Form Rpie-2016 - Real Property Income And Expense Worksheet And Instructions For Adult Care And Nursing Home Facilities Page 15
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16RPIE-2016-A - Real Property Income & Expense Form - Adult Care / Nursing Home Facilities Only
Page 3
sECtIoN k - INCoME Do not list any negative figures.
2016
2015
2014
Income
Income
Income
Income
Income
Income
($ per year)
per Patient
($ per year)
per Patient
($ per year)
per Patient
(Rounded to
per Day
(Rounded to
per Day
(Rounded to
per Day
nearest $)
(PPD)
(nearest $)
(PPD)
(nearest $)
(PPD)
Adult Care /
Nursing home Facilty
Real Estate Rental Income
1. Rent
Adult Care / Nursing home
Facilty Income
2. Payor source
1. Medicare Part A
2. Medicaid
3. Private & Other
4. Managed Care
5. Assisted Living
3. Additional services
6. Ancillary
7. Miscellaneous
4. total Adult Care / Nursing
home Facility Income
8. Signage / Billboard
9. Cell Towers
10. Other (describe)
a.
b.
c.
5. total Income
sECtIoN L - EXPENsEs. Do not list any negative figures.
2016
2015
2014
Expenses
Expenses
Expenses
Expenses
Expenses
Expenses
($ per year)
per Patient
($ per year)
per Patient
($ per year)
per Patient
(Rounded to
per Day
(Rounded to
per Day
(Rounded to
per Day
nearest $)
(PPD)
(nearest $)
(PPD)
(nearest $)
(PPD)
1. Patient Care
1. Nursing Care
2. Social Services & Activities
3. Therapy & Ancillary
2. support Costs
4. Dietary
5. Laundry & Housekeeping
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Rpie-2016 - Real Property Income And Expense Worksheet And Instructions For Gas Station, Car Wash And Oil Change Facilities
Financial
Form Rpie-2016 - Real Property Income And Expense Worksheet And Instructions For Self-storage Facilities
Financial
Related Categories
Parent category: Financial