the action removes obsolete references to state schools ... fab 2019-01-09 final...

208
1 INITIAL RULE IMPACT STATEMENT TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 625. CERTIFICATE OF NEED STANDARDS FOR ICF/MR ICF/IID 1. DESCRIPTION: This action will amend numerous sections within this chapter. The current Rule uses the term “Mentally Retarded”. This term is outdated and may be considered disrespectful. This proposal replaces the aforementioned term with “Individuals with Intellectual Disabilities”. Pursuant to 25 O.S. § 40 statutes and administrative rules should avoid language that equates persons with their condition and should replace nonrespectful language by referring to persons with disabilities as persons first. Further, national organizations such as the Americans with Disabilities Act National Network, American Association on Intellectual and Developmental Disabilities and Centers for Medicare and Medicaid encourage use of more respectful language that has gained wide acceptance in recent disability laws. The action removes obsolete references to state schools operated by the State Department of Human Services and updates the reference to 42 CFR Section 442.400, relating to Standards for Payment to Nursing Facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities. 2. DESCRIPTION OF PERSONS AFFECTED AND COST IMPACT RESPONSE: Persons directly affected will be residents of nursing and specialized facilities as well as their family members. Additionally, the proposed amendments have the potential to affect numerous other individuals by encouraging respectful language to be used by the general public. 3. DESCRIPTION OF PERSONS BENEFITING, VALUE OF BENEFIT AND EXPECTED HEALTH OUTCOMES: Persons benefiting will include residents and their families as well as owners, operators, staff of nursing homes and specialized facilities and associated professionals. The amendments will encourage residents to be referred to in a more respectful manner. This change in language will promote respect and will have a positive impact on the perception of residents as well as their family members. The Oklahoma State Department of Health (OSDH) received correspondence from an individual who is concerned about the current language. The individual voiced the desire to have the offensive language removed from use and stated that the terminology is outrageous and unacceptable. Further, she asked if the OSDH could work to improve the way in which individuals with disabilities are referenced within the Oklahoma Administrative Code (OAC). In November 2006, 25 O.S. §40 was adopted and states that all new and revised administrative rules should replace nonrespectful language. Since 2006, only one section with disrespectful language has been amended to remove the language. In an effort to expedite this process, the OSDH proposes these rule changes to alter the language of all affected sections of the OAC at one time. 4. ECONOMIC IMPACT, COST OF COMPLIANCE AND FEE CHANGES: There is no anticipated economic impact or cost associated with compliance. 5. COST AND BENEFITS OF IMPLEMENTATION AND ENFORCEMENT TO THE AGENCY: The cost to the OSDH to implement the amendments will be approximately $784 to cover the costs of rule drafting, adoption, publication, distribution, and education. The proposed rules will be implemented

Upload: others

Post on 27-Jul-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

1

INITIAL RULE IMPACT STATEMENT

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 625. CERTIFICATE OF NEED STANDARDS FOR ICF/MR ICF/IID

1. DESCRIPTION:

This action will amend numerous sections within this chapter. The current Rule uses the term “Mentally Retarded”. This term is outdated and may be considered disrespectful. This proposal replaces the aforementioned term with “Individuals with Intellectual Disabilities”. Pursuant to 25 O.S. § 40 statutes and administrative rules should avoid language that equates persons with their condition and should replace nonrespectful language by referring to persons with disabilities as persons first. Further, national organizations such as the Americans with Disabilities Act National Network, American Association on Intellectual and Developmental Disabilities and Centers for Medicare and Medicaid encourage use of more respectful language that has gained wide acceptance in recent disability laws. The action removes obsolete references to state schools operated by the State Department of Human Services and updates the reference to 42 CFR Section 442.400, relating to Standards for Payment to Nursing Facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities.

2. DESCRIPTION OF PERSONS AFFECTED AND COST IMPACT RESPONSE:

Persons directly affected will be residents of nursing and specialized facilities as well as their family members. Additionally, the proposed amendments have the potential to affect numerous other individuals by encouraging respectful language to be used by the general public.

3. DESCRIPTION OF PERSONS BENEFITING, VALUE OF BENEFIT AND EXPECTED

HEALTH OUTCOMES: Persons benefiting will include residents and their families as well as owners, operators, staff of nursing homes and specialized facilities and associated professionals. The amendments will encourage residents to be referred to in a more respectful manner. This change in language will promote respect and will have a positive impact on the perception of residents as well as their family members. The Oklahoma State Department of Health (OSDH) received correspondence from an individual who is concerned about the current language. The individual voiced the desire to have the offensive language removed from use and stated that the terminology is outrageous and unacceptable. Further, she asked if the OSDH could work to improve the way in which individuals with disabilities are referenced within the Oklahoma Administrative Code (OAC). In November 2006, 25 O.S. §40 was adopted and states that all new and revised administrative rules should replace nonrespectful language. Since 2006, only one section with disrespectful language has been amended to remove the language. In an effort to expedite this process, the OSDH proposes these rule changes to alter the language of all affected sections of the OAC at one time.

4. ECONOMIC IMPACT, COST OF COMPLIANCE AND FEE CHANGES: There is no anticipated economic impact or cost associated with compliance.

5. COST AND BENEFITS OF IMPLEMENTATION AND ENFORCEMENT TO THE AGENCY:

The cost to the OSDH to implement the amendments will be approximately $784 to cover the costs of rule drafting, adoption, publication, distribution, and education. The proposed rules will be implemented

Page 2: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

2

and enforced by existing OSDH personnel and will not result in an increase in authorized full-time equivalent personnel. No impacts on other agencies are anticipated.

6. IMPACT ON POLITICAL SUBDIVISIONS: There will be no impact on political subdivisions and it will not require their cooperation in implementing or enforcing the proposed amendment.

7. ADVERSE EFFECT ON SMALL BUSINESS:

There is no anticipated adverse effect on small business.

8. EFFORTS TO MINIMIZE COSTS OF RULE: The costs associated with this rule change are minimal and include only the costs of drafting, adoption, publication, distribution and education.

9. EFFECT ON PUBLIC HEALTH AND SAFETY:

This change will help foster inclusiveness and acceptance of individuals with disabilities by referring to them as individuals first. The language used in the updated rule is more respectful and will have a positive effect on individuals with intellectual and developmental disabilities.

10. DETRIMENTAL EFFECTS ON PUBLIC HEALTH AND SAFETY WITHOUT ADOPTION: If this change is not made, Oklahoma will continue to utilize outdated and nonrespectful language

regarding individuals with disabilities. This language has an adverse effect on the individuals as well as their family members.

11. PREPARATION AND MODIFICATION DATES:

This rule impact statement was prepared on August 14, 2017, and last revised October 27, 2017.

Page 3: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:625 Amendments

1

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 625. CERTIFICATE OF NEED STANDARDS FOR ICF/MR ICF/IID

310:625-1-1. Purpose This Chapter shall apply to Certificate of Need applications reviewed by the Department for

proposed Intermediate Care Facility/Mentally Retarded Individuals with Intellectual Disabilities (ICF/MR) (ICF/IID) beds and implements part of the Long-term Care Certificate of Need Act. This Chapter shall not apply to ICF/MR ICF/IID 16s and smaller facilities. 310:625-1-2. Service area

