Attach 17 VVH Census.pdf
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- Attached to
- MANAGEMENT & OPERATIONS OF RMC AND VVH
- Solicitation number
- 5400028394
- Issued by
- Allendale County, South Carolina
About this file
This document is a Detailed Census Report for Veterans Victory House, covering resident occupancy and payer information from April 1 to April 7, 2025. The report provides a comprehensive overview of 100+ veterans residing in the facility, with detailed tracking of their daily care levels, room assignments, and payment sources. Residents are primarily covered by Veterans State SNF (State Nursing Facility) payments, with additional payers including Medicaid, Medicare A, and Medicaid Pending.
The census report breaks down resident information by multiple dimensions, including number of days stayed, payer code, PDPM (Patient-Driven Payment Model) classification, care levels, and room type. Most residents are in semi-private rooms, with a total of 1,337 paid days recorded during the reporting period. The facility shows a diverse mix of payment sources, with Veterans State SNF being the predominant payer (1,039 days), followed by Veterans SCD (Service-Connected Disability) at 214 days, Medicaid SC at 56 days, and Medicare A at 14 days. The report demonstrates full occupancy with zero unpaid days during the tracked period.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attach 18 VVH Water & Gas.xlsx | XLSX spreadsheet | |
| Attach 9 Red. RMC Census.pdf | ||
| Attach 17 Red. VVH Census.pdf | ||
| Amendment 1.docx | DOCX document | |
| Attach 10 RMC Gas Usage.pdf | ||
| Attach 16 VVH Floor plans.pdf | ||
| Attach 9 RMC Census.pdf | ||
| Attach 15 VVH Gro.pdf | ||
| Attach 8 RMC Floor Plans.pdf | ||
| Attach 3 Pre.docx | DOCX document | |
| Solicitation Document.docx | DOCX document | |
| Attach 6 RMC Asset List.xlsx | XLSX spreadsheet | |
| Attach 14 VVH Asset List.xlsx | XLSX spreadsheet | |
| Attach 4 RMC Inventory.xlsx | XLSX spreadsheet | |
| Attach 11 RMC Water Usage.pdf | ||
| Attach 12 VVH Inven.docx | DOCX document | |
| Attach 7 RMC Ground Map.pdf | ||
| Attach 13 VVH Rm Equip.docx | DOCX document | |
| Attach 5 RMC Equip-Furn.odt | ODT document |
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Text version
Date: Apr 8, 2025 Veterans Victory House Veterans Victory House Time: 14:18:27 ET Detailed Census Report - By Payer User: Jo Ann Ward from 4/1/2025 to 4/7/2025 Page # 1
Unit: All Floor: All Payers: All Bed Certification: All
Resident ResidentID Number
# of Days
Payer Code
PDPM
HIPPS
Care Level
Alt Care Level
1 2 3 4 5 6 7 Room
Rate Type
ABSHER, JESSE
(10700104) 7 MCA EBIB1 EBIB1 STD A A A A A A A 103-A Semi
