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APPLICATION FOR AN ADJUSTMENTTO THE ALABAMA STATE HEALTH

PLAN

31 SPECIALTY CAREASSISTED LIVING FACILITY BEDS

IN ETOWAH COUNTY

SUBMITTED BYTHRIVE SENIOR LIVING, LLC

1

TABLE OF CONTENTS

GOAL 4

PROPOSED ADJUSTMENT 5APPLICANT AND CONTACT INFORMATION 6INTRODUCTION 7WHY IS THIS ADJUSTMENT NEEDED? 10

Demand for SCALF Services exceeds the available supply .10

Demand is growing faster than the population 11Current inventory includes SCALF beds that

hold probational licenses .. : 12Options for Choice for Senior Citizens 12

FACTS & FIGURES ABOUT ALZHEIMER'S DISEASE 14

Alabama Alzheimer's Statistics .14POPULATION PROJECTIONS 15IMPACT ON OTHER FACILITIES 16USE OF EXISTING SERVICES 17QUALITY OF CARE 18STAFFING 19NAMES OF PATIENTS DENIED SERVICES 19PHYSICIANS COMMITTED TO INVOLVEMENT 20INDUSTRY 21

Leading Employers in Etowah County 22ADDITIONAL INFORMATION ON THRIVE SENIOR LIVING 23LETTERS OF SUPPORT 23

2

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PROPOSED ADJUSTMENT

The Adjustment the SHCC is requested to adopt is as follows:

410-2-4-.04 Limited Care Facilities - Specialty Care Assisted Living Facilities

(2)(e) Adjustments. The bed need, as determined by the methodology, is subject to adjustmentsby the SHCC. The specialty care assisted living facility bed need may need to be adjusted if theSHCC if an applicant can prove that the identified needs of a targeted population are not beingmet by existing specialty care assisted living facilities in the county of the targeted population.Consistent with this provision, coupled with Section 410-2-5-.04(2)(0). the SHCC has recognized

the need fOran additional thirty-one (31) specialty care assisted living facility beds in EtowahCounty.

It should be noted that the beds requested through this adjustment application are expressly in

addition to the four (4) beds already shown as needed in the Statistical Update issued October 27,2015. As such, approval of this adjustment would increase the demonstrated need in EtowahCounty to thirty-five (35) SCALF beds.

The current provisions of the Alabama State Health Plan applicable to Specialty Care AssistedLiving Facilities may be found at Attachment 1.

A map of the Etowah County area showing the existing facilities providing similar services maybe found at Attachment 2.

5

APPLICANT & CONTACT INFORMATION

Applicant: Thrive Senior Living, LLCAttention: AlanMoise

Chief Investment Officer171 17th StreetSuite 1500Atlanta, GA 30363404-890-7988

Contact: Peck FoxThe Fox Law Firm, LLC250 Commerce StreetSuite 200AMontgomery,AL 36104334-676-3404

Proof of Publication: To be provided to SHPDA under separate cover within the timemandated by rule.

Fee: $3500, payable to the State Health Planning and Development Agency

6

INTRODUCTION

Thrive Senior Living, LLC ("Thrive") is an Atlanta-based innovative and high-growth operator

of assisted living and memory care communities with a core focus model focused on improving

resident quality of life through intelligent design, innovation and accountability. With locations

across the southern United States, Thrive is continuing to expand. Thrive currently owns and/or

operates some twenty-one (21) communities: 7 in Georgia, 3 in Texas, 3 in Florida, 3 in Virginia,

2 in South Carolina, and one each in Alabama, Maryland and Ohio; each of these communities

has a memory care component, utilizing what is defined in Alabama as specialty care assisted

living facility ("SCALF") beds. The Thrive community in Alabama - Thrive at Jones Farm,

located in southeastern Huntsville, in Madison County, Alabama - is now awaiting finallicensure from the Alabama Department of Public Health.

Etowah County is located in the foothills of the Appalachian Mountains at the southern end of

Lookout Mountain in northeastern Alabama. Etowah has the twelfth largest total population of

Alabama's 67 counties, although the segment of the population aged 65 and older ranks tenth.

The county seat, Gadsden, is the twelfth largest city in Alabama, and has a central location that is

accessible to many larger metropolitan areas - the city is within one hour of Birmingham, two ofAtlanta, and three of Nashville.

Currently, according to the Alabama Department of Public Health ("ADPH"), Etowah County

has only three licensed Specialty Care Assisted Living Facilities' ("SCALF"), with a total of 74

licensed beds. Additionally, two of these facilities accounting for 62 of these 74 beds are shown

as holding only "Probational Licenses." These listings, printed from the ADPH website.? may be

Specialty CareAssisted Living Facilities are defined by Section 410-2-4-.04{l)of the State Health Planas"intermediate care facilities which provide their residents with increasedcare and/or supervision, which isdesigned to address the residents' special needs due to the onset of dementia, Alzheimer's diseaseor similarcognitive impairment and which is in addition to assistancewith normal daily activities including, but not limitedto, restriction of egressfor residents where appropriate and necessaryto protect the resident and which require alicense from the Department of Public Health asa [SCALF].... " SCALFsare at times also referred to as "memorycare" facilities.

2 www.adph.org

7

found at Attachment 3. According to the most recent Statistical Update! issued by the State

Health Planning and Development Agency ("SHPDA") on October 27, 2015, a need for 78 beds

existed in Etowah County, resulting in a net bed need of four (4). This Statistical Update is

provided at Attachment 4. As a matter of comparison, the next two previous Statistical Updates

issued by SHPDA, dated August 12,2014 and September 18,2012, are provided at Attachment

5. These, respectively showed a need for 211 SCALF beds in 2014, and 184 in 2012. Since there

is a positive net bed need shown in Etowah County, pursuant to Section 410-2-4-.04(2)(d)7 of

the State Health Plan4, Thrive could file a Certificate of Need ("CON") application seeking to

construct and operate a 16-bed SCALF; however, the company conducted a needs assessment

showing that need for a larger facility exists in Etowah County. As such, this adjustment seeking

thirty-one (31) SCALF beds in addition to the four (4) already needed is proposed.

Overlaid against this environment is that Etowah County is among the fastest growing areas of

Alabama in the segment of the population aged 65 and above. According to the Center for

Business and Economic Research ("CBER") at the University of Alabama', the total population

of Etowah County is basically flat. In fact, CBER projects that the county's total population will

actually decrease from 2010 to 2040. However, in terms of the 65+ population of Etowah

County, CBER reports that, from 2010 through 2040, that segment of the population will growby 41.8%.

3 A "statistical update" is an update of a specific section of the SHPto reflect more current population,utilization, or other statistical data. Suchan update ismade by the SHPDAstaff on an as-needed basis.SeeAla.Admin. Code§41O-2-S-.04.

.. Section 410-2-4-.04(2)(d)7 provides "No application for the establishment of a new, freestanding SCALFshall be approved for fewer than sixteen (16) beds, to allow for the financial feasibility and viability of a project.Becauseof this, need may be adjusted by the Agency for any county currently showing a need of more than zero(0) but fewer than sixteen (16) total beds to a total need of sixteen (16) new beds, but only in the consideration ofan application for the construction of a new facility in that county. Need shall not be adjusted in consideration ofan application involving the expansion of a currently authorized and licensedSCALF or for the conversion of bedsat an existing Assisted LivingFacility."

5 According to SHPDARule410-1-6-.06(1)(b), "current population estimates or prolecnons published by theCenter for Businessand EconomicResearch,University of Alabama, and data from the SHPDADivision of DataManagement will be considered to be the most reliable data available."

8

------- -- - -

Year Total Population 65+ Population % of Total 65+ Data Source2000 103,459 16,560 16.00 2000 Census2010 104,430 16,508 15.81 2010 Census2015 103,156 18,296 17.73 CBER Estimate2020 102,137 19,670 19.26 CBER Projection2025 101,245 21,388 21.12 CBER Projection2030 100,612 22,404 22.27 CBER Projection2035 100,280 22,982 22.92 CBER Projection2040 100,127 23,404 23.37 CBER Projection

Such increases in 65+ population can be expected to cause the need for SCALF services in

Etowah County to expand, as this group of the population needs such services at a higher rate,

and the numerical methodology utilized in the State Health Plan is driven by this very population

component. Overlaid against this environment are the facts that is that research continues to

show a growing incidence of Alzheimer's Disease and other dementia among our senior citizens.

