Value:
Contract	24,000.0
Related	0.0
Total	24,000.0

Medical Director (View Report Statewide)

Item Name:	Item Value:
Contract	0.587
Related	0.0
Total	0.587

Intravenous Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Related	0.0
Total	0.0

Intravenous Therapy (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Related	0.0
Total	0.0

Beauty and Barber Shop (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Total	0.0

Beauty and Barber Shop (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Total	0.0

Medical Records (View Report Statewide)

Item Name:	Item Value:
Salaries	19,341.0
Benefits	4,077.0
Supplies	0.0
Contract	0.0
Other	0.0
Related	23,504.7
Total	46,922.7

Medical Records (View Report Statewide)

Item Name:	Item Value:
Salaries	0.473
Benefits	0.100
Supplies	0.0
Contract	0.0
Other	0.0
Related	0.575
Total	1.148

Religious Services (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Total	0.0

Religious Services (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Total	0.0

In-Service Training (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Total	0.0

In-Service Training (View Report Statewide)

Item Name:	Item Value:
Salaries	0.0
Benefits	0.0
Supplies	0.0
Contract	0.0
Other	0.0
Total	0.0

Dues and Subscriptions (View Report Statewide)

Organization	Purpose	Amount	Allowable
Walker Co Chamber	Dues	379.0	0.0
Alliance For Quality Nursing Home Care	Dues	2,240.0	1,120.0
Dietary Managers Assoc	Dues	147.0	74.0
Ghca	Dues	2,940.0	1,470.0
Gnha	Dues	4,113.0	2,057.0
Loveless, Regina	Dues	30.0	15.0
Petty Cash	Dues	80.0	40.0

Dues and Subscriptions (View Report Statewide)

Organization	Purpose	Amount	Allowable
Walker Co Chamber	Dues	0.009	0.0
Alliance For Quality Nursing Home Care	Dues	0.055	0.027
Dietary Managers Assoc	Dues	0.004	0.002
Ghca	Dues	0.072	0.036
Gnha	Dues	0.101	0.050
Loveless, Regina	Dues	0.001	0.000
Petty Cash	Dues	0.002	0.001

Summary (View Report Statewide)

Item Name:	Item Value:
Routine	8,565.0
Physician Care	600.0
Phys. Therapy	0.0
Pharmacy	0.0
Speech Therapy	0.0
Oxygen Therapy	1,140.0
Occu. Therapy	0.0
Med. Supplies	0.0
Rec. Activities	360.0
Other	0.0
Radiology	8,567.0
Med. Director	24,000.0
Intravenous	0.0
Plant Oper.	33,783.0
Admin & Gen.	12,191.0
Beauty & Barber	0.0
Med. Records	0.0
Religious	0.0
Training	0.0

Summary (View Report Statewide)

Item Name:	Item Value:
Routine	0.210
Physician Care	0.015
Phys. Therapy	0.0
Pharmacy	0.0
Speech Therapy	0.0
Oxygen Therapy	0.028
Occu. Therapy	0.0
Med. Supplies	0.0
Rec. Activities	0.009
Other	0.0
Radiology	0.210
Med. Director	0.587
Intravenous	0.0
Plant Oper.	0.826
Admin & Gen.	0.298
Beauty & Barber	0.0
Med. Records	0.0
Religious	0.0
Training	0.0

Assets Acquired - Related Party (View Report Statewide)

Name	description	Original Cost	Cost

Assets Acquired - Related Party (View Report Statewide)

Name	description	Original Cost	Cost

Related Party Contract Services (View Report Statewide)

Related Party	Description	Fee Arrangment	Amount
Pruitt Corp	Maintenance	Allocation	0.0
Uni Choice	Environmental Svc Maintenance/Repairs	Allocation	15,813.0
United Rehab	Pt, St, Ot	Allocation	303,475.0
United Medical	Purchase Of Supplies	Purchases	304,272.9
Ups	Prescription Drugs	Purchases	204,541.0
Ups	Medical Records	Allocation	4,704.0
United Clinical Svcs	Home Office Allocation	Percentage Allocation	132,225.0
Pruitt Corp	Home Office Allocation	Percentage Allocation	438,012.0
Ups`	Purchases Of Supplies	Purchases	40,806.0
United Collection Svcs	Collection Svcs	Allocation	133.0
Ups Home Office	Consulting	Allocation	21,000.0