For review purposes under these standards, the service area for an ICF/MR ICF/IID shall be the Mentally Retarded School Service Region service region or area, as designated by the State Department of Human Services, in which it is located or proposed for location. In the event an application for Certificate of Need is considered for a specialized ICF/MR ICF/IID facility for which only one or two facilities may be needed, or where no service area is designated, in the State, then the Department may treat the entire State as the service area. 310:625-1-3. Burden of proof It shall be incumbent on each applicant to clearly demonstrate an unmet need for additional ICF/MR ICF/IID beds in the applicable service area and to demonstrate conformance with all standards specified herein. 310:625-1-4. Standards (a) No new ICF/MR ICF/IID beds, except ICF/MR ICF/IID 16s and smaller, shall be approved in the service area unless the total number of ICF/MR ICF/IID beds in the service area falls below the following standard: 84 ICF/MR ICF/IID beds per 100,000 general population. (b) An application for ICF/MR ICF/IID beds shall not be approved unless the applicant demonstrates familiarity with and understanding of certification standards for an ICF/MR ICF/IID, specified in 42 CFR Section 442. 400 442.400, relating to Standards for Payment to Nursing Facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities. (c) The identity of the licensed administrator of the existing or proposed facility must be provided by the applicant as a prerequisite to issuance of a Certificate of Need. (d) No additional ICF/MR ICF/IID beds, whether proposed through construction or conversion of existing space, shall be approved for any existing ICF/MR ICF/IID unless it has maintained an occupancy rate of at least 95%, based upon a calculation of occupancy reflected in the monthly average daily census reports of the Department of Human Services, or the Department, for the most recent six month period for which official data is available when the application is filed. (e) Any ICF/MR ICF/IID beds approved, but not yet in place in the service area, shall be included in the evaluation for determining bed need specified in subsection (a). (f) Any existing ICF/MR ICF/IID which proposes an expansion of beds by conversion or construction and which has a record of questionable quality of care, as demonstrated through complaint investigation records, or other means, may be denied a Certificate of Need despite the conformity of the proposal to other standards delineated herein. (g) In determining the bed need in subsection (a), the beds at the three state schools are hereby determined to be the number of beds necessary to have a 90% occupancy, based upon a calculation of occupancy reflected in the monthly average daily census reports of the Department of Human

Page 4: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:625 Amendments

2

Services for the most recent six month period for which official data is available when the application is filed. (h) The Department shall consider the relationship of a Certificate of Need application to any plan adopted by the Department of Human Services concerning the distribution and allocation of services for mentally retarded or developmentally disabled persons individuals with intellectual or developmental disabilities.

Page 5: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

1

INITIAL RULE IMPACT STATEMENT

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 630. CERTIFICATE OF NEED STANDARDS FOR LICENSED NURSING FACILITY

BEDS

1. DESCRIPTION: The current Rule uses the term “Mentally Retarded”. This term is outdated and may be considered disrespectful. This proposal replaces the aforementioned term with “Individuals with Intellectual Disabilities”. Pursuant to Title 25 O.S. § 40, statutes and administrative rules should avoid language that equates persons with their condition and should replace nonrespectful language by referring to persons with disabilities as persons first. Further, national organizations such as the Americans with Disabilities Act National Network, American Association on Intellectual and Developmental Disabilities and Centers for Medicare and Medicaid encourage use of more respectful language that has gained wide acceptance in recent disability laws.

2. DESCRIPTION OF PERSONS AFFECTED AND COST IMPACT RESPONSE:

Persons directly affected will be residents of nursing and specialized facilities as well as their family members. Additionally, the proposed amendments have the potential to affect numerous other individuals by encouraging respectful language to be used by the general public.

3. DESCRIPTION OF PERSONS BENEFITING, VALUE OF BENEFIT AND EXPECTED

HEALTH OUTCOMES: Persons benefiting will include residents and their families as well as owners, operators, staff of nursing homes and specialized facilities and associated professionals. The amendments will encourage residents to be referred to in a more respectful manner. This change in language will promote respect and will have a positive impact on the perception of residents as well as their family members. The Oklahoma State Department of Health (OSDH) received correspondence from an individual who is concerned about the current language. The individual voiced the desire to have the offensive language removed from use and stated that the terminology is outrageous and unacceptable. Further, she asked if the OSDH could work to improve the way in which individuals with disabilities are referenced within the Oklahoma Administrative Code (OAC). In November 2006, 25 O.S. §40 was adopted and states that all new and revised administrative rules should replace nonrespectful language. Since 2006, only one section with disrespectful language has been amended to remove the language. In an effort to expedite this process, the OSDH proposes these rule changes to alter the language of all affected sections of the OAC at one time.

4. ECONOMIC IMPACT, COST OF COMPLIANCE AND FEE CHANGES: There is no anticipated economic impact or cost associated with compliance.

5. COST AND BENEFITS OF IMPLEMENTATION AND ENFORCEMENT TO THE AGENCY:

The cost to the OSDH to implement the amendments will be approximately $784 to cover the costs of rule drafting, adoption, publication, distribution, and education. The proposed rules will be implemented and enforced by existing OSDH personnel and will not result in an increase in authorized full-time equivalent personnel.

No impacts on other agencies are anticipated.

6. IMPACT ON POLITICAL SUBDIVISIONS:

Page 6: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

2

There will be no impact on political subdivisions and it will not require their cooperation in implementing or enforcing the proposed amendment.

7. ADVERSE EFFECT ON SMALL BUSINESS:

There is no anticipated adverse effect on small business.

8. EFFORTS TO MINIMIZE COSTS OF RULE: The costs associated with this rule change are minimal and include only the costs of drafting, adoption, publication, distribution and education.

9. EFFECT ON PUBLIC HEALTH AND SAFETY:

This change will help foster inclusiveness and acceptance of individuals with disabilities by referring to them as individuals first. The language used in the updated rule is more respectful and will have a positive effect on individuals with intellectual and developmental disabilities.

10. DETRIMENTAL EFFECTS ON PUBLIC HEALTH AND SAFETY WITHOUT ADOPTION: If this change is not made, Oklahoma will continue to utilize outdated and nonrespectful language

regarding individuals with disabilities. This language has an adverse effect on the individuals as well as their family members.

11. PREPARATION AND MODIFICATION DATES:

This rule impact statement was prepared on August 14, 2017, and last revised October 27, 2017.

Page 7: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

September 26, 2017 Draft OAC 310:630 Amendments

1

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 630. CERTIFICATE OF NEED STANDARDS FOR LICENSED NURSING

FACILITY BEDS

310:630-1-1. Purpose This Chapter shall apply to Certificate of Need applications reviewed by the Department for proposed licensed nursing facility (LNF) beds. This Chapter establishes review criteria and standards as authorized pursuant to Title 63 O.S. Section 1-851.2(A)(7). (1) The Department shall use these standards in considering an application's conformity to the Long Term Care Certificate of Need Act. (2) Each applicant who proposes licensed nursing facility beds has the burden to clearly demonstrate conformity to these standards. (3) For purposes of this Chapter, licensed nursing facility (LNF) beds shall include all facilities defined under the Nursing Home Care Act, 63 O.S. Section 1-1901 et seq., excluding any facility certified for service to the mentally retarded individuals with intellectual disabilities. 310:630-1-3. Standards (a) The applicant shall demonstrate that existing licensed nursing facility beds are not and will not be adequate in the service area described in 310:630-1-2, based on the need of the population.

(1) The applicant shall demonstrate that there are persons who need services in the area but are unable to obtain those services due to the inadequacy of existing LNF facilities in the area. (2) The applicant shall demonstrate the probable impact of the proposed beds on the ratio of LNF beds to the number of persons age 75 and over statewide. The applicant must show that the proposed new beds likely will not cause the statewide ratio to exceed 179 beds per 1000 persons age 75 and over, and that the project is consistent with the achievement of an optimal target ratio of 152 beds per 1000 persons age 75 and over. (3) The applicant shall demonstrate the probable impact of the proposed beds on the ratio of LNF beds to the number of persons age 75 and over in the service area. No application shall cause an excessive increase in the bed to population ratio of a service area. The determination of whether or not an increase is excessive shall be based on the percentage of increase a project will cause in an area's bed to population ratio, and on a comparison of the area's bed to population ratio against the statewide ratio. (4) The most recent population data published at the time the application is filed shall be used. The source of population projections for current and future years shall be based on year 2000 census data as published by the Oklahoma Department of Commerce. (5) If the applicant proposes a special service area under 310:630-1-2, then the applicant shall demonstrate that the target population will have access to the proposed services through public or private transportation.

(b) The applicant shall demonstrate that alternative or substitute services are not and will not be available or are and will be inadequate to meet the needs of the population.

(1) An overall mean occupancy rate of 85% should be maintained in LNF beds in the Service Area described in OAC 310:630-1-2.

(A) This mean shall be based upon data from all similarly-licensed facilities in the Service Area using monthly reports filed with the Department of Health, taking into consideration the following:

Page 8: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

September 26, 2017 Draft OAC 310:630 Amendments

2

(i) any specialized facility for mentally retarded persons individuals with intellectual disabilities or intermediate care facility for mentally retarded persons individuals with intellectual disabilities in the area shall be excluded; (ii) in the case of a nursing facility application, any hospital-based skilled nursing unit shown to serve a different health service need shall be excluded; (iii) in the case of a hospital-based skilled nursing unit application, any nursing facility shown to serve a different health service need shall be excluded; (iv) in the case of a facility demonstrating a special service area under OAC 310:630-1-2(b), each facility not shown to be adequate or appropriate to meet the needs of the facility's special population shall be excluded.