In fact, according to the Alzheimer's Association, it is estimated there will be a 22.2% increase

in the number of persons aged 65 and older with Alzheimer's in Alabama by the year 2025.

This Adjustment Application requests thirty-one (31) SCALF beds, in addition to those already

shown as being needed in the most recently published Statistical Update. If the Adjustment

Application is approved, Thrive intends to apply for a CON to construct and operate these beds,

to be placed at a campus to be developed at 2620 Rainbow Drive in Rainbow City. This

proposed location of SCALF beds would be, according to MapQuest, 9.2 miles from the 51-bed

MeadowoodRetirement Village (which holds a probational license), and 8.6 miles from the 11-

bed Oak Landing (which also holds a probational license, and has never filed an annual data

report with SHPDA). The campus to be developed by Thrive would offer a full complement ofsenior housing options, up to and includingmemory care.

Although the most recent Statistical Update shows a need for only 4 additional SCALF beds in

Etowah County, a PreliminaryMarket Analysis prepared by Thrive and attached hereto as

Attachment 8, shows that there is a need for additional beds to fully meet the community need

9

and demand in Etowah County. As discussed in this application, addition of these beds to the

available inventory in the subject area will enhance the quality of life for memory care residents

and their families in the Etowah County area.

WHY IS THIS ADJUSTMENT NEEDED?

The following are some of the reasons that additional SCALF beds are needed within theproposed geographic area:

(1) Demand for SCALF services exceeds the available supply of beds;

(2) Demand for SCALF services is growing as fast as the population, if not faster;

(3) There is a need to respond, at least in part, to the inclusion of beds in inventorywhich

hold only a probational license issued by the Department of Public Health; and

(4) There is a need to augment the availability of options for choice in living arrangements

for seniors, as determined by the senior population, their families, and their caregivers.

Demand for SCALF Services Exceeds the Available Supply of SCALF Beds

As shown by the most recent Statistical Update, market demand for SCALF services exists in

Etowah County in numbers exceeding the current licensed inventory. In addition, an examination

of the annual data reports filed with SHPDA by SCALF operators'', the utilization of availablebeds has increased in recent years, increasing from 74% in 2015 to 82.5% in 2016.

This is particularly persuasive when beds near the proposed Thrive location are considered. The

Royal Haven at Regency Pointe facility, only 2.7 miles from Thrive's proposed site, reported an

occupancy of93.8% in 2016, while the 51-bed probationally-licensedMeadowood, the facility

located farthest away from the proposed Thrive site, reported only 79.9%.Naturally, one major

consideration in determining whether to place a relative in a memory care facility is the quality

of care provided; existence of only a probational license at facilities accounting for 62 of 74 totalbeds in the county is almost assuredly a negative force in increasing occupancy.

6 For purposes of discussionsof data reported by ScALFfacilities, occupancy at ll-bed Oak landing inAttalla is not included, since they have never filed a data report with SHPDA.

10

Clearly, demand for SCALF services is in excess of the available supply.

Demand for SCALF services is growing as fast as the population, if not faster.

In the area of SCALF services, the primary age group to be served is the segment of the

population aged 65 and above. Within this segment, the principal age served is over 80, and themajority of persons needing service are female.

As shown in the areas of this Adjustment Application dealing with population projections, the65+ population of Etowah County is growing at a rate far surpassing that of the county as a

whole (an increase of 19.2% from 2010-2020, as opposed to a slight decrease in total

population). The Center for Business and Economic Research at the University of Alabama

estimates this increase will continue through at least 2040, as it is projected the 65 and overpopulation segment will increase over 41% during that time.

Additionally, as reported by the Alzheimer's Association, the United States will see a 44%

increase in individuals with Alzheimer's disease by 2025. According to U.S. Census data, the

size of the 65+ population will grow to approximately 70 million by 2030. Since age is known to

be a leading risk factor for Alzheimer's disease, the United States could experience a 70%increase in the prevalence of Alzheimer's disease during that period.

As shown in the Preliminary Market Analysis prepared by Thrive (attached as Attachment 8)

demand in the proposed geographic area will actually far exceed the adjustment sought here.

11

The current inventory of resources in the area includes SCALF beds that hold probationallicenses.

The most recent Statistical Update to the 2014-2017 Alabama State Health Plan, published by

SHPDAon October 27,2015, shows a need for 78 SCALFbeds in Etowah County, pursuant to

the numerical methodology. The Statistical Update also shows a current inventory of 74 licensed

beds (although 62 of those hold only probational licenses). Accordingly, the Statistical Update

shows a net need for four (4) additional beds in Etowah County. As discussed earlier, Thrive's

own analysis shows a demand for additional beds, leading to this adjustment proposal.

Currently, the Alabama Department of Public Health ("ADPH") shows 74 beds as being

licensed, although 62 of these have only been issued "probational licenses" pursuant to ADPH

policies and procedures. Under the rules and regulations of ADPH, a probational license is

granted when the agency has reason to believe the operation of the facility is questionable.

It should also be noted that, of the SCALF beds in Etowah County, only one of the facilities _Royal Haven at Regency Pointe (12 beds) - is within the immediate area of Thrive's planned

community. Given traffic congestion in the area, this further restricts available choice for seniorliving in the area. Additionally, most senior living residents choose locations within five (5) to

ten (10) miles from their neighborhoods, according to a study from The Assisted Living

Industry.' As such, additional beds are needed in this section of Etowah County.

Options for Choice in Living Arrangements for Senior Citizens

As shown, a need for additional SCALF beds in Etowah County has already been recognized by

SHPDA. Inaddition, the most important population cohort in determining need for these services

is growing at a rapid rate. By not having adequate resources for senior citizens, their families and

caregivers to choose between for housing options, Alzheimer's disease and other dementias take

a devastating toll on families and caregivers. As shown by the Alzheimer's Association, in 2016,

15.9million family and other unpaid caregivers of persons with Alzheimer's provided an

estimated 18.2billion hours of unpaid care. Nearly 60% of Alzheimer's and dementia caregiversrate the emotional stress of their responsibilities as high or very high. Almost 40% of such

7TheAssisted Living Industry, 2009 Overview.

12

caregivers suffer from depression. Due to the physical and emotions toll of caregiving,

Alzheimer's and dementia caregivers incurred $10.8 billion in additional healthcare costs of their

own in 2016. Additional beds are a necessary step toward ensuring that senior citizens havechoice, including the preferred method of "aging-in-place."

13

FACTS AND FIGURES ABOUT ALzHEIMER'S DISEASE

(From the Alzheimer's Association-www.alz.org;forfurtherinformation,seeAttachment8)

• Alzheimer's disease is the only cause of death in the top lOin America that cannot beprevented, cured or slowed.

• 1 in 3 Seniors dies with Alzheimer's or another dementia.

• Alzheimer's disease is the sixth leading cause of death in the United States.

• An estimated 5.4 million Americans of all ages are living with Alzheimer's disease. Anestimated 5.2 million are 65 or older.

• The number of Americans with Alzheimer's disease and other dementias will grow each

year as the size and proportion of the population 65 and older continues to increase. By

2025, the number of persons 65 and older with Alzheimer's disease is estimated to reach

7.1 million - a 40% increase from 2015. By 2050, this is projected to reach 13.8 million.

• In 2016, an estimated 700,000 Americans 65 and older died with Alzheimer's disease.

• Alzheimer's disease takes a devastating toll on caregivers. Nearly 60% of Alzheimer's

and dementia caregivers rate the emotional stress as high or very high; about 40% suffer

from depression. Due to the physical and emotional toll of caregiving, Alzheimer's and

dementia caregivers had $10.8 billion in additional healthcare costs of their own in 2016.