Related Party Contract Services (View Report Statewide)

Related Party	Description	Fee Arrangment	Amount
Pruitt Corp	Maintenance	Allocation	0.0
Uni Choice	Environmental Svc Maintenance/Repairs	Allocation	0.387
United Rehab	Pt, St, Ot	Allocation	7.424
United Medical	Purchase Of Supplies	Purchases	7.443
Ups	Prescription Drugs	Purchases	5.003
Ups	Medical Records	Allocation	0.115
United Clinical Svcs	Home Office Allocation	Percentage Allocation	3.234
Pruitt Corp	Home Office Allocation	Percentage Allocation	10.715
Ups`	Purchases Of Supplies	Purchases	0.998
United Collection Svcs	Collection Svcs	Allocation	0.003
Ups Home Office	Consulting	Allocation	0.514

Non-Related Party Contract Services (View Report Statewide)

Entity Name	Service	Fee Arrangement	Amount
Clinical Lab Svc	Lab	As Needed	6,386.0
Hutcheson Medical Center	Lab	As Needed	2,372.0
Pri X Ray Llc	X Ray	As Needed	8,567.0
Hutcheson Medical Center	Ambulance	As Needed	2,611.0
Angel Emergency	Ambulance	As Needed	6,233.0
Dr. Mark Elam	Medical Director	Monthly	18,000.0
Mullen Elder Care Pc	Medical Director	Monthly	6,000.0
Biotech Systems	Pest Control	Monthly	3,510.0
Park City Cleaning & Filter	Cleaning	As Needed	1,325.0
Seaborn Refrigeration, Inc.	Equip Maintenance	As Needed	1,549.0
Simplex Grinnell	Fire System Svc	As Needed	5,275.0
Stericycle, Inc.	Bio Medical Waste	As Needed	2,842.0
Waste Usa	Garbage Disposal	Monthly	10,466.0
Yards R Us	Lawn Care	Monthly	5,451.0
American Healthtech	Software Fees	As Needed	2,515.0
Clinical Lab Svc	Drug Screening	As Needed	6,466.0
Creative Human Resources	Background Cks	As Needed	1,262.0
Ltcq, Inc.	Data Analysis	As Needed	7,691.0

Non-Related Party Contract Services (View Report Statewide)

Entity Name	Service	Fee Arrangement	Amount
Clinical Lab Svc	Lab	As Needed	0.156
Hutcheson Medical Center	Lab	As Needed	0.058
Pri X Ray Llc	X Ray	As Needed	0.210
Hutcheson Medical Center	Ambulance	As Needed	0.064
Angel Emergency	Ambulance	As Needed	0.152
Dr. Mark Elam	Medical Director	Monthly	0.440
Mullen Elder Care Pc	Medical Director	Monthly	0.147
Biotech Systems	Pest Control	Monthly	0.086
Park City Cleaning & Filter	Cleaning	As Needed	0.032
Seaborn Refrigeration, Inc.	Equip Maintenance	As Needed	0.038
Simplex Grinnell	Fire System Svc	As Needed	0.129
Stericycle, Inc.	Bio Medical Waste	As Needed	0.070
Waste Usa	Garbage Disposal	Monthly	0.256
Yards R Us	Lawn Care	Monthly	0.133
American Healthtech	Software Fees	As Needed	0.062
Clinical Lab Svc	Drug Screening	As Needed	0.158
Creative Human Resources	Background Cks	As Needed	0.031
Ltcq, Inc.	Data Analysis	As Needed	0.188

Prepaid Assets (View Report Statewide)

Item Name:	Item Value:
Insurance	13,171.0
Taxes	0.0
Interest	0.0
Rent	0.0
Licenses	0.0
Other	7,212.0

Prepaid Assets (View Report Statewide)

Item Name:	Item Value:
Insurance	0.322
Taxes	0.0
Interest	0.0
Rent	0.0
Licenses	0.0
Other	0.176

Fixed Assets (View Report Statewide)

Item Name:	Item Value:
Assets and Cap. Leases	582,931.0
Acccum. Depreciation	384,946.0
Total	197,985.0

Fixed Assets (View Report Statewide)

Item Name:	Item Value:
Assets and Cap. Leases	14.260
Acccum. Depreciation	9.416
Total	4.843

