21 East Main Street, Waukon, IA 52172 · CCN 165240 · chain SANFORD
Composite
99.2 / 100 percentile
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
60
Model
v1.2
Reads as: riskier than 99.2% of the 14,684 facilities in the snf peer group. percentile within peer group, 100 = highest risk. Grade bands are fixed percentile cuts (F is the top 5% of peer risk), so a grade is a position, not an absolute level.
weighted_contribution sums to pre_rank_index over rows where counts_toward_index is true. The composite is the facility's percentile position of that index within its peer group, so contributions explain the input, and the rank explains the score.
Change-of-ownership footprint in the CMS Provider of Services file: control-family, legal-name and address deltas across quarterly snapshots, plus certification reset recency and Medicare tenure.
R23/W4-3. Deterministic logistic p(Medicare termination within 12m), SNF only. Label = first POS termination date (any code: voluntary closure, involuntary termination, merger exit); facilities already terminated by the panel date are excluded, not counted as safe. Trained on panels 2024-07/2024-10/2025-01 (n=46,466, 283 positives), evaluated on the held-out later panel 2025-04 BEFORE shipping: AUC 0.971, top-decile lift 9.5x, top-decile capture 95.4% of the 65 terminations that followed. Separability is high because closures announce themselves in the data: collapsing occupancy is the strongest signal, and the learned NEGATIVE weight on 12m deficiency counts is the surveys-stop signature of a facility winding down, not a claim that clean inspections are dangerous. Same 15 as-of-date features and anti-leakage chassis as p_chow_12m; SFF entry rejected as a label (only one month of SFF history exists, so as-of transitions cannot be reconstructed). Score = probability x 100; grade NULL. Not in any composite.
R22/W4-2. Deterministic logistic p(CHOW within 12m), SNF only. Trained on panels 2024-07/2024-10/2025-01 (n=50,700, 1,207 positives), evaluated on the held-out later panel 2025-04 BEFORE shipping: AUC 0.874, top-decile lift 5.0x (top 10% of predictions captured 49.6% of the CHOWs that actually closed in the next 12 months). Shipped coefficients are the evaluated ones; no post-holdout refit. Caveat: holdout positives (133) run below the training base rate because recent CHOWs surface in public records with a lag, so measured lift is conservative. Features are as-of-date public records: PBJ staffing level/trend/contract share (quarterly history to 2022Q1), deficiency and CMP counts (12m), ownership tenure and churn from CHOW-evidenced transactions, beds, occupancy, ownership type, chain size. Chain membership and ownership type are current-state (history not published). SFF and star ratings deliberately excluded (no as-of history). Notable learned direction: long ownership tenure RAISES sale odds and a recent prior CHOW lowers them. Score = probability x 100; grade is NULL because a probability is not a quality letter. Not in any composite.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later regulatory_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later regulatory_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later staffing_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later staffing_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Rows with counts_toward_composite false come from models that are addressable or retracted rather than default. They exist and may be informative, but they did not enter the published composite and must not be summed as though they had.
p_adverse_action_12m: probability the facility's Medicare participation terminates within 12 months (any POS termination code; already-terminated facilities are excluded, not scored safe). Deterministic logistic over as-of-date public records, SNF only. Holdout (2025-04 panel, evaluated before shipping): AUC 0.971, top-decile lift 9.5x. Closures announce themselves: collapsing occupancy dominates, and fewer recent surveys is a winding-down signature. inputs.features holds raw feature values, inputs.contributions each feature's standardized pull on the log-odds. Predictions never enter the composite. See /v1/models. | p_chow_12m: probability of a change of ownership within 12 months. Deterministic logistic over as-of-date public records, SNF only. Holdout (2025-04 panel, evaluated before shipping): AUC 0.874, top-decile lift 5.0x. inputs.features holds raw feature values, inputs.contributions each feature's standardized pull on the log-odds. Predictions never enter the composite. See /v1/models for full notes.
Probability the facility's Medicare participation ends within 12 months, from public records only. Red bars raise exit odds. A negative pull from deficiencies is the winding-down signature — surveys stop as a facility empties — not evidence that clean inspections are dangerous.