• Nearly one in every five Medicare dollars is spent on people with Alzheimer's or other

dementi as. By 2050, this will reach one in every three Medicare dollars.

• Someone in the U.S. develops Alzheimer's disease every 66 seconds.Alabama Alzheimer's Statistics

• It is estimated that 1885 Alabamians died from Alzheimer's disease in 2014.

• In 2016, there were approximately 89,000 Alabamians 65 and older with Alzheimer's. Itis projected that these figures will increase to 110,000 in 2025, a 26.4% increase.

• In 2016, it is estimated that 303,000 Alzheimer's and dementia caregivers to Alabama

residents provided 345 million hours of unpaid care, with a total value of $4.36 billion.

This resulted in an estimated increase in the cost of health care for these caregivers of$177 million.

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POPULATION PROJECTIONS

Etowah County is not currently among the fastest growing areas of Alabama. In fact, according

to the Center for Business and Economic Research C"CBER") at the University of Alabama',

between 2000 and 2010, the population of Etowah County actually decreased; this trend in total

county population is projected by CBER to continue in the coming years.

However, in terms of the 65+ population of Etowah County, CBER estimates that, from 2010

through 2015, it grew by almost 11%, clearly outstripping the trend in total county population.

CBER anticipates that this increase will continue through at least 2040, as it projects an increase

in this population cohort in Etowah County of some 41.8% during that time. The 65+

population of Etowah County is projected to increase by some 7000 residents between 2010 and

2040, during a period when the total county population is projected to decrease by 3000.

Such an increase in 65+ popu1ation can be expected to have a positive impact on the need for

SCALF services in Etowah County, as this group of the population uses such services at a higherrate, and the numerical methodology utilized in the State Health Plan is driven by this verypopulation component.

Additional support in the area of population and demographic growth may be found in the

population projections attached as Attachment 7 and the Preliminary Market Analysis attachedhereto as Attachment 8.

8 According to SHPDA Rule 410-1-6-.06, population estimates and proiectlons from the Center for Businessand Economic Research at the University of Alabama and data from the SHPDADivision of Data Management areconsidered the most reliable data available.

15

IMPACT ON OTHER FACILITIES

Thrive does not anticipate this proposed adjustment having an impact on existing SCALFs in thesubject area due to:

(1) Currently, 62 of74 total licensed SCALF beds in Etowah County have been granted onlyprobational licenses by the Alabama Department of Public Health;

(2) Over the last three annual SHPDAdata reporting cycles, the utilization of SCALF

services at the two facilities that have filed reports has increased;(3) Only 12 existing SCALF beds are within 8.5 miles of the proposed Thrive location;

(4) The current and projected positive population factors for Etowah County;

(5) The increasing incidence of dementia of all forms, includingAlzheimer's Disease, asdiscussed earlier;

(6) Enhanced local access to SCALF services in Etowah County can be expected to increasethe overall use rate for SCALF services, as is typical; and

(7) The unmet demand in the subject area, as plainly illustrated by the Market Analysis

included herein as Attachment 8, shows a clear anticipation that the majority of residents

of a facility created pursuant to a Certificate of Need granted pursuant to this adjustment,

if granted, would be new users of SCALF services, and therefore would create nodetrimental impact on existing providers.

16

USE OF EXISTING SERVICES

SHPDAAnnual Reports for all SCALFs inEtowah County were obtained and reviewed for thethree most recent years. Utilization data found in those Annual Reports is summarized andpresented in Attachment 10.

Only two of the existing facilities have filed reports with SHPDA. These reports show an

increase in occupancy of over 8% between 2015 and 2016. This is clearly a significant growth in

the use of existing resources, and plainly illustrates that the identified needs of the population

needing to utilize SCALF services are not being adequately served by the existing SCALFmethodology.

The utilization of existing services; the presence of only 12 SCALF beds holding a non­

probational license; the projected growth in both overall population and 65+ population for

Etowah County; and the reputation and abilities of Thrive as a SCALFprovider are all positive

factors that point toward Etowah County being an appropriateplace for an adjustment to expand

the available SCALF beds. Location of additional SCALF beds in the county would enhance

local access to SCALF services for residents and their families, alleviating distance concerns.

17

QUALITY OF CARE

In any type of health care setting, there should be a clear and paramount focus on what is best forthe patient. Obtaining the right level of care at the appropriate time in treatment of a patient iscritical, and has a direct impact on outcomes. In the Etowah County area, there is a problem withobtaining the right level of care due to lack of available options.

It has been determined under the State Health Plan that the presence of an adequate number ofSCALFbeds is critical to the provision of a full continuum of care for our seniors. Without thepresence of such adequate resources and facilities, seniors may have to utilize a different, lessefficient resource, or to reside at a SCALF in a different county, resulting in their removal fromeasy access by family, friends, and caregivers. Either of these results in a lower quality of carethan can be provided by an aging-in-pace alternative.

SCALFs,when coupled with Assisted Living Facility beds and Independent Living beds, can allprovide cost-effective levels of senior living that help with a continuum of care in the agingprocess. Only by having adequate resources in all levels of care can the true aim be realized.

18

STAFFING

The estimated staffing for these additional SCALF beds within Etowah County would

necessarily have to meet both regulatory standards prescribed by the Alabama Department of

Public Health and the operational standards of the ultimate licensee(s) for the beds, followingaward of one or more Certificates of Need ("CON").

Specialty care assisted living is required to have an administrator, a medical director, at least one

Registered Nurse, and a unit coordinator. In addition, SCALF facilities are required to have staff

coverage meeting or exceeding the staffing ratios specified in regulation on a 24 hour per day,seven day a week basis.

The addition of these beds to the Etowah County marketplace would result in the addition of jobs

to the local and regional labor markets. Recent estimates provided to SHPDA reflect estimated

growth of 40 or more new jobs for each 16 bed SCALF component. Information regarding these

new jobs will also be a required component of the CON applications filed to meet the needcreated by the proposed adjustment.

NAMES OF PATIENTS DENIED SERVICES

Included in the Organizational Outline provided in Section 410-2-5-.05 of the Alabama

Administrative Code is the instruction to provide the names of individuals denied services of the

type covered by a proposed adjustment. However, various laws and regulations restrict the listing

of such persons, and state laws and regulations may prevent the State Health Planning and

Development Agency from receiving the names of patients, residents, families and caregivers.

The Applicant has attempted to achieve the same goal herein by providing quantitative dataconcerning availability of services.

19

PHYSICIANS COMMITTED TO INVOLVEMENT

Etowah County is home to outstanding medical facilities, including Gadsden Regional Medical

Center ("Gadsden Regional") and Riverview Regional Medical Center ("Riverview").

Gadsden Regional is a 346-bed general acute care hospital, with some 230 physicians on medical

staff. Gadsden Regional is accredited by The Joint Commission, provides a full range of medical

services, and has received recognition or awards from a number of health or medicalogranizations.

Riverview is a 281-bed acute care hospital affiliated with the Prime Healthcare Services chain of

community hospitals. Riverview, which was originally founded in 1926 as Holy Name of Jesus

Hospital, is accredited by The Joint Commission, provides a full range of medical services, and

has received recognition or awards from a number of health or medical organizations. Riverview

is the medical center located closest to the proposed site of the Thrive community, approximatelyonly three (3) miles north away.

In addition, Etowah County is served by the 68-bed Mountain View Hospital, which provides

comprehensive emotional and behavioral support programs for children and adults on an

inpatient and outpatient basis, and the 44-bed Health Rehabilitation Hospital of Gadsden, which

provides inpatient and outpatient services for strokes, joint replacements, head injuries, andneurological disorders.

Throughout its communities across the southern United States, Thrive works closely and

cooperatively with local medical professionals to ensure that the needs of patients of those

particular practices are taken into account in the delivery of program resources to area residents.

The proposed adjustment for additional SCALF beds does not directly depend upon the need for

additional physicians or physician specialties in the geographic area. The selection of a physicianis a matter for determination by a resident, through consultation with the resident's family andother caregivers.