(B) The mean shall be calculated using data for the most recent six month period for which reports are published by the Department of Health, as of the first day of the month during which an application is initially filed.

(i) Beds reserved for residents who were temporarily absent from facilities for hospitalization or other therapeutic purposes shall be considered to have been occupied. (ii) The area bed capacity used to calculate the occupancy rate shall be reduced by the number of beds that are not available because rooms licensed for multiple occupants have been reserved for single occupants throughout the six-month period.

(C) In determining the service area's conformity to the occupancy goal specified in this subsection, the Department shall investigate the causes for low-occupancy operation of other facilities in the service area. The Department shall exclude such low-occupancy facility from the service area calculations if the facility has been in operation continuously under the current licensee for twenty-four (24) or more months and:

(i) The facility's state license or federal certification during the sixty (60) months preceding the filing of the application has been revoked, rescinded, canceled, terminated, involuntarily suspended or refused renewal; (ii) The facility has a history of noncompliance as defined in 63:1-851.1(6); or (iii) The facility has not complied with all lawful orders of suspension, temporary management, or administrative penalty issued by the Department, another state agency, or by the federal Health Care Financing Administration; (iv) The facility's owner, operator, manager, or medical director has been convicted of a criminal offense related to the operation or management of a long-term care facility; or (v) The facility has been assessed an administrative penalty above the level of deficiency with one or more of the following unfavorable factors:

(I) The administrative penalty included a citation of immediate jeopardy or actual harm to a resident; (II) The circumstance cited in connection with a civil money penalty or other administrative penalty resulted in the death of a resident; or (III) Multiple civil money penalties, denials of payment, or other administrative penalty have been assessed based on findings of substandard quality of care, actual harm, or potential for more than minimal harm, at the facility within the preceding 60 months.

(2) The applicant shall demonstrate that the proposed beds are needed in addition to any beds previously approved under the State Certificate of Need laws but not yet in operation in the service area.

Page 9: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

September 26, 2017 Draft OAC 310:630 Amendments

3

(3) The applicant's demonstration shall include consideration of the adequacy of such alternative services as residential care facilities, Eldercare, home health care, hospice, assisted living and adult day care.

(c) The applicant shall demonstrate adequate financial resources for the new or expanded long-term care services and for the continued operation thereof.

(1) Reimbursement shall be structured to realistically provide for care and services to persons living in the service area. (2) The proposed charges shall be in line with the prevailing rate of similar institutions and services within the health service area. (3) The projected utilization rates shall be sufficient to maintain cost-effectiveness. (4) The projected cash flow shall give the proposed project financial viability within three years. (5) The relationship of the institution's assets to liabilities shall not be increased by the proposed project to the point of threatening the financial viability of the institution. (6) The applicant shall supply a cost/benefit analysis to justify the cost-effectiveness of the proposed project.

(d) The applicant shall demonstrate that sufficient personnel will be available to properly staff and operate the proposed new or expanded long-term care service.

(1) A proposal to provide new or expanded long-term care service must provide assurances that the appropriate numbers and types of staff will be available to comply with licensure requirements. (2) Professional and paraprofessional staffing of new or expanded long-term care services must not compromise the staffing of existing long-term care services. (3) The applicant shall disclose all current and prior experience in the operation of health care facilities, giving names of facilities, locations, and dates. If the applicant has less than sixty (60) months experience in health care facility operations immediately preceding the filing of the application, then the applicant shall:

(i) Provide a plan which details how experienced and competent staffing and leadership, including but not limited to the director of nursing, the medical director, the administrator, and the applicant's policy body, will be placed in charge of facility operations; and (ii) Agree to advise the OSDH, prior to any change in the staffing and leadership during the first six months of operation of the new or expanded facility.

Page 10: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

1

INITIAL RULE IMPACT STATEMENT

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 663. CONTINUUM OF CARE AND ASSISTED LIVING

1. DESCRIPTION:

The current Rule uses the term “Mental Retardation”. This term is outdated and may be considered disrespectful. This proposal replaces the aforementioned term with “Intellectual Disabilities”. Pursuant to Title 25 O.S. § 40 ,statutes and administrative rules should avoid language that equates persons with their condition and should replace nonrespectful language by referring to persons with disabilities as persons first. In order to promote consistency, it is necessary to amend all chapters that contain this terminology, even if those chapters do not equate persons with their condition. Further, national organizations such as the Americans with Disabilities Act National Network, American Association on Intellectual and Developmental Disabilities and Centers for Medicare and Medicaid encourage use of more respectful language that has gained wide acceptance in recent disability laws.

2. DESCRIPTION OF PERSONS AFFECTED AND COST IMPACT RESPONSE:

Persons directly affected will be residents of nursing and specialized facilities as well as their family members. Additionally, the proposed amendments have the potential to affect numerous other individuals by encouraging respectful language to be used by the general public.

3. DESCRIPTION OF PERSONS BENEFITING, VALUE OF BENEFIT AND EXPECTED

HEALTH OUTCOMES: Persons benefiting will include residents and their families as well as owners, operators, staff of nursing homes and specialized facilities and associated professionals. The amendments will encourage residents to be referred to in a more respectful manner. This change in language will promote respect and will have a positive impact on the perception of residents as well as their family members. The Oklahoma State Department of Health (OSDH) received correspondence from an individual who is concerned about the current language. The individual voiced the desire to have the offensive language removed from use and stated that the terminology is outrageous and unacceptable. Further, she asked if the OSDH could work to improve the way in which individuals with disabilities are referenced within the Oklahoma Administrative Code (OAC). In November 2006, 25 O.S. §40 was adopted and states that all new and revised administrative rules should replace nonrespectful language. Since 2006, only one section with disrespectful language has been amended to remove the language. In an effort to expedite this process, the OSDH proposes these rule changes to alter the language of all affected sections of the OAC at one time.

4. ECONOMIC IMPACT, COST OF COMPLIANCE AND FEE CHANGES: There is no anticipated economic impact or cost associated with compliance.

5. COST AND BENEFITS OF IMPLEMENTATION AND ENFORCEMENT TO THE AGENCY:

The cost to the OSDH to implement the amendments will be approximately $784 to cover the costs of rule drafting, adoption, publication, distribution, and education. The proposed rules will be implemented and enforced by existing OSDH personnel and will not result in an increase in authorized full-time equivalent personnel.

No impacts on other agencies are anticipated.

6. IMPACT ON POLITICAL SUBDIVISIONS:

Page 11: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

2

There will be no impact on political subdivisions and it will not require their cooperation in implementing or enforcing the proposed amendment.

7. ADVERSE EFFECT ON SMALL BUSINESS:

There is no anticipated adverse effect on small business.

8. EFFORTS TO MINIMIZE COSTS OF RULE: The costs associated with this rule change are minimal and include only the costs of drafting, adoption, publication, distribution and education.

9. EFFECT ON PUBLIC HEALTH AND SAFETY:

This change will help foster inclusiveness and acceptance of individuals with disabilities by referring to them as individuals first. The language used in the updated rule is more respectful and will have a positive effect on individuals with intellectual and developmental disabilities.

10. DETRIMENTAL EFFECTS ON PUBLIC HEALTH AND SAFETY WITHOUT ADOPTION: If this change is not made, Oklahoma will continue to utilize outdated and nonrespectful language

regarding individuals with disabilities. This language has an adverse effect on the individuals as well as their family members. Persons benefiting will include residents and their families as well as owners, operators, staff of nursing homes and specialized facilities and associated professionals. The amendments will encourage residents to be referred to in a more respectful manner. This will have a positive impact on the residents and their family members. The Oklahoma State Department of Health (OSDH) received correspondence from an individual who is concerned about the current language. The individual voiced the desire to have the offensive language removed from use and stated that the terminology is outrageous and unacceptable. Further, she asked if the OSDH could work to improve the way in which individuals with disabilities are referenced within the Oklahoma Administrative Code (OAC). In November 2006, 25 O.S. §40 was adopted and states that all new and revised administrative rules should replace nonrespectful language. Since 2006, only one section with disrespectful language has been amended to remove the language. In an effort to expedite this process, the OSDH proposes these rule changes to alter the language of all affected sections of the OAC at one time.