Staffing vs peers
16
2025Q4 HPRD
This facility
IA median
National median
National p25–p75
Total nurse
2.54
3.15
3.28
2.90–3.77
RN
0.91
0.46
0.39
0.25–0.58
Weekend total
2.38
2.96
3.11
—
Weekday total
2.60
3.20
3.35
—
Quarter
Days
Avg census
Total HPRD
RN
LPN
CNA
Weekend
Contract %
2025Q4
92
46.3
2.54
0.91
0.43
1.20
2.38
0.0%
2025Q3
92
51.5
2.59
0.82
0.45
1.31
2.36
1.3%
2025Q2
91
53.3
2.53
0.84
0.34
1.34
2.30
4.2%
2025Q1
90
51.7
2.65
0.84
0.52
1.29
2.32
2.6%
2024Q4
92
49.5
2.74
0.97
0.34
1.44
2.30
9.0%
2024Q3
92
51.7
2.76
0.90
0.38
1.48
2.30
14.0%
2024Q2
91
51.8
3.14
0.98
0.43
1.73
2.58
22.0%
2024Q1
91
51.5
2.75
1.12
0.23
1.39
2.34
8.4%
2023Q4
92
50.3
2.55
1.02
0.28
1.25
2.14
5.5%
2023Q3
92
49.2
2.65
0.89
0.46
1.30
2.23
5.4%
2023Q2
91
48.2
2.71
0.78
0.33
1.60
2.40
2.1%
2023Q1
90
52.2
2.75
0.79
0.40
1.55
2.50
0.0%
2022Q4
92
51.6
2.65
0.61
0.60
1.44
2.31
0.0%
2022Q3
92
45.5
2.73
0.56
0.72
1.45
2.42
0.0%
2022Q2
91
44.2
2.35
0.54
0.70
1.12
1.93
0.0%
2022Q1
90
45.2
2.09
0.68
0.41
1.00
1.86
0.0%
HPRD is census-weighted: total hours over the quarter divided by total resident-days, not an average of daily ratios. Source is CMS Payroll-Based Journal daily records; only SNFs report PBJ, so other settings legitimately return zero rows.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
J
2025-08-21
2025-04-16
Health
F0640
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
D
2025-05-01
2025-04-16
Health
F0695
Provide safe and appropriate respiratory care for a resident when needed.
D
2025-05-01
2025-04-16
Health
F0757
Ensure each resident’s drug regimen must be free from unnecessary drugs.
D
2025-05-01
2025-04-16
Health
F0868
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
E
2025-05-01
2025-01-30
Health · complaint
F0550
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
D
2025-02-12
2024-07-11
Health
F0637
Assess the resident when there is a significant change in condition
B
2024-08-08
2024-07-11
Health
F0880
Provide and implement an infection prevention and control program.
D
2024-08-08
2023-05-11
Health
F0688
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
D
2023-05-26
2023-05-11
Health
F0732
Post nurse staffing information every day.
C
2023-05-26
scope_severity uses the CMS letter grid: A is least serious, L most. J, K and L are immediate jeopardy. Rows are the surveyor's findings of record, not the model's opinion.
Licensure actions
0
No licensure actions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Ownership
46
Owner
Role
Pct
From
Status
Source
SANFORD
5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
2019-01-01
current
pecos_ownership
BROWN, GEORGE
CORPORATE DIRECTOR
—
2025-01-01
current
pecos_ownership
DYKHOUSE, DANA
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
ENGBRECHT, WESLEY
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
FLUIT, JOEL
CORPORATE OFFICER
—
2022-10-01
current
pecos_ownership
GASSEN, WILLIAM
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
GULSVIG, NEIL
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
HERSETH SANDLIN, STEPHANIE
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
LEDERMAN, MORDECHAI
ADP OF THE SNF
—
2020-01-01
current
pecos_ownership
LUNDEEN, MARK
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
MCCAUSLAND, MAUREEN
CORPORATE DIRECTOR
—
2025-01-01
current
pecos_ownership
MIDDLETON, AIMEE
CORPORATE OFFICER
—
2022-01-27
current
pecos_ownership
MOLBERT, LAURIS
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
MORRISON, TONY
ADP OF THE SNF
—
2019-01-01
current
pecos_ownership
NORTH, ANDREW
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
OLSON, NICHOLAS
CORPORATE OFFICER
—
2024-04-08
current
pecos_ownership
SCHEMA, NATHAN
CORPORATE OFFICER
—
2022-01-01
current
pecos_ownership
SCHIEFFER, KEVIN
CORPORATE DIRECTOR
—
2025-01-01
current
pecos_ownership
SHULKIN, DAVID
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
TEIKEN, BRENT
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
OPERATIONAL/MANAGERIAL CONTROL
—
2019-01-01
current
pecos_ownership
VENTLING-HERRMANN, MARNIE
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
WENZEL, THOMAS
CORPORATE DIRECTOR
—
2025-01-01
current
pecos_ownership
WILKINS, JESSICA
OPERATIONAL/MANAGERIAL CONTROL
—
2024-03-10
current
pecos_ownership
AIMEE MIDDLETON
CORPORATE OFFICER
0%
2022-01-27
ended 2026-05-18
pecos_ownership