Other Assets (View Report Statewide)

Item Name:	Item Value:
Long-term Investments	0.0
Fixed Asset Replacement	0.0
Deferred Loan Costs	0.0
Deferred Finance Costs	0.0
Org. Expense	0.0
Goodwill	49,335.0
Total	53,399.0

Other Assets (View Report Statewide)

Item Name:	Item Value:
Long-term Investments	0.0
Fixed Asset Replacement	0.0
Deferred Loan Costs	0.0
Deferred Finance Costs	0.0
Org. Expense	0.0
Goodwill	1.207
Total	1.306

Long Term Liabilities (View Report Statewide)

Item Name:	Item Value:
Mortgage Notes	0.0
Notes	97,011.0
Cap. Lease Obligations	0.0
Loans pre-1966	0.0
Loans post-1966	0.0
Deferred Taxes	0.0
Total	97,011.0

Long Term Liabilities (View Report Statewide)

Item Name:	Item Value:
Mortgage Notes	0.0
Notes	2.373
Cap. Lease Obligations	0.0
Loans pre-1966	0.0
Loans post-1966	0.0
Deferred Taxes	0.0
Total	2.373

Summary (View Report Statewide)

Item Name:	Item Value:
Fixed Assets	197,985.0
Other Assets	53,399.0
Current Liabilities	445,244.0
Long Term Liabilities	97,011.0
Interest Bearing Debt	145,459.0
Capital	2,629,874.0
Liabilities & Capital	3,172,129.0
Liabilities	542,255.0
Current Assets	2,920,745.0

Summary (View Report Statewide)

Item Name:	Item Value:
Fixed Assets	4.843
Other Assets	1.306
Current Liabilities	10.891
Long Term Liabilities	2.373
Interest Bearing Debt	3.558
Capital	64.332
Liabilities & Capital	77.596
Liabilities	13.265
Current Assets	71.447

Accrued Liabilities (View Report Statewide)

Item Name:	Item Value:
Pension	0.0
Profit Sharing	0.0
Property Tax	6,931.0
Sales Tax	0.0
Interest	0.0
Third Party Advances	0.0
Third Party Payables	0.0
Income Tax	0.0

Accrued Liabilities (View Report Statewide)

Item Name:	Item Value:
Pension	0.0
Profit Sharing	0.0
Property Tax	0.170
Sales Tax	0.0
Interest	0.0
Third Party Advances	0.0
Third Party Payables	0.0
Income Tax	0.0

Current Liabilities 1 (View Report Statewide)

Item Name:	Item Value:
Trade	128,874.0
Acc. Payable-Officers	0.0
Employees	0.0
Bank	0.0
Notes Payable-Officers	0.0
Long-term Debt	48,448.0

Current Liabilities 1 (View Report Statewide)

Item Name:	Item Value:
Trade	3.152
Acc. Payable-Officers	0.0
Employees	0.0
Bank	0.0
Notes Payable-Officers	0.0
Long-term Debt	1.185

Current Liabilities 2 (View Report Statewide)

Item Name:	Item Value:
Bonus & Salaries	171,827.0
Vacation & Sick Pay	61,061.0
Payroll Taxes	28,103.0
Patients Deposits	0.0
Dividends	0.0
Other	0.0
Total	445,244.0

Current Liabilities 2 (View Report Statewide)

Item Name:	Item Value:
Bonus & Salaries	4.203
Vacation & Sick Pay	1.494
Payroll Taxes	0.687
Patients Deposits	0.0
Dividends	0.0
Other	0.0
Total	10.891

Current Assets 1 (View Report Statewide)

Item Name:	Item Value:
Cash	6,916.0
Investments	0.0
Inpatient Receivables	0.0
Third Party Receivables	0.0
Employees	0.0
Officers	2,782,751.0
Notes Receivable	0.0

Current Assets 1 (View Report Statewide)

Item Name:	Item Value:
Cash	0.169
Investments	0.0
Inpatient Receivables	0.0
Third Party Receivables	0.0
Employees	0.0
Officers	68.071
Notes Receivable	0.0

Current Assets 2 (View Report Statewide)

Item Name:	Item Value:
Other Receivables	110,534.0
Accrued Interest	0.0
Doubtful Acc. Allow.	0.0
Inventories	0.0
Other	0.0
Deposits	161.0
Total	2,920,745.0