11. PREPARATION AND MODIFICATION DATES:

This rule impact statement was prepared on August 14, 2017, and last revised October 27, 2017.

Page 12: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

September 26, 2018 Draft OAC 310:675 Amendments

1

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 663. CONTINUUM OF CARE AND ASSISTED LIVING

SUBCHAPTER 5. RESIDENT ASSESSMENTS

310:663-5-3. Description of resident assessment form (a) The admission assessment form shall include but not be limited to the following:

(1) resident's identification; (2) disease diagnosis/infections; (3) mental health history, and mental retardation intellectual disability or developmental disability; (4) physical functioning which includes the numbers of persons needed to assist with activities of daily living; (5) incontinence; (6) medications; (7) special treatment and procedures; (8) cognitive function; and (9) signatures and dates.

(b) The comprehensive assessment includes the following information: (1) physical functional status; (2) mental functional status; (3) customary routine; (4) disease diagnosis; (5) oral/nutritional status; (6) medications; (7) devices and restraints; (8) special treatments; (9) skin condition; (10) psychosocial status; (11) sensory and physical impairments; and (12) medically defined conditions and prior medical history.

Page 13: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

1

INITIAL RULE IMPACT STATEMENT

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 675. NURSING AND SPECIALIZED FACILITIES

1. DESCRIPTION:

This action will amend numerous sections within this chapter. The current Rule uses the terms “Mental Retardation”, “Mentally Retarded” and “Qualified Mental Retardation Professional”. These terms are outdated and may be considered disrespectful. This proposal replaces the aforementioned terms with “Individuals with Intellectual Disabilities”, “Individuals with Developmental Disabilities”, or “Qualified Intellectual Disability Professional”. Pursuant to Title 25 O.S. § 40 statutes and administrative rules should avoid language that equates persons with their condition and should replace nonrespectful language by referring to persons with disabilities as persons first. Further, national organizations such as the Americans with Disabilities Act National Network, American Association on Intellectual and Developmental Disabilities and Centers for Medicare and Medicaid encourage use of more respectful language that has gained wide acceptance in recent disability laws. An amendment is provided at 310:675-5-1, to update the incorporation by reference from the National Bureau of Standards Fire Safety Evaluation System to the National Fire Protection Association's NFPA 101A Guide on Alternative Approaches to Life Safety, 2010 Edition. This update addresses the latest standards used by architect's and the Centers for Medicare and Medicaid Services (CMS). An amendment is provided at 310:675-5-18 to explicitly identify the applicable portions of the National Fire Protection Association (NFPA) 101: Life Safety Code, 2012 Edition that applies to design and construction requirements. This revision aids architects so that they can design based on the requirements applied by the CMS. At 310:675-5-20 an incorporation by reference is inserted to address a secondary incorporation by reference that was present in the NFPA99, 2012 Edition. The heating and ventilating systems standards at the American Society of Heating, Refrigerating and Air-Conditioning Engineers, ASHRAE 170, 2008 Edition, are referenced by NFPA99, 2012 Edition. They are now explicitly incorporated by reference. At 310:675-5-21, the incorporation by reference for emergency electric service is updated from the 1977 NFPA standard to the 2012 NFPA standard. By updating the references to NFPA 99 and ASHRAE we avoid facilities designed to meet state requirements but that do not meet CMS requirements. A scrivener's error omitted the removal of a reference to the old life safety code in 310:675-11-5. This section was amended in 2017 to incorporate the 2012 edition of the Life Safety Code adopted by the Centers for Medicare & Medicaid Services. The amendment to this section addresses this omission by striking the old reference and supporting language applicable to the former code.

2. DESCRIPTION OF PERSONS AFFECTED AND COST IMPACT RESPONSE:

Persons directly affected will be residents of nursing and specialized facilities as well as their family members. Additionally, the proposed amendments have the potential to affect numerous other individuals by encouraging respectful language to be used by the general public. Building design will be affected architects and owners must ensure they design to these standards, which are the physical plant standards applied to Medicare and Medicaid certified providers. Comment on cost impact will be sought in public comment period.

3. DESCRIPTION OF PERSONS BENEFITING, VALUE OF BENEFIT AND EXPECTED

HEALTH OUTCOMES:

Page 14: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

2

Persons benefiting will include residents and their families as well as owners, operators, staff of nursing homes and specialized facilities and associated professionals. The amendments will encourage residents to be referred to in a more respectful manner. This change in language will promote respect and will have a positive impact on the perception of residents as well as their family members. The Oklahoma State Department of Health (OSDH) received correspondence from an individual who is concerned about the current language. The individual voiced the desire to have the offensive language removed from use and stated that the terminology is outrageous and unacceptable. Further, she asked if the OSDH could work to improve the way in which individuals with disabilities are referenced within the Oklahoma Administrative Code (OAC). In November 2006, 25 O.S. Section 40 was adopted and states that all new and revised administrative rules should replace nonrespectful language. Since 2006, only one section with disrespectful language has been amended to remove the language. In an effort to expedite this process, the OSDH proposes these rule changes to alter the language of all affected sections of the OAC at one time.

4. ECONOMIC IMPACT, COST OF COMPLIANCE AND FEE CHANGES: There are no fee changes with this rule change. There may be economic impact and costs associated with clarifying and updating the applicable life safety code standards. Some of the clarifications to the incorporated standards remove confusion and potential costs to comply to the incorporated standards addressed in 2017. Public comment is sought to assess economic impact and the cost of compliance.

5. COST AND BENEFITS OF IMPLEMENTATION AND ENFORCEMENT TO THE AGENCY: There are no anticipated costs to implement or enforce these rules beyond ordinary program costs. The proposed rules will be implemented and enforced by existing OSDH personnel and will not result in an increase in authorized full-time equivalent personnel. No impacts on other agencies are anticipated.

6. IMPACT ON POLITICAL SUBDIVISIONS: There will be no impact on political subdivisions and it will not require their cooperation in implementing or enforcing the proposed amendment.

7. ADVERSE EFFECT ON SMALL BUSINESS:

The Department engaged the Long Term Care Advisory Board and other stakeholders for input on adverse effects from these proposed changes. We also seek public comment to identify such effects on small business.

8. EFFORTS TO MINIMIZE COSTS OF RULE: No less costly means are currently identified.

9. EFFECT ON PUBLIC HEALTH AND SAFETY:

This change will help foster inclusiveness and acceptance of individuals with disabilities by referring to them as individuals first. The language used in the updated rule is more respectful and will have a positive effect on individuals with intellectual and developmental disabilities. The changes in physical plant standards promote more efficient and safe design.

10. DETRIMENTAL EFFECTS ON PUBLIC HEALTH AND SAFETY WITHOUT ADOPTION: If this change is not made, Oklahoma will continue to utilize outdated and nonrespectful language regarding individuals with disabilities. This language has an adverse effect on the individuals as well as their family members. State building design standards will remain be in conflict with federal standards, the Medicare and Medicaid standards for physical plant must be met for reimbursement. Removing

Page 15: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

3

confusion surrounding conflicting standards is in the economic interests of health care providers and Oklahoma's citizens.

11. PREPARATION AND MODIFICATION DATES:

This rule impact statement was prepared on December 7, 2018.