20

INDUSTRY

Etowah County, located in the foothills of the Appalachian Mountains in northeastern Alabama,

has a diverse economy, with automotive suppliers, health care and education being among the

largest components. The largest overall industrial employer is Goodyear Tire and Rubber

Company. According to Area Development magazine, amongAlabama's 11metropolitan areas,

Etowah County ranked second in manufacturingjob growth as a percentage of population, third

in employment growth as a percentage of population, and third in reduction of local

unemployment rate. Etowah County is currently working to develop the Etowah CountyMega

Site, an 800-plus acre industrial park adjacent to Interstate 59, with rail access, high-pressure gaslines, power lines, and fiber optics

The area also has public school systemswith advanced academic and fme arts programs, and

were the first in the state to adopt a Tech-Prep diploma curriculum. The county is home to a

large community college along with branches of three state universities. The community college

offers several industrial-relateddegrees; registered apprenticeshipprograms are also available formold makers, machinists and tool & Die makers.

The county seat, Gadsden, is a Keep America Beautiful national award-winner, a recipient of the

U.S. Conference of Mayors City Livability Award, and a winner of the prestigious "All-AmericaCity" award from the National Civic League

21

Leading Employers in Etowah County(Source: Gadsden-Etowah County Industrial Development Authority)

Employer EmployeesGoodyear Tire & Rubber Co., Inc. 1790Gadsden Regional Medical Center 1200Etowah County Board of Education 1084Riverview Regional Medical Center 850Wal-Mart 737Gadsden Community Coll~e 696Koch Foods 624Gadsden City Board of Education 620City of Gadsden 519Keystone Foods 508Inteva Products 450Etowah County Commission 338Fehrer Automotive 321Quality of Life Health Services 300Osborn Transportation 285Choice Fabricators 280

In addition, the above chart does not reflect recent economic development announcementsrelated to planned expansions of Prince Metal Stamping USA, Inc., and Fehrer AutomotiveNorth America, LLC, which are estimated to produce from 100to 150additional jobs each.

22

ADDITIONAL INFORMATION ON mRIVE SENIOR LIVING

Thrive Senior Living is an Atlanta-based, innovative and high-growth operator of assisted livingand memory care communities with a business model focused on improving resident quality oflife through intelligent design, innovation, and accountability. With locations across the southernUnited States, Thrive is continuing to expand and develop a suite of solutions uniquely tailoredto the assisted living industry.

The mission of Thrive is to set standards of excellence for providing care, watchful oversight andquality service for clients, residents and their families. Progress is demonstrated byresponsiveness, service excellence, and the dedication of the Thrive team to quality care. Theguiding principles of Thrive are:

• Creation of a culture in the community to provide quality of life for all residents;

• An active living environment that makes a positive contribution to the lives of allresidents;

• Outstanding facilities and a vibrant community environment for residents;

• Open communication throughout the organization; and

• The use of "Diakonos Management Perinciples" in all business dealings. Diakonos is theGreek origin of the English word "Deacon," meaning "one who serves."

LETTERS OF SUPPORT

Letters of Support for the proposed adjustment are presented as Attachment 11,or will subsequently beprovided to SHPDA in a timely fashion allowed by rule.

23

Attachment 1:State Health Plan ProvisionsRelating to SCALF Services

24

Alabama Administrative Code

410. STATE REALm PLANNING ANDDEVELOPMENT AGENCY

Chapter 410.2-4. FACILITIES

Current through Register Vol. 35, No.6, March 31,2017

410.z-t...04. Limited Care Facilities - Specialty CareAssisted Living Facilities

(1)

Definition. Specialty Care Assisted Living Facilities areintermediate care facilities which provide their residentswith increased care andlor supervision which is designed toaddress the residents' special needs due to the onset ofdementia, Alzheimer's disease or similar cognitiveimpairment and which is in addition to assistance withnormal daily activities including, but not limited to,restriction of egress for residents where appropriate andnecessary to protect the resident and which require a licensefrom the Department of Public as a Specialty Care AssistedLiving Facilities pursuant to Ala. Admin. Code§420-5-20,et seq.

(2)

Specialty Care Assisted Living Facility Bed NeedMethodology

(a)

Purpose. The purpose of this specialty care assisted livingfacility bed need methodology is'to identify, by county, thenumber of beds needed to assure the continued availability,accessibility, and affordability of quality care for residentsof Alabama.

(b)

General. Formulation of this bed need methodology wasaccomplished by a committee of the Statewide HealthCoordinating Council (SHCC). The committee whichprovided its recommendations to the SHCC, was composedof providers and consumers of health care. Only the SHCC,with the Governor's final approval, can make changes tothis methodology except that the SHPDA staff shallannually update bed need projections and inventories toreflect more current population and utilization statistics.Such updated information is available for a fee uponrequest. Adjustments are addressed in paragraph (E).

(c)

Basic Methodology. Considering the availability of morecommunity and home based services for the elderly inAlabama, there should be a minimum of 4 beds per 1,000population 65 and older for each county.

The bed need formula is as follows:

(4 beds per thousand) x (population 6S and older)Projected Bed Need

(d)

Planning Policies

1.

Projects to develop specialty care assisted living facilitiesor units in areas where there exist medically underserved,low income, or minority populations should be givenpriority over projects not being developed in these criticalareas when the project to develop specialty care assistedliving facilities in areas where there exists medicallyunderserved, low income or minority populations is notmore costly to develop than other like projects.

2.

Bed need projections will be based on a three-yearplanning horizon.

3.

Planning will be on a countywide basis.

4.

Subject to SHCC adjustments. no beds will be added in anycounty where that county's projected ratio exceeds 4 bedsper 1,000 population 6S and older.

S.

When any specialty care assisted living facilityrelinquishes its license to operate. either voluntarily orinvoluntarily other than by a Certificate of Need approvedtransfer, or by obtaining title by a foreclosure as specified inthe opinion rendered by the Alabama Attorney General.November 17, 1980, the need for the facility and itsresources will automatically be eliminated from thefacilities portion of the State Health Plan. The new bed needrequirement in the county where the facility was locatedwill be that number which will bring the county ratio up to

4 beds per 1,000 population 6S and older.

6.

Additional need may be shown in situations involving asustained high occupancy rate either for a county or for asingle facility. An applicant may apply for additional beds,and thus the establishment of need above and beyond thestandardmethodology, utilizing one of the following twopolicies. Once additional beds have been applied for underone of the policies, that applicant shall not qualify to applyfor additional beds under either of these policies unless anduntil the established time limits listed below have passed.All CON authorized SCALF beds shall be included inconsideration of occupancy rate and bed need.

(i)

If the occupancy rate for a county is greater than 92%utilizing the census data in the most recent full year"Annual Report(s) for Specialty Care Assisted LivingFacilities (Form DM-I)" published by or filed withSHPDA, an additional need of the greater of either tenpercent (10010) of the current total CON Authorized bedcapacity of that county or sixteen (16) total beds may beapproved for either the creation of a new facility or for theexpansion of existing facilities within that county.However, due to the priority of providing the most costeffective health care services available, a new facilitycreated under this policy sball only be allowed through theconversion of existing beds at an Assisted Living Facilitycurrently in possession of a regular, non-probationarylicense from the Alabama Department of Public Health.Once additional need has been shown under this policy, nonew need shall be shown in that county based upon this rulefor twenty-four (24) months following issuance of theinitial CON, to allow for the impact of those beds in thatcounty to be analyzed. Should the initial applicant for bedsin a county not apply for the total number of beds allowedto be created under this rule, the remaining beds would thenbe available to be applied for by other providers in thecounty. so long as said providers meet the conditions listedin this rule.

(il)

If the occupancy rate for a single facility is greater than92% utilizing the census data in the last two (2) most recentfull year "Annual R.eport(s) for Specialty Care AssistedLiving Facilities (Form DM-I)" published by or filed withSHPDA, irrespective of the total occupancy rate of thecounty over that time period, up to sixteen (16) additionalbeds may be approved for the expansion of that facilityonly. Once additional beds have been approved under thispolicy, no new beds shall be approved for that facility fortwenty-four (24) months following issuance of the CON, to

allow for the impact of those beds at that facility to beanalyzed.