ACKERMAN, DANIEL
(103725154) 7 VAS STD A A A A A A A 115-A Semi
ACKERMAN, HOGEL
(103725239) 7 VAS STD A A A A A A A 161-A Semi
ADAMS, GEORGE
(10700055) 7 VAS STD A A A A A A A 155-B Semi
AGUILAR, NICANOR
(10585509) 7 VAS STD A A A A A A A 117-A P
ALBERTS, CHARLES
(103725236) 7 VAS STD A A A A A A A 114-B Semi
ALLEN, EMMETT
(10431577) 7 VAS STD A A A A A A A 105-B Semi ALLS, JOHN (10700079) 7 VAS STD A A A A A A A 106-B Semi
ALMOND, DONALD
(10700062) 7 VAS STD A A A A A A A 149-A Semi ALSTON, GENE (7301800) 7 VAS STD A A A A A A A 148-B Semi
ANDERSON, FRANKLIN
(10700110) 7 VAS STD A A A A A A A 138-B Semi
ANDERSON, WILLIAM
(103725127) 7 VAS STD A A A A A A A 113-B Semi
ANDREWS, JOHN
(10700091) 7 VAS STD A A A A A A A 147-A Semi
ANTLEY, JOSEPH
(103725195) 7 SCD STD A A A A A A A 129-B Semi AVANT, JAMES (10560295) 7 VAS STD A A A A A A A 149-A Semi
AVANT, RONALD
(103725234) 7 SCD STD A A A A A A A 129-B Semi
BAILEY, STEPHEN
(10700041) 7 VAS STD A A A A A A A 104-A Semi BANKS, ROGER (10700109) 2 VAS STD A A 116-B Semi
2 VAS STD HP HP 116-B Semi 3 VAS STD A A A 116-B Semi
BARBOUR, CURTIS
(103725240) 7 SCD STD A A A A A A A 149-A Semi
BEASLEY, RONALD
(10263530) 7 VAS STD A A A A A A A 121-A P
BEATO, JOSEPH
(10700085) 7 VAS STD A A A A A A A 116-A Semi
BECKETT, GEORGE
(10700001) 7 VAS STD A A A A A A A 114-B Semi
BLACKBURN, WILLIAM
(103725233) 7 VAS STD A A A A A A A 148-B Semi BLAKE, BENNY (10700113) 4 SCD STD A A A A 128-B Semi
1 SCD STD TP 128-B Semi 2 SCD STD A A 128-B Semi
BLUE, JOSEPH (10700112) 7 VAS STD A A A A A A A 123-A Semi
BOLTZ, JOSEPH (10530722) 7 VAS STD A A A A A A A 118-A P
BOWLES, ARTHUR
(10488937) 7 VAS STD A A A A A A A 138-A Semi
BRANCH, WILLARD
(103725243) 7 MCA FEPE1 FEPE1 STD A A A A A A A 152-A Semi
BRIGHT, ROBERT
(103725261) 7 VAS STD A A A A A A A 106-B Semi
BRIGMAN, PHIL
(103725231) 7 VAS STD A A A A A A A 106-A Semi
BROCKMAN, TAMMY
(10700012) 1 SCD STD A 124-B Semi
6 SCD STD HP HP HP HP HP HP 124-B Semi
Page # 2
Resident ResidentID Number
# of Days
Payer Code
PDPM
HIPPS
Care Level
Alt Care Level
1 2 3 4 5 6 7 Room
Rate Type
BROOKS, WALTER
(103725256) 7 VAS STD A A A A A A A 159-B Semi BRYANT, ELREE (10700011) 7 VAS STD A A A A A A A 130-A Semi
BRYANT, LAWRENCE
(10700083) 7 VAS STD A A A A A A A 139-B Semi BUSH, LESTER (10700116) 7 VAS STD A A A A A A A 137-A Semi
BUTLER, LARRY (10700040) 7 VAS STD A A A A A A A 122-A P
CALLAHAN, CHARLES
(10700090) 7 VAS STD A A A A A A A 149-A Semi
CAMPBELL, MURRAY
(10700078) 7 VAS STD A A A A A A A 135-A P
CAMPBELLE, JOHN
(103725165) 7 VAS STD A A A A A A A 130-B Semi
CLAYTON, GEORGE
(103725126) 7 MCD STD A A A A A A A 123-B Semi
CRAWFORD, PAUL
(10700014) 7 VAS STD A A A A A A A 114-B Semi
CROMER, KENNETH