Page 16: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

1

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 675. NURSING AND SPECIALIZED FACILITIES

SUBCHAPTER 1. GENERAL PROVISIONS

310:675-1-2. Definitions The following words and terms, when used in this Chapter, shall have the following meaning, unless the context clearly indicates otherwise: "Act" means Title 63 of the Oklahoma Statutes, Sections 1-1901 and following as amended also known as the Nursing Home Care Act. "Allied health professional" means one of the following persons: physician assistant, physical, speech, or occupational therapist, occupational therapy assistant, physical therapy assistant, or qualified social worker. "Attendant" means the person having control of an animal/pet visiting or in residence in a facility. "Approval" means the mandatory state government process by which an agency or program is reviewed, and publicly proclaimed, to render a service worthy of note. "CEP" means the nurse aide competency evaluation program. "Certification" means the process by which a non-governmental agency, or association, or governmental agency attests that an individual or facility has met certain predetermined standards specified by the certifying body. "Certified medication aide" means a person who has passed a Department approved program for administering medications. "Certified nurse aide" means any person who provides, for compensation, nursing care or health-related services to residents of a facility, who is not a licensed health professional and has completed a Department approved training and competency program. "Charge nurse" means a registered nurse or licensed practical nurse responsible for supervising nursing services on a specific shift. "Chemical restraints" means the use of a medication for the purpose of discipline, convenience, or in an emergency situation to control mood or behavior and not required to treat the resident's symptoms. "Consultant registered nurse" means a registered nurse who provides consultation to the director of nursing and administrator concerning the delivery of nursing care for all residents in the facility. "Denial" means a decision made by the appropriate body to disapprove an application. "Direct care staff" means nursing, activity, social and therapy staff. "Director of nursing" means either a registered nurse or licensed practical nurse, who has the authority and responsibility to administer nursing services within the facility. "Emergency" means, for the purposes of Title 63 O.S. Section 1-1912, a serious, potentially life-threatening or life-endangering situation in which immediate action is necessary to ensure the health, safety, or welfare of residents, and for which the facility:

(A) does not have a plan acceptable to the Department to ensure health, safety or welfare of residents; or

(B) refuses to remedy the situation. "Health related services" means any medically directed service provided by any person in a facility that may include but is not limited to, the following: (A) Positioning and turning of residents.

Page 17: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

2

(B) Self-help skill training. (C) Assistance with prosthetic/assistive devices. (D) Medication administration. (E) Nutrition and hydration. (F) Monitoring of resident vital signs. (G) Catheter and nasogastric care. (H) Behavior modification programs. (I) Administering a medically related care plan (J) Restorative services. "In charge" and "supervision" means the administrator must have the requisite authorization from the licensee to make those purchases and incur those necessarily attendant debts in order to comply with the rules promulgated by the Board and all pertinent state statutes. "Inservice education" means activities intended to assist the individual to acquire, maintain, and/or increase competence in fulfilling the assigned responsibilities specific to the employer's expectations. "Licensed health professional" means one of the following: a physician; dentist, podiatrist, chiropractor, physician assistant, nurse practitioner; pharmacist; physical, speech, or occupational therapist; registered nurse, licensed practical nurse; licensed or certified social worker; or licensed/registered dietician. "Licensed nurse" means a registered nurse or a licensed practical nurse who is currently licensed by the Oklahoma Board of Nursing. "Licensed pharmacist" means a person who is a graduate of an accredited pharmacy program and is currently licensed by the Oklahoma Board of Pharmacy. "Licensed practical nurse" means a person who is a graduate of a state approved practical nursing education program, or who meets other qualifications established by the Oklahoma Board of Nursing, and is currently licensed by the Oklahoma Board of Nursing. "Licensure" means the process by which the Department grants to persons or entities the right to establish, operate, or maintain any facility. "Local law enforcement" means:

(A) The municipal police department, if the facility is within the jurisdiction of any municipality of this state, or (B) The county sheriff, if the facility is outside the jurisdiction of any municipality within this state.

"Manager" or "supervisor" means the person or entity which performs administrative services for the licensee. The manager or supervisor is not legally responsible for the decisions and liabilities of the licensee, and does not stand to gain or lose financially as a result of the operation of the facility. The manager is paid a fee or salary for services, and the primary remuneration shall not be based upon the financial performance of the facility. "Misappropriation of resident's property" means the taking, secretion, misapplication, deprivation, transfer, or attempted transfer to any person not entitled to receive any property, real or personal, or anything of value belonging to or under the legal control of a resident, without the effective consent of the resident or other appropriate legal authority, or the taking of any action contrary to any duty imposed by federal or state law prescribing conduct relating to the custody or disposition of resident's property. "Nurse aide" means any person providing nursing or nursing related services to residents in a facility, but does not include an individual who is a licensed health professional, or who volunteers to provide such services without monetary compensation.

Page 18: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

3

"Nurse aide trainee" means any person who has been employed by a facility to provide nursing care or health related services, and is enrolled in but has not completed a Department approved training and competency program. "Orientation" means the training for a particular job activity given to all employees. "Perishables" means food supplies, to include dietary supplements and intravenous feedings, medical supplies, and medications. "Physical restraints" means any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the resident cannot remove easily, that is not used for the purpose of therapeutic intervention or body alignment as determined by resident assessment and care planning, and which restricts the resident's desired freedom of movement and access to his or her body. "Qualified nutritionist" is a Department approved person who holds a baccalaureate with major studies in food and nutrition, dietetics, or food service management; has one year experience in the dietetic service of a health care institution; and participates in continuing education annually. "Registered/licensed dietitian" means a person who is registered as a dietitian by the American Dietetic Association and licensed by the Oklahoma Board of Medical Licensure and Supervision. "Registered nurse" means a person who is a graduate of a state approved registered nursing education program, and who is currently licensed by the Oklahoma Board of Nursing. "Registry" means a Department maintained list of individuals who have successfully completed a nurse aide training and competency evaluation program, or a competency evaluation program, approved by the Department. "Revoke" means to rescind approval of a previous action. "Specialized facility" means any facility which offers or provides inpatient long-term care services on a twenty-four hour basis to a limited category of persons requiring such services, including, but not limited to, a facility providing health or habilitation services for developmentally disabled persons means any home, establishment, or institution which offers or provides inpatient long-term care services on a twenty-four-hour basis to a limited category of persons requiring such services, including but not limited to a facility providing health or habilitation services for [individuals with intellectual or developmental disabilities] [63:1-1902(11)], infants and/or children, or individuals with Alzheimer's and or dementia residents. "Standards of nursing practice" means an authoritative statement that describes a level of care or performance common to the profession of nursing by which the quality of nursing practice can be judged. Standards of nursing practice include both standards of care and standards of professional performance. "Standards of care" means a description of a competent level of care demonstrated by a process of accurate assessment and diagnosis, planning, appropriate interventions, and predicted patient outcomes. (Appendix B of this Chapter.) "Standards of professional performance" means a description of a competent level of behavior in the professional role including activities related to quality assurance, education, consultation, research, ethics, resource utilization, accountability, peer review, and interdisciplinary collaboration. "Suspended license" means a license that is issued for a period not to exceed three years to a facility which has temporarily closed or ceased operations. "Training and competency evaluation program" means a program approved by the Department to instruct and evaluate individuals to act as nurse aides. "Transfer" means the move of a resident from one facility to another facility. "Intra-facility transfer" means the moving of a resident from one room to another within a facility.

Page 19: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

4

"Transfer of ownership" means a change of substantial, or controlling interest, in the ownership of a facility. A change of less than five percent (5%) of the interest of the owner does not constitute a transfer of ownership unless it also results in a change of control of the owner. "Willful violation" means:

(A) a pattern of violation of the direct-care staffing requirement; (B) a violation of the direct-care staffing requirement in which the facility knew or should have known staffing would be insufficient to meet the requirement yet took no action to avert the violation; or (C) the reporting of materially inaccurate or misleading information of direct-care staffing to the Health Care Authority.

SUBCHAPTER 3. LICENSES

310:675-3-1.1. Application for licensure (a) No person or entity shall operate a facility without first obtaining a license. (b) The applicant shall file a licensure application in a timely manner, on the forms provided by the Department, with a check for the filing fee payable to the Oklahoma State Department of Health. The filing fee is set by statute, and currently is calculated as Ten Dollars ($10.00) per licensed bed. (c) The facility owner shall be the applicant for the license, unless a receiver has been appointed. If there is a receiver, the receiver shall be the applicant. (d) If the facility is leased, then the person or entity to whom the facility is leased shall be the applicant. If the lessee does not assume all rights to the facility and the lessor reserves some participatory rights in the operation of the facility, then both entities shall make joint application for the license. (e) The applicant for license shall disclose the name, address, and tax identification number of a person or entity who has the legal duties of filing employment tax returns and paying employment taxes with respect to staff required to meet the needs of facility residents, including but not limited to administrators, nurses, nurse aides, certified medication aides, dieticians, nutritionists, food service staff, qualified mental retardation intellectual disability professional, and activities, social services, maintenance and housekeeping personnel. (f) An application is not considered to be filed unless it is accompanied by the application fee. The application fee, however, shall not be required from a receiver or temporary manager appointed by, or at the request of, the Department.