Current Assets 2 (View Report Statewide)

Item Name:	Item Value:
Other Receivables	2.704
Accrued Interest	0.0
Doubtful Acc. Allow.	0.0
Inventories	0.0
Other	0.0
Deposits	0.004
Total	71.447

Interest Bearing Debt (View Report Statewide)

Payable To	Loan Date	Ending Balance	Loan Purpose	Interest Rate
United Health Services	3/2008	11,805.0	Liability Insurance	3.7
United Health Services Property	7/2007	769.0	Property Insurance	6.1
Synovus	1/2008	117,461.0	Equipment	5.5
United Health Services	9/2006	15,424.0	Equipment	7.0

Interest Bearing Debt (View Report Statewide)

Payable To	Loan Date	Ending Balance	Loan Purpose
United Health Services	3/2008	0.289	Liability Insurance
United Health Services Property	7/2007	0.019	Property Insurance
Synovus	1/2008	2.873	Equipment
United Health Services	9/2006	0.377	Equipment

Wage and Employee Benefits Compensation (View Report Statewide)

Item Name:	Item Value:
Routine NF	1,766,739.0
Routine ICFMR	0.0
Special	113,662.0
Op. & Main.	62,472.0
Admin & Gen.	218,919.0
Nurse Training	0.0
Total	2,562,231.0

Wage and Employee Benefits Compensation (View Report Statewide)

Item Name:	Item Value:
Routine NF	43.218
Routine ICFMR	0.0
Special	2.780
Op. & Main.	1.528
Admin & Gen.	5.355
Nurse Training	0.0
Total	62.677

Wage and Employee Details (View Report Statewide)

Item Name:	Item Value:
Wor. Comp.	157,739.0
Payroll Tax	203,745.0
Life Ins.	0.0
Health Ins.	165,560.0
Retirement	70,386.0
Profit Sharing	0.0
Other	1,144.0
Total	598,574.0

Wage and Employee Details (View Report Statewide)

Item Name:	Item Value:
Wor. Comp.	3.859
Payroll Tax	4.984
Life Ins.	0.0
Health Ins.	4.050
Retirement	1.722
Profit Sharing	0.0
Other	0.028
Total	14.642

Staffing Cost Summary (View Report Statewide)

Name	Position	Compensation	Hours Paid	Retirement or Pension
Campbell,Susan Marie	Don	18,033.3	578.0	613.1
Haynes Charles Faye	Prn	1,704.4	56.5	57.9
Solock Sherry Jean	Administrator	86,093.8	2,088.0	2,927.2
Niemi,Barbara	Rn	43,864.5	1,650.3	1,491.4
Dunn,Martha	Adon	33,359.7	1,241.8	1,134.2
Tennant,Tanya M	Adon	1,277.4	53.0	43.4
Mc Ginnis,La Dora	Don	15,360.0	512.0	522.2
Thomas,Delcia	Adon	2,794.4	110.0	95.0
Moore,David	Don	12,240.0	408.0	416.2
Nation,Jody	Don	18,234.2	644.5	620.0

Staffing Cost Summary (View Report Statewide)

Name	Position	Compensation	Hours Paid	Retirement or Pension
Campbell,Susan Marie	Don	0.441	0.014	0.015
Haynes Charles Faye	Prn	0.042	0.001	0.001
Solock Sherry Jean	Administrator	2.106	0.051	0.072
Niemi,Barbara	Rn	1.073	0.040	0.036
Dunn,Martha	Adon	0.816	0.030	0.028
Tennant,Tanya M	Adon	0.031	0.001	0.001
Mc Ginnis,La Dora	Don	0.376	0.013	0.013
Thomas,Delcia	Adon	0.068	0.003	0.002
Moore,David	Don	0.299	0.010	0.010
Nation,Jody	Don	0.446	0.016	0.015

Compensated Employees or Officers (View Report Statewide)

Name	Title	Relationship	Hours	Compensation
Solock, Sherry Jean	Administrator	None	40	86,094.0

Compensated Employees or Officers (View Report Statewide)

Name	Title	Relationship	Hours	Compensation
Solock, Sherry Jean	Administrator	None	40	2.106

Insurance (View Report Statewide)

