Form Rpie-2016 - Real Property Income And Expense Worksheet And Instructions For Adult Care And Nursing Home Facilities Page 16
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16RPIE-2016-A - Real Property Income & Expense Form - Adult Care / Nursing Home Facilities Only
Page 4
sECtIoN L - EXPENsEs (CoN’t). 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 $)
(PPD)
3. Real Estate Related Costs
6. Project Maintenance &
Repair
7. Energy
8. Insurance
9. Administrative & General
10. Employee Benefits
11. Management Fee
12. Other (describe)
a.
b.
c.
4. total Expenses
sECtIoN L2 - RECAPItULAtIoN, FURNItURE, FIXtUREs AND EQUIPMENt.
2016
2015
2014
1. Furniture, Fixtures &
Expenses
Expenses
Expenses
Expenses
Expenses
Expenses
Equipment (FF & E) Used in
($ per year)
per Patient
($ per year)
per Patient
($ per year)
per Patient
Adult Care / Nursing home
(Rounded to
per Day
(Rounded to
per Day
(Rounded to
per Day
Facility operations
nearest $)
(PPD)
(nearest $)
(PPD)
(nearest $)
(PPD)
1. Is there a reserve for
FF & E?
YES
NO
❑
❑
2. Contribution to reserve in
reporting year
3. Cost of FF & E items
purchased in reporting
year
4. Book cost of all FF & E
at year end
5. Depreciation of FF & E
for reporting year
6. Book cost less accumulated
depreciation
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