SUBCHAPTER 5. PHYSICAL PLANT 310:675-5-1. Application (a) The requirements of this Subchapter shall be applicable to all new construction of, or modification to, long-term care facilities constructed after the effective date of these regulations. Licensed facilities in operation on the effective date of these regulations shall continue to comply with the construction and safety regulations applicable to the issuance of their 1980 license. (b) In the determination of compliance with fire safety regulations, the State Fire Marshal and the Department may utilize a system of value equivalents, such as the National Bureau of Standards Fire Safety Evaluation System NFPA 101A Guide on Alternative Approaches to Life

Page 20: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

5

Safety, 2010 Edition, which provides alternative methods for achieving compliance with the regulations. 310:675-5-18. Design and construction The requirements in applicable portions of the National Fire Protection Association (NFPA) 101: Life Safety Code, 2012 Edition and 2012 Life Safety Code Tentative Interim Amendments (TIA) 12-1, 12-2, 12-3, and 12-4; and NFPA 99 Health Care Facility Code (HCFC), 2012 edition, excluding chapters 7, 8, 12 and 13, and 2012 HCFC TIA 12-2, 12-3, 12-4, 12-5 and 12-6, adopted in 81 Federal Register 26871 by the Centers for Medicare & and Medicaid Services on July 5, 2016, are incorporated by reference. For Medicare or Medicaid certified nursing or specialized facilities, the Life Safety Code adopted by the Centers for Medicare & Medicaid Services prevails if there is a conflict between the Life Safety Code and this Chapter. A high degree of safety for the occupants shall be provided to minimize the incidence of accidents with special consideration for residents who will be ambulatory to assist them in self care. Hazards such as sharp corners shall be avoided.

(1) Existing facilities. Nonconforming portions which because of financial hardship are not being totally modernized, shall comply with the safety requirements dealing with details and finishes as listed in Chapter 13 NFPA Standard 1-1, 1981 NFPA 101, 2012 Edition, Chapters 19 or 43. (2) New construction projects including additions and alterations. Details and finishes shall comply with the following:

(A) Items such as drinking fountains, telephone booths, vending machines, and portable equipment shall be located so as not to restrict corridor traffic or reduce the corridor width below the required minimum. (B) All rooms containing bathtubs, sitz baths, showers, and water closets, subject to occupancy by residents, shall be equipped with doors and hardware which will permit access from the outside in any emergency. When such rooms have only one opening or are small, the doors shall be capable of opening outward or be otherwise designed to be opened without need to push against a resident who may have collapsed within the room. (C) The minimum width of all doors to resident rooms and rooms needing access for beds shall be 3'8" (1.12 m.). Doors to rooms needing access for stretchers and to resident's toilet rooms and other rooms needing access for wheelchairs shall have a minimum width of 2'10" (86.3 cm.). (D) Doors on all openings between corridors and rooms or spaces subject to occupancy, except elevator doors, shall be swing type. Openings to showers, baths, resident's toilets, and other small wet type areas not subject to fire hazard are exempt from this requirement. (E) Windows and outer doors which may be frequently left in an open position shall be provided with insect screens. Windows shall be designed to prevent accidental falls when open. (F) Resident rooms intended for occupancy of 24 hours or more shall have windows operable without the use of tools and shall have sills not more than 3'0" (91 cm.) above the floor. Windows in buildings designed with an engineered smoke control system in accordance with NFPA 90A are not required to be operable. However, attention is called to the fact that natural ventilation possible with operable windows may in some areas permit a reduction in energy requirements. (G) Doors, except doors to spaces such as small closets which are not subject to occupancy, shall not swing into corridors in a manner that might obstruct traffic flow or reduce the required corridor width. (Large walk-in type closets are considered as occupiable spaces.)

Page 21: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

6

(H) Safety glazing shall be of materials and at locations required by the Oklahoma Safety Glazing Material Law. (I) Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate use of wheelchairs and carts and shall be constructed to restrict the passage of smoke. (J) Grab bars shall be provided at all residents' toilets, showers, tubs, and sitz baths. The bar shall have 1 1/2" (3.8 cm.) clearance to walls and shall have sufficient strength and anchorage to sustain a concentrated load of 250 lbs. (113.4 kg.). (K) Recessed soap dishes shall be provided in showers and bathrooms. (L) Handrails shall be provided on both sides of corridors used by residents. A clear distance of 1 1/2" (3.8 cm.) shall be provided between the handrail and the wall. Ends of handrails and grab bars shall be constructed to prevent snagging the clothes of residents. (M) Location and arrangement of handwashing facilities shall permit their proper use and operation. (N) Lavatories and handwashing facilities shall be securely anchored to withstand an applied vertical load of not less than 250 lbs. (113.4 kg.) on the front of the fixture. (O) Mirrors shall be arranged for convenient use by residents in wheelchairs as well as by residents in a standing position. Mirrors shall not be installed at handwashing fixtures in food preparation areas. (P) Provisions for hand drying shall be included at all handwashing facilities. These shall be single-use separate, individual paper or cloth units enclosed in such a way as to provide protection against the dust or soil and ensure single unit dispensing. Hot air dryers are permitted provided that installation is such to preclude possible contamination by recirculation of air. (Q) The minimum ceiling height shall be 8'0" (2.44 m.) with the following exceptions:

(i) Boiler rooms shall have ceiling clearances not less than 2'6" (76 cm.) above the main boiler header and connecting piping. (ii) Rooms containing ceiling-mounted equipment shall have height required to accommodate the equipment. (iii) Ceilings in corridors, storage rooms, toilet rooms, and other minor rooms shall be not less than 7'8" (2.34 m.). (iv) Suspended tracks, rails and pipes located in path of normal traffic shall not be less than 6'8" (2.03 m.) above the floor.

(R) Recreation rooms, exercise rooms, and similar spaces where impact noise may be generated shall not be located directly over resident bed areas unless special provisions are made to minimize such noise. (S) Rooms containing heat producing equipment (such as boiler or heater rooms and laundries) shall be insulated and ventilated to prevent any floor surface above from exceeding a temperature 10° F. (6° C.) above the ambient room temperature.

(3) Finishes. (A) Floor materials shall be easily cleanable and have wear resistance appropriate for the location involved. Floors in areas used for food preparation or food assembly shall be water-resistant and grease-proof. Joints in tile and similar material in such areas shall be resistant to food acids. In all areas frequently subject to wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. Floors that are subject to traffic while wet (such as shower and bath areas, kitchens, and similar work areas) shall have a non-slip surface. (B) Wall bases in kitchens, soiled workrooms, and other areas which are frequently subject to wet cleaning methods shall be made integral and covered with the floor, tightly sealed within

Page 22: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

7

the wall, and constructed without voids that can harbor insects. (C) Wall finishes shall be washable and, in the immediate area of plumbing fixtures, shall be smooth and moisture resistant. Finish trim, and wall and floor constructions in dietary and food preparation areas shall be free from spaces that can harbor rodents and insects. (D) Floor and wall penetrations by pipes, ducts, and conduits shall be tightly sealed to minimize entry of rodents and insects. Joints of structural elements shall be similarly sealed. (E) Ceilings throughout shall be easily cleanable. Ceilings in the dietary and food preparation areas shall have a finished ceiling covering all overhead piping and duct work. Finished ceilings may be omitted in mechanical and equipment spaces, shops, general storage areas, and similar spaces, unless required for fire-resistive purposes.

310:675-5-20. Mechanical requirements (a) Steam and hot water systems (1) Boilers shall have the capacity, based upon the net ratings published by Hydronics Institute,

to supply the normal requirements of all systems and equipment. The number and arrangement of boilers shall be such that when one boiler breaks down or routine maintenance requires that one boiler be temporarily taken out of service, the capacity of the remaining boiler(s) shall be at least 70% of the total required capacity, except that in areas with a design temperature of 20 ° F. (-7 ° C.) or more, based on the Median of Extremes in the American Society of Heating, Refrigerating and Air-Conditioning Engineers ASHRAI (ASHRAE) Handbook of Fundamentals, the remaining boiler(s) do not have to include boiler capacity for space heaters.