Item Name:	Item Value:
Coverage Type
Contributions	N/A
Claims
Captive Ins.	no
Captive Ins. Type	General Liability and Workers Comp
Self-Insured	no

Insurance (View Report Statewide)

Item Name:	Item Value:
Coverage Type
Contributions	N/A
Claims
Captive Ins.	no
Captive Ins. Type	General Liability and Workers Comp
Self-Insured	no

Vehicles (View Report Statewide)

Year	Make	Model	Original Cost	Personal Use %

Vehicles (View Report Statewide)

Year	Make	Model	Original Cost	Personal Use %

Patient Day Trends for RUG Categories (View Report Statewide)

Item Name:	Item Value:
Rehabiliation	951.0
Extensive Services	696.0
Special Care	126.0
Clinically Complex	50.0
Impaired Cognition	86.0
Behavior Only	0.0
Physical Function Reduced	58.0
Default Rate	0.0
Total - All Categories	4,038.0

Patient Day Trends for RUG Categories (View Report Statewide)

Item Name:	Item Value:
Rehabiliation	0.023
Extensive Services	0.017
Special Care	0.003
Clinically Complex	0.001
Impaired Cognition	0.002
Behavior Only	0.0
Physical Function Reduced	0.001
Default Rate	0.0
Total - All Categories	0.099

Rehabilitation - Ultra High (View Report Statewide)

Item Name:	Item Value:
RUC	32.0
RUB	113.0
RUA	92.0
RUX	77.0
RUL	128.0
Subtotal	442.0
Period Ended	06/30/2008

Rehabilitation - Ultra High (View Report Statewide)

Item Name:	Item Value:
RUC	0.001
RUB	0.003
RUA	0.002
RUX	77.0
RUL	0.003
Subtotal	0.011
Period Ended	06/30/2008

Rehabilitation - Very High (View Report Statewide)

Item Name:	Item Value:
RVC	0.0
RVB	378.0
RVA	26.0
RVX	35.0
RVL	251.0
Subtotal	690.0
Period Ended	06/30/2008

Rehabilitation - Very High (View Report Statewide)

Item Name:	Item Value:
RVC	0.0
RVB	0.009
RVA	0.001
RVX	0.001
RVL	0.006
Subtotal	0.017
Period Ended	06/30/2008

Rehabilitation - High (View Report Statewide)

Item Name:	Item Value:
RHC	227.0
RHB	329.0
RHA	50.0
RHX	0.0
RHL	0.0
Subtotal	606.0
Period Ended	06/30/2008

Rehabilitation - High (View Report Statewide)

Item Name:	Item Value:
RHC	0.006
RHB	0.008
RHA	0.001
RHX	0.0
RHL	0.0
Subtotal	0.015
Period Ended	06/30/2008

Rehabilitation - Medium (View Report Statewide)

Item Name:	Item Value:
RMC	92.0
RMB	278.0
RMA	70.0
RMX	356.0
RML	468.0
Subtotal	1,264.0
Period Ended	06/30/2008

Rehabilitation - Medium (View Report Statewide)

Item Name:	Item Value:
RMC	0.002
RMB	0.007
RMA	0.002
RMX	0.009
RML	0.011
Subtotal	0.031
Period Ended	06/30/2008

Rehabilitation - Low (View Report Statewide)

Item Name:	Item Value:
RLB	0.0
RLA	20.0
RLX	0.0
Subtotal	20.0
Period Ended	06/30/2008

Rehabilitation - Low (View Report Statewide)

Item Name:	Item Value:
RLB	0.0
RLA	0.000
RLX	0.0
Subtotal	0.000
Period Ended	06/30/2008

Extensive Services (View Report Statewide)

Item Name:	Item Value:
SE3	240.0
SE2	456.0
SE1	0.0
Extensive Services	696.0
Period Ended	06/30/2008

Extensive Services (View Report Statewide)

Item Name:	Item Value:
SE3	0.006
SE2	0.011
SE1	0.0
Extensive Services	0.017
Period Ended	06/30/2008

Special Care (View Report Statewide)

Item Name:	Item Value:
SSC	30.0
SSB	6.0
SSA	90.0
Total	126.0
Period Ended	06/30/2008

Special Care (View Report Statewide)

Item Name:	Item Value:
SSC	0.001
SSB	0.000
SSA	0.002
Total	0.003
Period Ended	06/30/2008