7.

No application for the establishment of a new, freestandingSCALF shall be approved for fewer than sixteen (16) beds,to allow for the financial feasibility and viability of aproject Because of this, need may be adjusted by theAgency for any county currently showing a need of morethan zero (0) but fewer than sixteen (16) total beds to a totalneed of sixteen (16) new beds,but only in the considerationof an application for the construction of a new facility inthat county. Need shall not be adjusted in consideration ofan application involving the expansion of a currentlyauthorized and licensed SCALF or for the conversion ofbeds at an existing Assisted Living Facility.

8.

Any CON Application filed by a licensed SCALF shall notbe deemed complete until, and unless:

(i)

The applicant has submitted all survey informationrequested by SHPDA prior to the application date; and

(ii)

The SHPDA Executive Director determines that the surveyinformation is complete.

9.

No licensed SCALF filing an intervention notice orstatement in opposition in any CON proceeding may cite orotherwise seek consideration by SHPDA of such facility'sutilization data until, and unless:

(i)

The intervenor or opponent has submitted all surveyinformation requested by SHPDA prior to the applicationdate; and

(ii)

The SHPDA Executive Director determines that the surveyinformation is complete.

(e)

Adjustments. The bed need, as determined by themethodology. is subject to adjustments by the SHCC. Thespecialty care assisted living facility bed need may need tobe adjusted by the SHCC if an applicant can prove that theidentified needs of a targeted population are not being met

by existing specialty care assisted living facilities in the 73county of the targeted population.

(f)

Notwithstanding the foregoing, any application forcertificate of need for specialty care assisted living facilitybeds for which a proper letter of intent was duly filed withSHPDA prior to the adoption of the bed need methodologyshall not be bound by this bed need methodology.

(g)

The determination of need for specialty care assisted livingfacility beds shall not be linked to the number of existingassisted living beds in the county.

30

7

BARBOUR

4,034

16

16

oo16

SPECIALTY CARE ASSISTED LIVING BED NEED BIBBPROJECTIONS

COUNTY

Pop 6S& Older 2006

4 Per 1,000 Pop 6S & Older

Total BedsNeeded

Licensed Beds

CON Issued

Net Beds Needed

AUTAUGA

5,622

22

22

80

o-58

BALDWIN

27,411

110

110

2,817

11

11

16

o-5

BLOUNT

7,881

32

32

50

70

-88

BULLOCK

1,530

6

6

oo

Attachment 2:Map of Proposed Geographic

Area for Adjustment

28

-----------------------------

5i3f2017 Gadsdan- GoogIeMIIpI

Google Maps Gadsden

A -1?O'lAL. H-A\leN tLt l2E(;~"I POIN-R (IS.O fA~TC;I2ANO~'7Goog1e 2m1

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Attachment 3:ADPH Health Care FacilitiesDirectory Listings for SCALFFacilities in Etowah County

30

512120174:53 PM Health Care Facilities Directory

Assisted Living Facilities (Specialty Care)

Etowah County

MeadowoodRetirementVillage,LLCSCALF509 PineviewAvenueGlencoe,AL 35905 (256)492-093551 bed CongregateSpecialtyCareAssistedLivingFacilityLicenseeType: LimitedLiabilityCompanyAdministrator:W. Bart ScottFac 10: P2802 Ucen .. : ProbationalMedicare:N/A................... __ _- .

Oak LandingSpecialtyCareAssistedLiving616GainesStreetAttalla,AL 35954 (256)553-178711bed GroupSpecialtyCareAssisted LivingFacilityLicenseeType: CorporationAdministrator:MelissaTInsleyFac 10: P2803 Ucen•• : ProbationalMedicare:N/A......................................................................................

RoyalHavenat RegencyPointe510 EastGrandAvenueRainbowCity,AL 35906 (256)442-185612bed GroupSpecialtyCareAssisted LivingFacilityLicenseeType: LimitedLiabilityCompanyAdministrator:JuliaWeidenbachFac 10: P2801 License:RegularMedicare:N/A•.••••.••..••...•.........................

Page 1 of 1

Attachment 4:State Health Plan StatisticalUpdate for SCALF FacilitiesPublished October 27, 2015

32

STATE HEALTH PLANNING AND DEVELOPMENT AGENCY100 NORTHUNION STREET,SUITE 870

MONTGOMERY.AlABAMA 36104

October 27t 2015

MEMORANDUM

TO: Recipients of the 2014-2017Alabama Slate Health Plan

FROM: Alva M. Lambert - j)Executive Director PI'"

SUBJECT: Statistical Update to the 2014-2017Alabama Stale Health Plan

Enclosed are statistical updates to the 2014-2017Alabama Slate Heallh Plan. Thefollowing sections should be replaced:

410-2-4-.04, Limited Care Facilities (SCALF), pages 105-106.

AMLlblw

Enclosure:As stated

MAIUNG ADDRESS:P.O.BOX 303025, MONTGOMERY,ALABAMA 36130-3025PHONE:(334) 242-4103 FAX:(334) 242-4113

so..

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Attachment 5:State Health Plan StatisticalUpdate for SCALF FacilitiesPublished August 12,2014

(No longer in effect)

36

":,." '.'.

, ;''i,0i~7\:(

STATE HEALTH PLANNING AND DEVELOPMENT AGENCY100 NORTHUNIONSTREET,SUITE870

MONTGOMERY,AlABAMA 36104

August 12,2014

MEMORANDUM

TO: Recipients of the 2004-2007Alabama Stale Health Plan

FROM: Alva M. Lambert .JExecutive Director (fM

SUBJECT: Statistical Update to the 2004-2007Alabama Slate Health Plan

Enclosed are statistical updates to the 2004-2007Alabama State Health Plan. Thefollowing sections should be replaced:

410-2-4-.04. Limited Care Facilities (SCALF). pages 105-106.

AMLlblw

Enclosure: As stated

MAIUNG ADDRESS: P.O.BOX 303025, MONTGOMERY,ALABAMA 36130-3025PHONE:(334) 242·4103 FAX:(334) 242-4113

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Attachment 6:State Health Plan StatisticalUpdate for SCALF FacilitiesPublished September 18, 2012

(No longer in effect)

41

-------- - ------

STATE HEALTH PLANNING AND DEVELOPMENT AGENCY100 NORTHUNIONSTREET,SUITE870

MONTGOMERY,ALABAMA 36104

September 18. 2012

MEMORANDUM

TO: Recipients of the 2004-2007 Alabama ,\'IU/(! llealth Plan

FROM: AI\'a M. lambert )/Executive Director ~"

SUBJECT: Suuistical Update to the 2004-2007 Alabama Stale Heahh Plun

Enclosed are statistical updates to the 2004-2007 Alabama SI"I4.~Health Pia". Thefollowing sections should he replaced:

410-2-4 ·.0.... Limited Care Facilities (St" 1.10'). pages IUS·IOu.

AMLJblw

Enclosure: As stated

MAILING ADDRESS:P.O.BOX 303025, MONTGOMERY,ALABAMA 36130·3025PHONE:(334) 242·4103 FAX:(334) 242·4113

so..