(10604432) 7 VAS STD A A A A A A A 128-A Semi CROSBY, BILLY (103725145) 7 VAS STD A A A A A A A 150-A Semi CULLEY, WILLIAM (10700020) 7 VAS STD A A A A A A A 148-A Semi
DEAN, JAMES (7917443) 7 SCD STD A A A A A A A 118-A P
DEARBORN, ROBERT
(103725158) 7 SCD STD A A A A A A A 125-B Semi
DELOACHE, JOHN
(10700022) 7 VAS STD A A A A A A A 151-A Semi DIBBLE, MICHAEL (10307613) 7 VAS STD A A A A A A A 105-A Semi
DICKSON, DEBORRAH
(10556902) 7 VAS STD A A A A A A A 140-A Semi
DOBSON, TERRELL
(10372642) 7 SCD STD A A A A A A A 137-B Semi DROLET, MARK (10700072) 7 SCD STD A A A A A A A 138-A Semi
ELLIOTT, MARGARET
(10700008) 7 VAS STD A A A A A A A 124-A Semi
ENNEVER, ADOLFO
(103725201) 7 SCD STD A A A A A A A 139-A Semi EPPS, CHARLES (10461511) 7 VAS STD A A A A A A A 126-A Semi FABIAN, JOAN (10700000) 7 VAS STD A A A A A A A 103-B Semi FARR, JAMES (103725211) 7 VAS STD A A A A A A A 104-B Semi FAVERO, DALE (103725203) 7 VAS STD A A A A A A A 113-B Semi
FERILLO, CHARLES
(103725144) 7 VAS STD A A A A A A A 125-A Semi FISK, DWAYNE (10614494) 2 MCD STD A A 148-B Semi
2 MCD STD TP TP 148-B Semi 3 MCD STD A A A 148-B Semi
FLOURNOY, EDWARD
(10590268) 7 VAS STD A A A A A A A 151-A Semi
FOSTER, ROBERT
(10700118) 4 SCD STD A A A A 146-B Semi
FRAZIER, BERNARD
(10700101) 7 VAS STD A A A A A A A 127-A Semi
FRAZIER, WILLIAM
(103725184) 7 VAS STD A A A A A A A 150-A Semi
FREDERICK, CHARLES
(10700065) 7 VAS STD A A A A A A A 139-B Semi
GADSDEN, BENJAMIN
(10587010) 7 VAS STD A A A A A A A 106-A Semi
Page # 3
ResidentID Number
# of Days
Payer Code
PDPM
HIPPS
Care Level
Alt Care Level
1 2 3 4 5 6 7 Room
Rate Type
GALL, ANDREW (10613401) 7 SCD STD A A A A A A A 114-A Semi
GAMBLE, CHARLTON
(10605592) 7 VAS STD A A A A A A A 124-B Semi GIBSON, DONNY (10330056) 7 MCD STD A A A A A A A 104-A Semi GILGEN, JOHN (103725232) 3 VAS STD A A A 146-B Semi
0 D -
GILLIARD, EDWARD
(10600529) 7 VAS STD A A A A A A A 146-A Semi
GILLYARD, NORMAN
(103725246) 7 VAS STD A A A A A A A 140-A Semi
GOLDEN, RANDY
(103725237) 7 VAS STD A A A A A A A 126-A Semi
GORDON, KENDALL
(10316302) 7 VAS STD A A A A A A A 135-A P
GOSWICK, JAMES (10700051) 7 VAS STD A A A A A A A 148-A Semi GREEN, JACK (10558726) 7 VAS STD A A A A A A A 139-B Semi
GRIFFIN, REMBERT
(10700076) 7 SCD STD A A A A A A A 114-A Semi GUERARD, HUME (10700009) 7 VAS STD A A A A A A A 155-A Semi
GUILFORD, HARRY
(103725267) 7 VAS STD A A A A A A A 149-B Semi
HAMILTON, JAMES
(10700111) 7 SCD STD A A A A A A A 125-A Semi
HAMPTON, JAMES
(10550725) 7 VAS STD A A A A A A A 116-B Semi
HARRELL, SIDNEY
(10700047) 7 VAS STD A A A A A A A 128-B Semi HARTZOG, ALTON (10576781) 7 PND STD A A A A A A A 106-A Semi HASTY, EDDIE (10700048) 7 VAS STD A A A A A A A 105-B Semi