Clinically Complex (View Report Statewide)

Item Name:	Item Value:
CC2	0.0
CC1	0.0
CB2	3.0
CB1	0.0
CA2	47.0
CA1	0.0
Total	50.0
Period Ended	06/30/2008

Clinically Complex (View Report Statewide)

Item Name:	Item Value:
CC2	0.0
CC1	0.0
CB2	0.000
CB1	0.0
CA2	0.001
CA1	0.0
Total	0.001
Period Ended	06/30/2008

Impaired Cognition (View Report Statewide)

Item Name:	Item Value:
IB2	0.0
IB1	42.0
IA2	0.0
IA1	44.0
Total	86.0
Period Ended	06/30/2008

Impaired Cognition (View Report Statewide)

Item Name:	Item Value:
IB2	0.0
IB1	0.001
IA2	0.0
IA1	44.0
Total	0.002
Period Ended	06/30/2008

Behavior Only (View Report Statewide)

Item Name:	Item Value:
BB2	0.0
BB1	0.0
BA2	0.0
BA1	0.0
Total	0.0
Period Ended	06/30/2008

Behavior Only (View Report Statewide)

Item Name:	Item Value:
BB2	0.0
BB1	0.0
BA2	0.0
BA1	0.0
Total	0.0
Period Ended	06/30/2008

Physical Function Reduced (View Report Statewide)

Item Name:	Item Value:
PE2	0.0
PE1	0.0
PD2	0.0
PD1	44.0
PC2	0.0
PC1	0.0
PB2	0.0
PB1	0.0
PA2	0.0
PA1	14.0
Total	58.0
Period Ended	06/30/2008

Physical Function Reduced (View Report Statewide)

Item Name:	Item Value:
PE2	0.0
PE1	0.0
PD2	0.0
PD1	44.0
PC2	0.0
PC1	0.0
PB2	0.0
PB1	0.0
PA2	0.0
PA1	0.000
Total	0.001
Period Ended	06/30/2008

All RUG Categories

Item Name:	Item Value:
RUC	32.0
RUB	113.0
RUA	92.0
RUX	77.0
RUL	128.0
Rehab Ultra High Subtotal	442.0
RVC	0.0
RVB	378.0
RVA	26.0
RVX	35.0
RVL	251.0
Rehab Very High Subtotal	690.0
RHC	227.0
RHB	329.0
RHA	50.0
RHX	0.0
RHL	0.0
Rehab High Subtotal	606.0
RMC	92.0
RMB	278.0
RMA	70.0
RMX	356.0
RML	468.0
Rehab Medium Subtotal	1,264.0
RLB	0.0
RLA	20.0
RLX	0.0
Rehab Low Subtotal	20.0
Rehab Total	951.0
SE3	240.0
SE2	456.0
SE1	0.0
Extensive Service Total	696.0
SSC	30.0
SSB	6.0
SSA	90.0
Special Care Total	126.0
CC2	0.0
CC1	0.0
CB2	3.0
CB1	0.0
CA2	47.0
CA1	0.0
Clinically Complex Total	50.0
IB2	0.0
IB1	42.0
IA2	0.0
IA1	44.0
Impaired Cognition Total	86.0
BB2	0.0
BB1	0.0
BA2	0.0
BA1	0.0
Behavior Only Total	0.0
PE2	0.0
PE1	0.0
PD2	0.0
PD1	44.0
PC2	0.0
PC1	0.0
PB2	0.0
PB1	0.0
PA2	0.0
PA1	14.0
Physical Function Reduced Total	58.0
Default Rate	0.0
All Categories Total	4,038.0