(2) Boiler feed pumps, heating circulating pumps, condensate return pumps, and fuel oil pumps shall be connected and installed to provide normal and standby service.

(3) Supply and return mains and risers of cooling, heating and process systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends, except that vacuum condensate return need not be valved at each piece of equipment.

(b) Heating and ventilating systems (1) Temperatures. For all areas occupied by residents, the indoor winter design temperature

shall be 75° F. (24° C.). For all other occupied areas, the indoor winter design temperature shall be 72° F. (22° C.). (NOTE: This does not preclude operation at lower temperatures where appropriate and resident safety is not affected. This requirement is for "capacity".) The indoor summer design temperature shall be 80° F. (27° C.) for all areas occupied by residents Design. The design of heating and ventilating systems shall comply with the requirements of ASHRAE 170, 2008 Edition, as referenced by NFPA99, 2012 Edition.

(2) Ventilation system details. All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system.

(A) Outdoor air intakes shall be located as far as practical but not less than 25' 0" (7.62 m.) from exhaust outlets or ventilating systems, combustion equipment stacks, medical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular exhaust and other noxious fumes (plumbing and vacuum vents that terminate above the level of the top of the air intakes may be located as close as 10' 0" (3.05 m.)). The bottom of outdoor air intakes serving central systems shall be located as high as practical but not less than 6' 0" (1.83 m.) above ground level, or if installed above the roof, 3' 0" (91 cm.) above roof level.

(B) The bottoms of ventilation openings shall not be less than 3" (7.6 cm.) above the floor of any room. (C) All central ventilation or air conditioning systems shall be equipped with filters. the filter

bed shall be located upstream of the air conditioning equipment, unless a prefilter is employed.

Page 23: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

8

In this case, the prefilter shall be upstream of the equipment and the main filter bed may be located further downstream.

(D) Filter frames shall be durable and carefully dimensioned and shall provide an airtight fit with the enclosing ductwork. All joints between filter segments and the enclosing ductwork shall be gasketed or sealed to provide a positive seal against air leakage.

(c) Plumbing and other piping systems. These systems shall be designed and installed in accordance with the requirements of PHCC National Standard Plumbing Code, Chapter 14, "Medical Care Facility Plumbing Equipment." (d) Plumbing fixtures. The material used for plumbing fixtures shall be of non-absorptive acid resistant material. (1) The water supply spout for lavatories and sinks required in resident care areas of skilled

nursing facilities only shall be mounted so that its discharge point is a minimum distance of 5" (12.7 cm.) above the rim of the fixture. In all facilities all fixtures used by medical and nursing staff, and all lavatories used by residents and food handlers shall be trimmed with valves which can be operated without the use of hands (single lever devices may be used subject to the above). Where blade handles are used for this purpose, they shall not exceed 4 1/2" (11.4 cm.) in length, except that handles on clinical sinks shall be not less than 6" (15.2 cm.) long.

(2) Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.

(3) Shower bases and tubs shall provide non-slip surfaces for standing residents. (e) Water supply systems (1) Systems shall be designed to supply water at sufficient pressure to operate all fixtures and

equipment during maximum demand periods. (2) Each water service main, branch main, riser, and branch to a group of fixtures shall be valved.

Stop valves shall be provided at each fixture. (3) Backflow preventers (vacuum breakers) shall be installed on hose bibbs, janitors' sinks,

bedpan flushing attachments, and on all other fixtures to which hoses or tubing can be attached. (4) Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with

silencers. (f) Hot water heaters and tanks (1) The hot water heating equipment shall have sufficient capacity to supply water at the

temperature and amounts indicated. (See Appendix A). Water temperatures to be taken at hot water points of use or inlet to processing equipment.

(2) Storage tank(s) shall be fabricated of corrosion-resistant metal lined with non-corrosive material.

(g) Drainage systems (1) Insofar as possible, drainage piping shall not be installed within the ceiling nor installed in an

exposed location in food preparation centers, food serving facilities, food storage areas, and other critical areas. Special precautions shall be taken to protect these areas from possible leakage or condensation from necessary overhead piping systems.

(2) Building sewers shall discharge into a community sewerage system. Where such a system is not available, a facility providing sewage treatment must conform to applicable local and State regulations.

(h) Identification. All piping in the HVAC service water systems shall be color coded or otherwise marked for easy identification. 310:675-5-21. Electrical requirements

Page 24: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

9

All material including equipment, conductors, control, and signaling devices shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities shown in the specifications or indicated on the plans. All materials shall be listed as complying with available standards of Underwriter's Laboratories, Inc., or other similarly established standards. All electrical installations and systems shall be tested to show that the equipment is installed and operates as planned or specified. (1) Panelboards. Panelboards serving lighting and appliance circuits shall be located on the same floor as the circuits they serve. This requirement does not apply to emergency system circuits. (2) Lighting. All spaces occupied by people, machinery, equipment within buildings, approaches to buildings, and parking lots shall have lighting. (A) Residents' rooms shall have general lighting and night lighting. A reading light shall be provided for each resident. Flexible light arms shall be mechanically controlled to prevent the bulb from coming in contact with bed linen. At least one light fixture for night lighting shall be switched at the entrance to each resident room. All switches for control of lighting in resident areas shall be of quiet operating type. (B) Nursing unit corridors shall have general illumination with provisions for reduction of light level at night. (3) Receptacles (convenience outlets) (A) Resident room shall have duplex grounding type receptacles as follows: One location each side of the head of each bed, one for television if used, and one on another wall. (B) Duplex grounding receptacles for general use shall be installed in all corridors approximately 50'0" (15.24 m.) apart and within 25'0" (7.62 m.) of ends of corridors. (4) Notification system (A) Resident areas. Each room, toilet and bathing area shall have a means for residents to directly contact nursing staff. This communication may be through audible or visual signs, electronic systems and may include “wireless systems.” (B) Wireless nurse call system. Facilities may substitute a wireless nurse call system for wired call systems or operate both a wireless and a wired nurse call system in parallel. (C) Resident's emergency. A nurse's call emergency button shall be provided for resident's use at each resident's toilet, bath, and shower room. Such button shall be usable by a collapsed resident lying on the floor (inclusion of a pull cord will satisfy this item.) (5) Emergency electric service. Emergency electric service shall be provided in accordance with NFPA 76-A, 1977, Chapter 05, Essential Electrical Systems for Nursing Homes, etc. NFPA 99, 2012 Edition. 310:675-5-24. Preparation of plans and specifications (a) Stage one. Preliminary plans and outline specifications shall be submitted and include sufficient information for approval by the Department of the following: scope of project; project location; required fire-safety and exiting criteria; building-construction type, compartmentation showing fire and smoke barriers, bed count and services; the assignment of all spaces, areas, and rooms for each floor level, including the basement. A nursing facility has the option, at its own risk, to bypass the stage one submittal and proceed directly to submittal of stage two documents. After the first review and before Department approval of stage one plans, the nursing facility at its own risk may choose to make a stage two submittal; a nursing facility electing this option would not be eligible for the fast track process. (b) Stage two. A proposed construction document shall be submitted that includes final drawings and specifications adequate for approval by the Department. All final plans and specifications shall

Page 25: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

10

be appropriately sealed and signed by an architect registered by the State of Oklahoma. All construction modifications of approved documents are subject to review and approval, and shall be submitted timely.

(1) Fast-track projects. The fast track process applies only to stage two submittals. A stage one submittal and functional program must be approved before entering the fast track process. (A) Equipment and built-in furnishings are to be identified in the stage one submittal. (B) The nursing facility has the option to submit two packages: civil, landscaping and structural in stage one, and the balance of the components in stage two. (C) Fast-track projects shall have prior approval and be submitted in no more than four (4) separate packages.

(i)Site work, foundation, structural, underslab mechanical, electrical, plumbing work, and related specifications. (ii) Complete architectural plans and specifications. (iii) All mechanical, electrical, and plumbing plans and specifications. (iv) Equipment and furnishings.

(2) Radiation protection. Any project that includes radiology or special imaging equipment used in medical diagnosis, treatment, and therapy of residents, shall include plans, specifications, and shielding criteria, prepared by a qualified medical physicist. These plans shall be submitted and approved by the Department prior to installation of the equipment.