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sellilloe:lBUIA"P8JSIssVeJeo~Ieloeds

Pop65& Total TotalOlder Beds Licensed Net Beds

COUNTY 2015 Needed Beds CON Issued Needed NotesLimestone 11.263 45 32 0 13Lowndes 2,354 9 0 0 9Macon 3,911 16 0 0 16Madison 46,070 184 224 0 (40)Marengo 3,802 15 16 0 (1)Marlon 6,589 26 0 26 0 (6)Marshall 15,804 63 22 0 41Mobile 60,145 241 285 0 (44)Monroe 4,239 17 0 0 17Montgomery 31,933 128 223 0 (95)Morgan 18,882 76 62 16 (2) (2)Perry 1,858 7 0 0 7Pickens 3,643 15 0 0 15Pike 4,897 20 0 0 20Randolph 4,581 18 16 0 2Russell 7,705 31 0 0 31St. Clair 13,432 54 37 0 17Shelby 29,135 117 152 0 (35)Sumter 2,064 8 0 0 8Talladega 14,200 57 32 0 25Tallapoosa 8,720 35 46 0 (11)Tuscaloosa 23.205 93 98 0 (5)Walker 13,545 54 14 0 40Washington 3,165 13 0 0 13Wilcox 2,003 8 0 0 8Winston 5,159 21 16 0 5

TOTAL n6,955 3,108 2,664 107 337

NOTeS (CONs Issued)(1).2264-8CALF· LlfeQuest of Florence LLC 32 Beds(2) - 228S-8CAlF • Decatur ALF Group, LLC 16 Beds(3) - 2515-8CALF • Ladlga Manor, LLC 8 Beds(4) • 2550-8CALF - Piedmont Health Care Authority 9 Beds(5) • 2571-8CAlF - Jacobs House, Inc. 8 Beds(6) - 2586-8CALF - St. Clair Services, Inc. 26 Beds(7) - AL2012-G36· Chateau Vestavia Hills, LLC 8 beds

18-Sep-12

106

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Alabama County Population Aged 65 and Over 2000-2015 and Projections 2020-2040 (Middle S2017 series

Census Census April 1, 2015 Change 2010-2040

2000 2010 Estimate 2020 2025 2030 2035 2040 Number Percent

Tallapoosa 6,872 7,193 8,274 8,694 9,556 9,991 10,037 9,889 2,696 37.5

Tuscaloosa 18,565 21,050 24,509 28,882 33,432 36,492 38,345 40,030 18,980 90.2

Walker 10,453 10,894 12,122 13,418 14,409 14,821 14,581 14,006 3,112 28.6

Washington 2,246 2,590 2,932 3,227 3,589 3,854 3,932 3,872 1,282 49.5

Wilcox 1,810 1,752 2,036 2,170 2,396 2,461 2,394 2,268 516 29.5

Winston 3,533 4,333 4,942 5,363 5,812 6,260 6,404 6,309 1,976 45.6

Note: These projections are driven by population change between Census2000 and Census2010, taking into account 2015 population estimates. Data on birthsand deaths for 2000 to 2010 aswell as more recent data from the Alabama Department of Public Health are used to derive birth and death rates for the state and

each county.

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Attachment 9:Fact Sheets from the

Alzheimer's Association

59

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alzheimer's ~ association­THE BRAINS BEHIND SAVING YOURS:

2016 Alzheimer's Disease Facts and Figures

Alzheimers takes a devastating toll - notjust on those wHh the disease, but onentire families.

• Nearty half of care contributors - those who arecaregivers of someone with Alzheimer's and/orcontribute financially to their care - cut back ontheir own expenses (induding food, transportationand medical care) to pay for dementia-related careof a family member or friend.

• care contributors are 28 percent more likelythanother adults to eat less or go hungry because theycannot afford to pay for food.

• One in five care contributors cut back on their owndoctor visits because of their care responsibilities.And, among caregivers, 74 percent report they are"somewhaf to "very" concerned about maintainingtheir own health since becoming a caregiver.

• On average, care contributors lose over $15.000in annual income as a result of reducing or quittingwork to meet the demands of caregiving.

• In total, 15.9 million family and friends provided18.1 bDlion hours of unpaid care in 2015 to thosewith Alzheimer's and other dementias. That carehad an estimated economic value of $221.3 billion.

Facts in Your State

The 2016 Alzheimeta ~ FacfJ end Figuresreport also contains state-tJy«ate data on the impactof the disease. FInd the fuIf feport and Information onyour stale at __ 9tJiJISI,

Consequences of Not Being Able toAfford Food, by Percent of Individuals

36%

Food Did Not Last Ale Less WenlHungry

Financial Steps Takento Help Pay forthe Needsof Someonewith Alzheimer's,

by Percent of CareContributors

48%

CutBack Cut Baclt Spent Spent Borrowedon on General Retirement Money

Spending Saving SavIngs Savings

The number of Americans living withAlzheimers disease is growing - andgrowing fast

• Today, 5.4 million Americans are living withAlzheimer's disease, IncJudIng an estimated200,000 under the age of 65. By 2050. up to16 million will have the disease.

• Nearty two-thirds of those with Alzheimer'sdisease - 3.3 million - are women.

• By 2025, 20 states wiHsee at least 35 percent orgreater growth In the number of people withAlzheimer's.

• Someone in the United States developsAlzheimer's every 66 seconds. In 2050. someoneIn the United States wi. develop the diseaseevery 33 seconds.

The growing Alzheimers crisis is helpingto bankrupt Medicare.

• In 2016, the direct costs to American society ofcaring for those with Alzheimer's will total anestimated $236 billion. with just under half of thecosts bome by Medicare.

• Nearly one in every five Medicare dollars is spenton people with Alzheimer's and other dementias.In 2050, itwli be one In every three dollars.

• Average per-person Medicare spending for thosewith Alzheimer's and other dementias is threetimes higher than average per-person spendingacross all other seniors. Medicaid payments are19 times higher.

• Unless something Is done, In 2050. Alzheimer'swin cost $1.1 trillion On 2016 dollars). Costs toMedicarewllincrease 365 percent to $589 billon.

2016Costs of Alzheimer'S III$236Billion

Alzheimers is not just memory loss -Alzheimer's kills.

• Alzheimer'S disease Is the 6th leading cause ofdeath in 1heUnited Statas and the 5th leadingcause of death for thOSe aged 65 and older.

• In 2013, over 84,000 Americans officially diedfrom Alzheimer's; In2016, an estimated 700,000people will die with Alzheimer's - meaning theywill die after having developed the disease.

• Deaths from Alzheimer's incraaaed 71 percentfrom 2000 to 2013, while deaths from other majordiseases (including heart disease. stroke, breastand prostate cancer. and HIV/AlDS) decreased.

• Among 70-year aids, 61 percent of those withAlzheimer's are expected to die before the age of60 compared with 30 percent of people withoutAlzheimer's - a rate twice as high.

• Alzheimer's Is the only cause of death among thetop 10 in America that cannot be prevented.cured. or even stowed.

Attachment 10:Summary of SCALF AnnualReports Filed with SHPDA2013-2016 for Facilities

Located in Etowah County,Alabama

64

2013 SUMMARY OF SCALF ANNUAL REPORTS FILED WITH SHPDAFacility ID Facility Name Beds Possible Total Occupancy Notes

Days Patient RateDays

Royal Haven at 12 4380 3350 76.5055-S2801 R~en~ PointeMeadowood Retirement 40 14,600 10,596 72.6055-S2802 Vill~eOak Landing

Initially licensed September 2013055-S280352 18,980 13,946 73.5TOTAL

2014 SUMMARY OF SCALF ANNUAL REPORTS FILED WITH SHPDAFacility 10 Facility Name Beds Possible Total Occupancy Notes

Days Patient RateDays

Royal Haven at 12 4380 2745 62.7055-S2801 Regency PointeMeadowood Retirement 40/51 15,876 13,173 83.0 Increased from 40 to 51 beds on November 4,2013055-S2802 VillageOak Landing Initially licensed September 2013;055-S2803

No reports filed with SHPDA52/63 20,256 15,918 78.6TOTAL

2015 SUMMARY OF SCALF ANNUAL REPORTS FILED WITH SHPDAFacility ID Facility Name Beds Possible Total Occupancy Notes

Days Patient RateDt!}'s

Royal Haven at 12 4380 2993 68.3055-S2801 Regency PointeMeadowood Retirement 51 18,615 14,051 75.5055-S2802 ViJI~eOak Landing

Initially licensed September 2013;055-S2803No ~rts filed with SHPDA63 22,995 17,044 74.1TOTAL

2016 SUMMARY OF SCALF ANNUAL REPORTS FILED WITH SHPDAFacility ID Facility Name Beds Possible Total Occupancy Notes

Days Patient RateDays

Royal Haven at 12 4392 4121 93.8055-S2801 R~en~ PointeMeadowood Retirement 51 18,666 14,909 79.9 Increased from 40 to 51 beds on November 4, 2013055-S2802 VillageOak Landing

Initially licensed September 2013;055-S2803No _!epOrts filed with SHPDA63 23,058 19,030 82.5TOTAL

2

Attachment 11:Letters of Support

67

Batey&Sanders, Inc.P.C1ao.x '_.GADalIN.A!..AIIAMA3IIG2.t_10 ~.1NDU81'RIAI. avo.• CAAROU.TON, GEORGIA 30117... ·IIMI)....... iLClOnt

April 24, 2017

Scott HundleyThrive SeniOr LMns

Iam•• resident of EtowahCounty Ind 1m siCninsthis petition to show trrf·strorw support fottheautbortzation of .aditlona.$ptda'ty care assr. 'Mns beds In Etowah County.n Ismy hope thattM beds will be placed In the are. proposed byThrive Senior t.ivfnc. I belieYethat. thts additional levelof, and access to, care IsImportant to maintain the continuity 0.'cartfor the residents of Etowah County.