HERNANDEZ, OSCAR
(103725209) 7 VAS STD A A A A A A A 103-B Semi HICKMAN, EARL (10588763) 7 MCD STD A A A A A A A 126-A Semi HICKS, EDWARD (10700060) 7 VAS STD A A A A A A A 105-A Semi HILTON JR, RAY (103725262) 7 VAS STD A A A A A A A 149-B Semi HOFF, ROBERT (10700032) 5 VAS STD A A A A A 124-A Semi
0 D -
HOLCOMBE, HUBERT
(103725128) 7 VAS STD A A A A A A A 131-A P
HOWELL, JEFFERSON
(10700024) 7 VAS STD A A A A A A A 140-B Semi
HUDSON, FRANCIS
(10406147) 7 MCD STD A A A A A A A 121-A P
INNISS, MALCOLM
(10700052) 7 SCD STD A A A A A A A 125-B Semi
JAMISON, TYRONE
(103725150) 7 MCD STD A A A A A A A 113-B Semi
JERNIGAN, DANIEL
(103725199) 1 VAS STD A 115-B Semi
1 VAS STD HP 115-B Semi 5 VAS STD A A A A A 115-B Semi
JOHNSON, DESMOND
(103725186) 7 VAS STD A A A A A A A 151-B Semi
JOHNSON, GLORIA
(103725166) 7 VAS STD A A A A A A A 131-A P
JOHNSON, MICHAEL
(10700005) 7 SCD STD A A A A A A A 154-B Semi
Page # 4
ResidentID Number
# of Days
Payer Code
PDPM
HIPPS
Care Level
Alt Care Level
1 2 3 4 5 6 7 Room
Rate Type
JOHNSTON, LEE (10700050) 7 VAS STD A A A A A A A 145-A Semi JONES, MORRIS (10596783) 7 VAS STD A A A A A A A 151-B Semi
KEMFORT, GEORGE
(10582936) 7 VAS STD A A A A A A A 137-A Semi
KINDERSKI, FREDRICK
(10700081) 4 VAS STD A A A A 151-A Semi
3 VAS STD HP HP HP 151-A Semi
KRAMM, BOHDAN
(10700092) 7 VAS STD A A A A A A A 116-A Semi
LAMKA, WALTER (10587971) 7 VAS STD A A A A A A A 135-A P
LANDRY, RICHARD
(10700105) 6 VAS STD A A A A A A 125-A Semi LAVINE, DEAN (10700064) 7 VAS STD A A A A A A A 124-B Semi LEBBY, ROBERT (10491369) 7 VAS STD A A A A A A A 127-A Semi
LEMPESIS, NICOLAS
(103725194) 7 MCD STD A A A A A A A 104-B Semi
LESUEUR, MARY
(10580413) 7 VAS STD A A A A A A A 123-B Semi
LINYARD, ARTHUR
(10700007) 7 VAS STD A A A A A A A 137-B Semi LUND, STEVEN (103725180) 7 VAS STD A A A A A A A 127-B Semi
LYNAH, DOUGLAS
(10700117) 7 SCD STD A A A A A A A 113-A Semi MACH, WILLIAM (10700082) 3 VAS STD A A A 115-A Semi
4 VAS STD TP TP TP TP 115-A Semi
MALORY, JESSIE
(10700069) 7 VAS STD A A A A A A A 126-B Semi
MASSARO, MICHAEL
(10586354) 7 VAS STD A A A A A A A 114-A Semi
MCADAMS, CHARLES
(10606908) 7 VAS STD A A A A A A A 149-B Semi
MCBRIDE, WILLIE
(103725205) 7 VAS STD A A A A A A A 132-A P
MCCUBBIN, THEODORE
(10700089) 7 SCD STD A A A A A A A 127-B Semi
MCDUFFIE, ERNEST
(10554092) 7 SCD STD A A A A A A A 129-A Semi
MCGARITY, MAJOR
(10606386) 7 VAS STD A A A A A A A 160-A P
MCNALLY, TIMOTHY
(103725214) 7 VAS STD A A A A A A A 145-B Semi MCRAE, PHILLIP (10591237) 7 VAS STD A A A A A A A 115-B Semi
MENENDEZ, ROBERT
(10391697) 7 VAS STD A A A A A A A 136-A P
MEW, JAMES (103725260) 7 VAS STD A A A A A A A 113-A Semi
MILLER, DARRYL