ANDREW NORTH
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
BRENT TEIKEN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
DANA DYKHOUSE
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
DAVID SHULKIN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
GEORGE BROWN
CORPORATE DIRECTOR
0%
2025-01-01
ended 2026-05-18
pecos_ownership
JOEL FLUIT
CORPORATE OFFICER
0%
2022-10-01
ended 2026-05-18
pecos_ownership
KEVIN SCHIEFFER
CORPORATE DIRECTOR
0%
2025-01-01
ended 2026-05-18
pecos_ownership
LAURIS MOLBERT
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
MARK LUNDEEN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
MARNIE VENTLING-HERRMANN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
MAUREEN MCCAUSLAND
CORPORATE DIRECTOR
0%
2025-01-01
ended 2026-05-18
pecos_ownership
NATHAN SCHEMA
CORPORATE OFFICER
0%
2022-01-01
ended 2026-05-18
pecos_ownership
NEIL GULSVIG
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
NICHOLAS OLSON
CORPORATE OFFICER
0%
2024-04-08
ended 2026-05-18
pecos_ownership
STEPHANIE HERSETH-SANDLIN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
THOMAS WENZEL
CORPORATE DIRECTOR
0%
2025-01-01
ended 2026-05-18
pecos_ownership
WESLEY ENGBRECHT
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
WILLIAM GASSEN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
JESSICA WILKINS
OPERATIONAL/MANAGERIAL CONTROL
—
2024-03-10
ended 2026-05-18
pecos_ownership
MORDECHAI LEDERMAN
OPERATIONAL/MANAGERIAL CONTROL
—
2020-01-01
ended 2026-05-18
pecos_ownership
TONY MORRISON
ADP OF THE SNF
—
2019-01-01
ended 2026-05-18
pecos_ownership
PECOS ownership and managing-control associations. Current edges have no end date in the source; historical edges are retained.
Related-party costs
5
FY end
Total allowable
Rent
Home office
Therapy
Staffing
Counterparties
PropCo
2024-12-31
$1,183,006
—
—
—
—
2
—
2023-12-31
$1,075,292
—
—
—
—
2
—
2022-12-31
$915,027
—
—
—
$1,965
2
—
2021-12-31
$909,142
—
—
—
—
2
—
2020-12-31
$1,085,960
—
—
—
$4,154
1
—
Cost-report related-party spend by fiscal year. has_propco flags real-estate counterparties.
Transactions
0
No transactions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Most recent same-state, same-setting trades. Most CHOW-derived trades carry no disclosed consideration, so price, $/bed, and cap rate show only where a sale price was resolved from a deed or filing — blanks are honest, not missing data.
Market rent context
30
Geo
Kind
BR
Amount
As of
Source
county 19005
fmr
0
$682
2025-10-01
HUD_USER_FMR
county 19005
acs median gross
1
$528
2024-12-31
CENSUS_ACS5
county 19005
fmr
1
$754
2025-10-01
HUD_USER_FMR
county 19005
acs median gross
2
$748
2024-12-31
CENSUS_ACS5
county 19005
fmr
2
$919
2025-10-01
HUD_USER_FMR
county 19005
acs median gross
3
$1,075
2024-12-31
CENSUS_ACS5
county 19005
fmr
3
$1,278
2025-10-01
HUD_USER_FMR
county 19005
acs median gross
4
$1,058
2024-12-31
CENSUS_ACS5
county 19005
fmr
4
$1,399
2025-10-01
HUD_USER_FMR
county 19005
acs median gross
$796
2024-12-31
CENSUS_ACS5
county 19005
acs recent mover gross
$564
2024-12-31
CENSUS_ACS5
zcta 52172
acs median gross
1
$430
2024-12-31
CENSUS_ACS5
zcta 52172
acs median gross
2
$777
2024-12-31
CENSUS_ACS5
zcta 52172
acs median gross
3
$1,102
2024-12-31
CENSUS_ACS5
zcta 52172
acs median gross
$793
2024-12-31
CENSUS_ACS5
zip 52172
payment standard 110
0
$803
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 90
0
$657
2025-10-01
HUD_USER_SAFMR
zip 52172
safmr
0
$730
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 110
1
$891
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 90
1
$729
2025-10-01
HUD_USER_SAFMR
zip 52172
safmr
1
$810
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 110
2
$1,089
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 90
2
$891
2025-10-01
HUD_USER_SAFMR
zip 52172
safmr
2
$990
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 110
3
$1,518
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 90
3
$1,242
2025-10-01
HUD_USER_SAFMR
zip 52172
safmr
3
$1,380
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 110
4
$1,661
2025-10-01
HUD_USER_SAFMR
zip 52172
payment standard 90
4
$1,359
2025-10-01
HUD_USER_SAFMR
zip 52172
safmr
4
$1,510
2025-10-01
HUD_USER_SAFMR
ACS median gross rents and HUD FMR/SAFMR for the facility's county and ZIP. Context for underwriting, not facility pricing.