~Y'5a"cIe~

~L\y\),hnll BoydPresident

•.......... , "Ufl."

Marte. Haller. ~.SRA HALLER REAL ESTATE ADVISORS, LLC~ ~ ~ ~ Estate Valuation& ConsultingReaf ~ Apprai8er

AprU21.2017

SaXtHundleyThrive Senior Uving

P.O. Sox0825~~~P,hoae:~1793

l>ea(.Scott.

I am a resident of Etowah.County and am signing this petition to show my strong support for theauthQrization of additional ~alty ca(e·asUedUving beds in Etowah County.

It ismy ho.pe that the beds ~n be placaJ inthe area proposed by Thrive Senior .LlvinJ. I believe that thi&ad(Ijtiona! lMI o~"and ~ 10,care i~UnportaiU to maintain the cooUridty of ~ ~r tltc ~(JeptJ ofEtowah County.

$(ott HundleyThrive Senior LN.DutScott,

I amI resident of Etowahcounty and1msiCninsthis petition to showmy stronaS\lpf)Olt fottheluthoriza~n of a4di~n~1 ~lty 9re.~ INfnc~ mEtow_County.

It ismy hope that the bedsWillbe placed in the 1m proposedbyThrive Senior ~ IbdMthaUhisadfJlttoM'leveJ01# 1f1d.~ tQ, ~re is.~!'ltto I11Itn"'n the contfnuIty ofc;t.l't ftw ttw.N$fdenuciEtowah COunty.

~~

~,..tA1'U.rJ,c,/t.Name

Scott HundleyThtIveSenIorUvlns

OearScott.

Iam a resident of Etowah Countyand am _Aine this petition to show my strona support for theauthorization ofadditJpUI specialty care 1SJIsted·'ivinabeds InE~h County.

It Ismy hope that the bedsWiIJbe placed in the area proposed by thriVe seniOr tJvitW.lbelieve that thisadditioNl' level of#ena~ssto, Clre Is in'tpo".nUo ma~ the (()ntintJftyof CIte for the ~ ofEtowahCOunty.

jA~e HALL~me

Scott HundleyThIive senior Living

OearScott,

lam, resident of Etowah Cognty .ndam sianl", this petition to.$how my stronc support for ~authorization of Idditfo~t specialty cart·assfsted 1M.,.beds InE~.h County.

It i$my hope that the bed$wUJ be p~ intheJr. ptOpo$td by Thrive senior Uvin&. 'be'Mtve that thisadditional fevel of, and·aceess to,Q(! is tmPOrtafttto maintain the<Ontinulty of care for the resfdentsofEtowah County.

~b Ai-rJ~/(Name

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JuIN.'lJOfU~aAlJtUMIPUnHD0)5

Scott Hund'eyThrive seniorUvlnsDear Scott,

• am , resident of Etowah County.nd .m sianina thl$ petftion to showmy ~ support ,.". theauthOrization of tlddltlcmaJ JpeCilIty cat'&.SSlstect IMns beds In Etowah County.

It ismy hope thJt the bedswUl be ptaced in the areaproposed by Thrive.SenkJr ~.I befleW thftthisaddltfonal JeveI of..and access to, care Is in"apottant tomaintain the continuity of care for the tesidenUofEtowah (ounty.

~" :ri.kiNMNtqme ~,"L """" ~ 'l>ft...

G,.ltd.... PL.~61

SCott HundleyThrive SeniorUvtna

OUt Scott.

I am a resident of EtowahCounty .nd:am .. nina tbb petition to show my stfOns supporUor theauthorization ofadd"ttionaI specialty care assisted livtn& beds In EtQwah County.

IUSmy hope«haUhe beds WlU be pjaced In the area proposed by Thri\<eSenior f.ivirII.lbelieve thlt:tbisadditional level of, andaccess to, care fslrnportant tomaintain the contfnufty of care for tt.e resident}ofEtowah County.

Sincerely.

~(td4~

:OI;)R'~ M 00/Name

Sc9tt HuncffevThrive Senior lMna

t am I """ent of EtQwIh Cot.mty and am slanf", thI$petition to shQw my SUO,.$UpJIOrt lor theauthotftatfon of additioNl spedalty Clre assIstH 1M", beds inEtowah CountY.

ItIsmy hope that the bedswill be placed'n the area Pf'OpOSed bvThriw SenJor LMnc- J believe that thisadditfonallevel of,and access to. care I$lmportant tomaintain the continuity of tate for the reslder1ts<CJ'Etowah Q)unty.

e

ISinctr •

'")L_ __

Scott HundleyThrive Senior Uvinc

Oear5cott

IJm a resldent.of£to.,h Countyand am signIna this petition to show my stronc.support ,or.Uteauthorization ofJdditlonat 5pe(iatty Clre ISS&tedIMne beds inEtowah COunty.

'tis my hope th,,~tlecfsWIllbep~ Inthe lret pI'Oposecf by Thrive s-niQrUvina. I ~,~ ~tthl$additional leW. ofj':antf ICteSs to, .Qre is Im~nt to maintain the continuity of care for the ~tsOfEtowab.County.

------------- --

Scott HundleyThrive Senior LiYtna

OearScott,

Iam J resident ofEtowah ~ty .andam si&nlnc this petitJon to $how.my stronc suPP<H1for theautboriutiOn of additional specialty (:Ite asslsted'ivq bed$1n EtowahCounty.

It 1$my hope that the beds .wW be placed in the .,.. prof)Osed byThrlveSeAior LMoa. Ibelieve tha.t thi$additionalleYel Of.and ICtess to. care is fmpottant to maintain the amtlnuity.of cart for the resldenrs.'Etowah ~nt.y.

F/HE l)eYIJIJt...pSNirne

Sc.ott HundleVThrive Senior UvinS

Oear$cott

, am " resident of Etowah Cot,lflty and am slanina this petition to show my $tIQf't&. suppQt1 for tbeauthorization afaddltional ~Ity care ~ livina beds in £tOwahCounty.

It ismy hOpe that the beds willbe placed in the are. propo_ byTbrive senior 1M"... believe that thisaddit~1 level of, ~nd ~ to, Care Is important to maintain the continuity ofeare Corthe resldenf.$ ofEtOWah County.

Sirw:erely,

Name

SCott HundleyThrIve Senior IMJ1I

'Im.restdInt ofEtowah County and this petition to show my stroncsupport for theauthorfzaUon ofaddltlcnl apedIIty cate hInc bids InEtavGh County.

ItII my hope tNt the bedswfJI be plaCId In the· propoIIdby11v1vt SenIor ~ IbeIIwtMt th)sacldftlanlllewI of•.and ICCIS$ to, care Islrnporbant tomaintain the candnuky of are for the NSidItftts ofEtowah County.

SfncttJIy.

~_._,-

ScottH(lndleythrive Senior Living

OearScott,

I am a resident of Etowah Countyand am sJgnlnCthis petition to show mf strons sUpport for the.uthotization of additional $J.tedalty care a$Sisted 1M",~ in Etowah CQunty.