(103725263) 7 VAS STD A A A A A A A 115-B Semi
MILLER, GLEN (10580720) 7 VAS STD A A A A A A A 136-A P
MILLER, MICHAEL
(103725164) 7 SCD STD A A A A A A A 116-A Semi
MORRIS, DAVID (10468157) 7 VAS STD A A A A A A A 132-A P
MOSCAK, WILLIAM
(10700088) 7 VAS STD A A A A A A A 149-B Semi
MYERS, HEZEKIAH
(10700093) 7 SCD STD A A A A A A A 139-A Semi
NICHOLS, THURMAN
(10546682) 7 SCD STD A A A A A A A 117-A P
NIELSON, ROBERT
(103725147) 7 VAS STD A A A A A A A 150-A Semi
Page # 5
ResidentID Number
# of Days
Payer Code
PDPM
HIPPS
Care Level
Alt Care Level
1 2 3 4 5 6 7 Room
Rate Type
OLSON, JOHN (10487838) 7 SCD STD A A A A A A A 128-B Semi OREE, NED (103725132) 7 VAS STD A A A A A A A 153-B Semi PAGAN, RICHARD (103725224) 7 VAS STD A A A A A A A 139-A Semi PAPPAS, JOHN (103725241) 7 VAS STD A A A A A A A 105-A Semi PELLUM, JAMES (103725182) 7 VAS STD A A A A A A A 153-A Semi
POSTELL, RICHARD
(10700046) 7 VAS STD A A A A A A A 154-A Semi
PRESSLEY, HENRY
(103725135) 7 VAS STD A A A A A A A 123-B Semi PUTMAN, THOMAS (10700115) 7 VAS STD A A A A A A A 150-B Semi REAL, GARY (10599246) 7 VAS STD A A A A A A A 115-A Semi REID, THOMAS (103725251) 7 VAS STD A A A A A A A 130-B Semi
REILLY, CHARLES (10495319) 7 PND STD A A A A A A A 121-A P
RICHARDS JR, JOHN
(10597797) 7 VAS STD A A A A A A A 137-A Semi RIDLEY, RONALD (103725253) 7 VAS STD A A A A A A A 130-A Semi RISHER, FRANCIS (10558723) 7 VAS STD A A A A A A A 126-B Semi
ROBERTS, CATHERINE
(103725220) 7 VAS STD A A A A A A A 123-A Semi
ROBINSON, LESTER
(103725196) 7 VAS STD A A A A A A A 129-B Semi
ROLLINS, THEODORE
(10700004) 7 VAS STD A A A A A A A 123-A Semi ROPER, OLIVER (103725204) 7 VAS STD A A A A A A A 103-A Semi RUSS, GEORGE (10700068) 7 VAS STD A A A A A A A 159-A Semi
SANDERS, GILFORD
(10327068) 7 VAS STD A A A A A A A 125-B Semi
SCHURLKNIGHT, ARNOLD
(103725252) 7 SCD STD A A A A A A A 148-B Semi SCIUTO, JOSEPH (10595939) 7 VAS STD A A A A A A A 105-B Semi SEMLE, ROBERT (103725227) 7 VAS STD A A A A A A A 151-B Semi
SHEPARD, WILLIAM
(103725189) 7 VAS STD A A A A A A A 116-B Semi
SHIRING, CAROL (10555637) 7 SCD STD A A A A A A A 118-A P
SMALLS, LEON (10279080) 7 VAS STD A A A A A A A 151-A Semi SMITH, BENJAMIN (10591941) 7 SCD STD A A A A A A A 126-B Semi SMITH, NORBERT (10700075) 7 VAS STD A A A A A A A 138-B Semi SMITH, SAMUEL (10700071) 7 VAS STD A A A A A A A 104-B Semi SMITH, THOMAS (02122261) 7 MCD STD A A A A A A A 150-B Semi SNYPE, JULIAN (103725269) 7 VAS STD A A A A A A A 130-B Semi STARRING, DORIS (103725123) 7 VAS STD A A A A A A A 140-B Semi STILLWELL, MARK (10178215) 7 VAS STD A A A A A A A 147-B Semi STOLL, ALBERT (10700106) 7 VAS STD A A A A A A A 152-B Semi
STONE, EDGAR (103725175) 3 VAS STD A A A 156-A P