All RUG Categories

Item Name:	Item Value:
RUC	0.001
RUB	0.003
RUA	0.002
RUX	77.0
RUL	0.003
Rehab Ultra High Subtotal	0.011
RVC	0.0
RVB	0.009
RVA	0.001
RVX	0.001
RVL	0.006
Rehab Very High Subtotal	0.017
RHC	0.006
RHB	0.008
RHA	0.001
RHX	0.0
RHL	0.0
Rehab High Subtotal	0.015
RMC	0.002
RMB	0.007
RMA	0.002
RMX	0.009
RML	0.011
Rehab Medium Subtotal	0.031
RLB	0.0
RLA	0.000
RLX	0.0
Rehab Low Subtotal	0.000
Rehab Total	0.023
SE3	0.006
SE2	0.011
SE1	0.0
Extensive Service Total	0.017
SSC	0.001
SSB	0.000
SSA	0.002
Special Care Total	0.003
CC2	0.0
CC1	0.0
CB2	0.000
CB1	0.0
CA2	0.001
CA1	0.0
Clinically Complex Total	0.001
IB2	0.0
IB1	0.001
IA2	0.0
IA1	44.0
Impaired Cognition Total	0.002
BB2	0.0
BB1	0.0
BA2	0.0
BA1	0.0
Behavior Only Total	0.0
PE2	0.0
PE1	0.0
PD2	0.0
PD1	44.0
PC2	0.0
PC1	0.0
PB2	0.0
PB1	0.0
PA2	0.0
PA1	0.000
Physical Function Reduced Total	0.001
Default Rate	0.0
All Categories Total	0.099

Heritage Healthcare At Shepherd Hills

Address: 800 Patterson Rd La Fayette, GA 30728

Phone: (706)638-4112

Beds: 112

Preparer Information (View Report Statewide)

Preparer Information (View Report Statewide)

Facility Summary (View Report Statewide)

Facility Summary (View Report Statewide)

Certifier Information (View Report Statewide)

Certifier Information (View Report Statewide)

Occupancy (View Report Statewide)

Occupancy (View Report Statewide)

Rate Data (View Report Statewide)

Rate Data (View Report Statewide)

Lease (View Report Statewide)

Lease (View Report Statewide)

Revenue (View Report Statewide)

Revenue (View Report Statewide)

Operating Expense (View Report Statewide)

Operating Expense (View Report Statewide)

Routine Service Revenue (View Report Statewide)

Routine Service Revenue (View Report Statewide)

Ancillary Revenue (View Report Statewide)

Ancillary Revenue (View Report Statewide)

Plant Operation and Maintenance (View Report Statewide)

Plant Operation and Maintenance (View Report Statewide)

Administrative and General 1 (View Report Statewide)

Administrative and General 1 (View Report Statewide)

Property (View Report Statewide)

Property (View Report Statewide)

Administrative and General 2 (View Report Statewide)

Administrative and General 2 (View Report Statewide)

Rent Expense (View Report Statewide)

Rent Expense (View Report Statewide)

Routine Service (View Report Statewide)

Routine Service (View Report Statewide)

Physician Care (View Report Statewide)

Physician Care (View Report Statewide)

Physical Therapy (View Report Statewide)

Physical Therapy (View Report Statewide)

Pharmacy (View Report Statewide)

Pharmacy (View Report Statewide)

Speech Therapy (View Report Statewide)

Speech Therapy (View Report Statewide)

Oxygen Therapy (View Report Statewide)

Oxygen Therapy (View Report Statewide)

Occupational Therapy (View Report Statewide)

Occupational Therapy (View Report Statewide)

Medical Supplies (View Report Statewide)

Medical Supplies (View Report Statewide)

Recreational Activities (View Report Statewide)

Recreational Activities (View Report Statewide)

Other Services (View Report Statewide)

Other Services (View Report Statewide)

Radiology (View Report Statewide)

Radiology (View Report Statewide)

Medical Director (View Report Statewide)

Medical Director (View Report Statewide)

Intravenous Therapy (View Report Statewide)

Intravenous Therapy (View Report Statewide)

Beauty and Barber Shop (View Report Statewide)

Beauty and Barber Shop (View Report Statewide)

Medical Records (View Report Statewide)

Medical Records (View Report Statewide)

Religious Services (View Report Statewide)

Religious Services (View Report Statewide)

In-Service Training (View Report Statewide)

In-Service Training (View Report Statewide)

Dues and Subscriptions (View Report Statewide)

Dues and Subscriptions (View Report Statewide)

Summary (View Report Statewide)

Summary (View Report Statewide)

Assets Acquired - Related Party (View Report Statewide)

Assets Acquired - Related Party (View Report Statewide)

Related Party Contract Services (View Report Statewide)

Related Party Contract Services (View Report Statewide)

Non-Related Party Contract Services (View Report Statewide)

Non-Related Party Contract Services (View Report Statewide)

Prepaid Assets (View Report Statewide)

Prepaid Assets (View Report Statewide)