It Ismy hope that tt.bedswill be placed Inthe are. proposed byThriveSenior LMnc. t ~Ii~e t,lltt this~~i~pJ.1 ~f of, 1nc:JI~"'to, care is important to m.,ntafnthe continuity of ear. fortheresklentlofEtowah County.

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Scott HundleyThrive Senior Uving

DearSCon.

Iam a re.sidem ofEtoW1h Counw .net am silnln, this petition to showmv stro... support for thea\ltboriution of additional spedatty care assisted.fivin& beds tn Etowah tounty.

It Ismy hope that the beds wUl be placed in the area proposed byThriveSenior tMl1J. Ibelieve that thisadditiOnal leVe'of. and access to. care Is important tomaintain the continuity ofcate for the residePts ofEtQwah CQunty.

Sincerely,

~~SJsned

~I

SCott HundleVTh~ Senior living

OearScott,

Iam a resident of E~h CQlJntv and am silnina this petition ~ $how "'Y $tl'OnsJ$UpPOrtfor theJuthoritatioo of additiOr-alSpecitltycare aSSisted1M. beds InEtowah County.

It ismy hQpe that~ ~ wfDbe placed In the lrea proposed byThrive Senior Uvi,.. t ben...,. ~ttt11$additJonal.Jevet of,.nd. access to, c:ate Is Important tq:maintain the (On~"tJity ofeate 'o .. the I'eSiMnts ofEtQwah County.

Scott HundlevThrive SeniorUvins

OearScott.

I am a residentot Etowah County ,nd Im*nins this petition tost\oW my strDnJSUppart for theauthorization cif ,ddftional spedaltycate assisted IMna beds In EtowilhCqunty.

It 1$my hope ~t.t,he be4s WI'be placed in the area ptoposed byThrive.Senior Livfn&. l.btl1eve~Ult.1$additiOnal level of, and aeces$to, c;are is Jmportaotto maintain ~ continuity of c:ai'e for the testdetttsiotEtQwJh ~nty.

ScottHuodleyTbtIve Senior Livins

Dear Scott,

Iam a resictefrt of E~ County and ...., si&nlnctills ~ to show my ~na~PPQf't for theauthorization of additional specialty care ISSfsted IMns beds InEtoWahCOunty.

Itismy hope that thebeds will be placed In the atea propOsed by Thrive Senior lIVirW.1.beIieve that this-_ltionar levelOf. and ~ tg,-=-re.j$lmportlnt to maintai.,.·tt1t COr1tlnuity Mq,. f9rttle""r¢$ ofEtowah County.

Sincerely,

-£l~Sipled

VI(jKI ~IIIL~Name

Scott HundlevThrive Senior Living

OearScott,

J am I residentof EtowahCounty .n(lam sf,.,in, ~is petition to show my mona support to! theilUthL)(lzatlon ohddttiOnaJ $petialty cate assisted IMna beds in Etowah CQunty.

It ismyhope tblt.th4! bed~will be placed in the area proposed by ThrfveSe®,.I.MnI .•J ~QM thM thisadditionalleVef of, and a«:ess tol care is Important tomaintain the contfnulty'Ofcard'or thttesidents ofEtOYOO County.

Wi II;A In MA..b"i.Name

Scott HundleyThrive Senior UvinS

OearScott.

Iam a reSident of Etowah County and am slgnin. this petition to show my stronJ IUJ)PQI'1 for thelutbo~tfOn ofaddltiona. specialty art aui$ted fMna ~c.ts in~towah COunty.

It ismy hope that the beds wU. ~ ~.fnt#)eare,proPQtl!d byllu'ive~jqr·lJvinc..l~levethatthisaddItional Ieve. of#and ac:cess to, care IsImportant tomaintain the continuity ofcare for dle.rulden1:J 0'£towah COunty.

Sincerely,

Name

SCott HundleyThriVeSenior Living

Oear5cott.

t am It residentof Etowah~nlY andlm~n.g tt1~Pltition.'to shoW my.$tronJ~tQrtheautherizatipn Qf addffiOnat$J)edalty care aSSIstedUvinabeds in Etow.h County.

It ismy hope ~t ~.,...$will be pJacedin the',area proposed byThrive SenlQruYfn&. I ~1I~e tflJt thi,additionaJ leVelof, and access to, care.is im~otto lnaln~il1the continuItYbf.care tot the~ofEtPWilh County.

..

Scott HundleVThrive Senior LlvInC

OearScott,

J am a resident 'ofEtowah COuntyand am signina tills petition tQ $howmy ~tronasupport for theauthQrizatic>nof aclditiQnalspeCialty care asfted IMns beds inEtowah COunty.

Itis my hQ." ~t~ I:MKfswiltbe Placed fn tI1e area proposed byThrive5enior WInI- I beDeve that thisadditional level of, and. acce$S to, care Is Important to .makt,~fn the PJntfnultv ofq,.for the residentsofEtow$h CcJlJnty.

Sincerely,

·SiSned

Bli!1t. j- ). I JI.4-//t!,e.Name

·Scott HuncttevThrive Senior living

Dear Scott,

t am a resident of Etowah Countyand am sicmna this petition to show my strong ~rt for theauthorization of additional $Pec;iJfty ear, a$Si$ted lMAIbeqS in ~tpwahCOunty.

JUs my hope that the"b~ wHlbe p~p In~.IV~$t;d byTh..w.S."lor UvlOi. tbeHeve that thisaddttlOriaJ IeVet ofl and access to" tate is ,",pOrtint tomalntaln the continuIty of cal'e for the ~ofEtowah county.

Sincerely,

~'e5=1W~~A4"t

Scott HundleyThriVeSenior Uviog

Dear$O)tt

f am a tesideotofEtowah County aod .m sIBninctbis ~tition lOshow my stronJ support for theIt.JUtomation of ~itiQnil spec;ia1tYc:areassisted IMnS beds in Etowah County.

Itismy hope that the beds will ~ placed In the areaproposed by ThriveSenior LMnc•• btQeye. th~ this.additiOnaJIeveJ of, and access to, care Is important tomaintain the CI)(lt.inbityof care for the residents ofEtowah County.

Z!:A)ISigned

~"\ ,d;;ll!: JI"Name

I1rJN'W~rfYil>PYf'()'~

'Atunco1.f~~310lIUIPJS&.1......1018.11)10~~U03atnUlllUJIWOlluilJodwfSJ8Je;,'~SSJ:X)'put'10laAaf,tUOfttppestqtt"'"Me!IMIj'JuW1JOju8$MP'IlAqpesOdoJdOJ.~.u,P8letdeq111MspaqalAt~adOyA""sft,

'AlunOJQlMOl3ujspaqIu","pe..8Je;,Allepad$(tUO)l!PPIjOuQPlZfJGqlne8t4t.lOJuoddosJu04!AwMOq$.01uOfmad'!titlulU'"wePUIAtunOll.feMQtlJOt~PfAJ•we.I

SuJAnJOIUesitA&otcuAa,punHU~

Scott HundleyThrive Senior Uvfng

OearScott,

Iam a resident of Etowah County and am siSnina this petition to showmy strOr:llsupport fortheauthoriZatiOn oftdditloflll spedJlty care usistedJiVina beds in EtOWahCOunty.

It Ismy hoPf! that the beds wilt be.placed In the tf'N proposed byThrive Senior UVI"._.1~ that thi$additional levelof. and access to, cate Is Important to maintain the continuity of care (or the I'eSldents ofEtowah COUIrtV.

Sincerely,

Scott Hundh!yThrive senior Llvins

OearScott.

Iam a r~At of EtQMh Cpunty aAd am.na this petition to $how my.strQn8 $Upportford1eauthOrizatiOn of addltiOna'spedaltycare assisted livlna beds in Etowah County.

It ismy hope that the bedswill be piaced in the area proposed byThrive Stnior LMna. IbelieVe that thisad<litiqnallevel of, .nd. acq$$ to..care IsimporQnt to marnta.n u..contiAuityof cart forU.residents ofEtowah County.

Slncetely,