0 D -
Page # 6
ResidentID Number
# of Days
Payer Code
PDPM
HIPPS
Care Level
Alt Care Level
1 2 3 4 5 6 7 Room
Rate Type
SULLIVAN, WILLIAM
(10601083) 7 VAS STD A A A A A A A 104-A Semi
SUNDLIE, ELMER
(103725178) 7 VAS STD A A A A A A A 130-A Semi
SWAIN, JAMES (9303185) 7 SCD STD A A A A A A A 122-A P
THIBAULT, STEPHEN
(10243324) 7 VAS STD A A A A A A A 103-B Semi TRUSS, WILLIE (103725212) 7 VAS STD A A A A A A A 150-B Semi TUCK, ROBIN (103725183) 7 VAS STD A A A A A A A 113-A Semi TUCKER, CYRIL (10527828) 7 SCD STD A A A A A A A 129-A Semi URBANSKI, LEO (10700067) 7 VAS STD A A A A A A A 140-A Semi
UTSEY JR, BERT
(103725191) 7 VAS STD A A A A A A A 138-A Semi
VON OELSCHLAEGER,
ALFRED (10596294) 7 VAS STD A A A A A A A 128-A Semi
VUOLO, DONALD
(103725217) 7 VAS STD A A A A A A A 140-B Semi WADE, SAMMIE (10700013) 7 SCD STD A A A A A A A 127-A Semi WAGENER, CARL (10575339) 7 VAS STD A A A A A A A 127-B Semi
WASHINGTON, BENJAMIN
(10700114) 7 VAS STD A A A A A A A 148-A Semi
WEBSTER, SANDRA
(10597108) 7 VAS STD A A A A A A A 103-A Semi WELLS, JAMES (10700080) 7 SCD STD A A A A A A A 129-A Semi
WERSTLER, JOHN
(103725265) 7 VAS STD A A A A A A A 137-B Semi
WHITE, EDWIN (10193466) 7 VAS STD A A A A A A A 122-A P
WHITE, WILLIAM (10608219) 7 VAS STD A A A A A A A 151-B Semi
WILSON, BENJAMIN
(10596085) 7 VAS STD A A A A A A A 138-B Semi
WILSON, GARY (103725133) 7 VAS STD A A A A A A A 157-A P
WILSON, JAMES (10558590) 7 VAS STD A A A A A A A 132-A P
WINKLER, EDWIN (10579853) 7 VAS STD A A A A A A A 136-A P
WOLF, PETER (10464630) 2 SCD STD A A 131-A P
5 SCD STD HP HP HP HP HP 131-A P
WORTH, MICHAEL
(103725190) 7 VAS STD A A A A A A A 128-A Semi
WRIGHT JR, THOMAS
(10596997) 7 VAS STD A A A A A A A 117-A P
YOST, WILLIAM (103725162) 7 VAS STD A A A A A A A 124-A Semi
PAID DAYS 1337 191 192 192 191 191 190 190
UNPAID DAYS 0 0 0 0 0 0 0 0
TOTAL DAYS 1337 191 192 192 191 191 190 190
Page # 7
Summary By:
Payer
# of Days 1 2 3 4 5 6 7
Medicaid SC (MCD) Paid 56 8 8 8 8 8 8 8 Medicaid Pending (PND) Paid 14 2 2 2 2 2 2 2 Medicare A (MCA) Paid 14 2 2 2 2 2 2 2 Veterans SCD (SCD) Paid 214 30 30 30 31 31 31 31 Veterans State SNF (VAS) Paid 1039 149 150 150 148 148 147 147
PAID DAYS 1337 191 192 192 191 191 190 190
Page # 8
Summary By:
Payer
# of Days
Care Level 1 2 3 4 5 6 7
Medicaid SC (STD) Paid 56 STD 8 8 8 8 8 8 8 Medicaid Pending (STD) Paid 14 STD 2 2 2 2 2 2 2 Medicare A (EBIB) Paid 7 EBIB 1 1 1 1 1 1 1
Paid 7 FEPE 1 1 1 1 1 1 1 Veterans SCD (STD) Paid 214 STD 30 30 30 31 31 31 31 Veterans State SNF (STD) Paid 1039 STD 149 150 150 148 148 147 147
PAID DAYS 1337 191 192 192 191 191 190 190
File details come from the government source that posted it. Updated .