(c) Reserved. (d) Floor plan scale. Floor plans are to be submitted at a scale of one-eighth (1/8) inch equals one (1) foot, with additional clarifying documents as required. (e) Application form. The submittal shall be made using a Department application form which requests information required by this Chapter and specifies the number of copies and format for document submittal.

SUBCHAPTER 9. RESIDENT CARE SERVICES

310:675-9-5.1. Assessment and care plans (a) A resident assessment and an individual care plan shall be completed and implemented for each resident. The care plan shall indicate the resident's current status and accurately identify the resident's needs. (b) The written resident assessment and care plan shall be reviewed and updated, at least quarterly, and as needed when the resident's condition indicates. (c) Efforts shall be made to include the resident and resident's representative in development and implementation of the care planning process.

(1) Resident assessment (A) The facility shall conduct, initially and periodically, a comprehensive, accurate, standardized, reproducible assessment for each resident's functional capacity. (B) Each resident shall have an assessment coordinated or conducted by a registered nurse. (C) Each individual completing a portion of the assessment shall sign, date, and certify the accuracy of that portion. (D) An assessment shall be completed within fourteen days after admission of the resident. (E) The resident assessment shall include a minimum data set (MDS) in the form required under 42 CFR 483.20. Each facility, with the exception of Intermediate Care Facilities for the Mentally Retarded (ICF/MR) Individuals with Intellectual Disabilities (ICF/IID),

Page 26: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

11

accurately shall complete the MDS for each resident in the facility, regardless of age, diagnosis, length of stay or payment category. (F) The MDS form shall require the following, as applicable:

(i) Admission assessment; (ii) Annual assessment; (iii)Significant change in status assessment; (iv) Significant correction of prior full assessment; (v) Significant correction of prior quarterly assessment; (vi) Quarterly review; and (vii) A subset of items upon a resident's transfer, reentry, discharge, and death.

(2) Resident pain assessment (A) Residents shall be screened for the presence of pain at least once every 30 days and whenever vital signs are taken.

(i) Licensed nursing staff shall perform the screening at least once every 30 days. Certified nurse aides may perform the screening more frequently as needed. (ii) The screening instrument shall grade the intensity and severity of pain using a resident-specific pain scale;

(B) An individualized pain assessment shall be conducted by a registered nurse for each resident:

(i) In conjunction with the admission, quarterly and annual assessments required at OAC 310:675-9-5.1.(c)(1)(F); and (ii) With onset of pain not previously addressed in a care plan or physician's orders.

(C) The goal is to alleviate or minimize pain while assisting the resident to maintain as high a level of functioning as possible. The pain assessment shall include, but not be limited to:

(i) A statement of how the resident describes the pain; (ii) Intensity and severity of pain graded using a resident-specific pain scale; (iii)Recent changes in pain; (iv) Location(s); (v) Onset and duration of pain, such as new pain within the last 3 days, recent pain within the last 3 months, or more distant pain greater than 3 months; (vi) Type of pain reported or represented by resident, such as constant or intermittent, and duration or frequency of pain; (vii) Current pain measured at its least and greatest levels; (viii) Aggravating and relieving factors; (ix) Treatment including a review of all therapies, including medication, and the regimen used to minimize pain; (x) Effects of pain and effectiveness of therapy on physical and social functions; (xi) Resident's treatment preferences and emotional responses to pain, including resident's expectations and how resident coped with pain; and (xii) If applicable, refer to pain assessment tool for the cognitively impaired.

(D) Results shall be recorded in the resident's clinical record showing changes in pain scale and changes in level of functioning. The physician shall be contacted as necessary. (E) Pain shall be treated promptly, effectively and for as long as necessary.

(3) Individual care plan (A) An individual care plan shall be developed and implemented for each resident to reflect the resident's needs.

Page 27: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

12

(B) The care plan shall be developed by an interdisciplinary team that includes a registered nurse with responsibility for the resident, and other appropriate staff in disciplines determined by the resident's needs. (C) The care plan shall include measurable objectives and timetables to meet the resident's medical, nursing, mental and psychosocial needs identified in the assessment. (D) The care plan shall be available to appropriate personnel providing care for the resident. (E) An initial care plan shall be completed at the time of admission. The individualized care plan shall be completed within twenty-one days after admission. (F) A care plan shall be completed within seven calendar days after the completion of the assessment.

310:675-5-24. Preparation of plans and specifications (a) Stage one. Preliminary plans and outline specifications shall be submitted and include sufficient information for approval by the Department of the following: scope of project; project location; required fire-safety and exiting criteria; building-construction type, compartmentation showing fire and smoke barriers, bed count and services; the assignment of all spaces, areas, and rooms for each floor level, including the basement. A nursing facility has the option, at its own risk, to bypass the stage one submittal and proceed directly to submittal of stage two documents. After the first review and before Department approval of stage one plans, the nursing facility at its own risk may choose to make a stage two submittal; a nursing facility electing this option would not be eligible for the fast track process. (b) Stage two. A proposed construction document shall be submitted that includes final drawings and specifications adequate for approval by the Department. All final plans and specifications shall be appropriately sealed and signed by an architect registered by the State of Oklahoma. All construction modifications of approved documents are subject to review and approval, and shall be submitted timely.

(1) Fast-track projects. The fast track process applies only to stage two submittals. A stage one submittal and functional program must be approved before entering the fast track process. (A) Equipment and built-in furnishings are to be identified in the stage one submittal. (B) The nursing facility has the option to submit two packages: civil, landscaping and structural in stage one, and the balance of the components in stage two. (C) Fast-track projects shall have prior approval and be submitted in no more than four (4) separate packages.

(i)Site work, foundation, structural, underslab mechanical, electrical, plumbing work, and related specifications. (ii) Complete architectural plans and specifications. (iii) All mechanical, electrical, and plumbing plans and specifications. (iv) Equipment and furnishings.

(2) Radiation protection. Any project that includes radiology or special imaging equipment used in medical diagnosis, treatment, and therapy of residents, shall include plans, specifications, and shielding criteria, prepared by a qualified medical physicist. These plans shall be submitted and approved by the Department prior to installation of the equipment.

(c) Reserved. (d) Floor plan scale. Floor plans are to be submitted at a scale of one-eighth (1/8) inch equals one (1) foot, with additional clarifying documents as required. (e) Application form. The submittal shall be made using a Department application form which requests information required by this Chapter and specifies the number of copies and format for document submittal.

Page 28: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

13

SUBCHAPTER 11. INTERMEDIATE CARE FACILITIES OF 16 BEDS AND LESS FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF/IID-16)

310:675-11-1. Scope

This Subchapter is applicable to small facilities serving the mentally retarded individuals with intellectual disabilities which provide residential accommodations and transitional living training to aid residents in adapting to live in the general society. Resident accommodations are limited to not more than 16 residents, plus any required "live-in" staff. Facilities qualifying under this subsection shall be exempt from other subsections of this Chapter, except for the definitions provided in 310:675-1-2 and as may be specifically referenced in this subsection. In addition to these requirements, all facilities must meet the provisions of the Nursing Home Care Act. 310:675-11-2. Active Treatment

In institutions for the mentally retarded individuals with intellectual disabilities, active treatment requires the following:

(1) The individual's regular participation, in accordance with an individual plan of care, in professionally developed and supervised activities, experience or therapies. (2) An individual written plan of care that sets forth measurable goals or objectives stated in terms of desirable behavior and that prescribes an integrated program of activities, experience or therapies necessary for the individual to reach those goals or objectives. The overall purpose of the plan is to help the individual function at the greatest physical, intellectual, social or vocational level he can presently or potentially achieve. (3) An interdisciplinary professional evaluation that consists of complete medical, social and psychological diagnosis and evaluations and an evaluation of the individual's need for institutional care; and is made by a physician, a social worker and other professionals, at least one of whom is a qualified mental retardation intellectual disability professional. (4) Reevaluation medically, socially and psychologically at least annually by the staff involved in carrying out the resident's individual plan of care. This must include review of the individual's progress toward meeting the plan objectives, the appropriateness of the individual plan of care, assessment of the resident's continuing need for institutional care, and consideration of alternate methods of care. (5) An individual postinstitutionalization plan, as part of the individual plan of care, developed before discharge by a qualified mental retardation intellectual disability professional and other appropriate professionals. This must include provision for appropriate services, protective supervision, and other follow-up services in the resident's new environment. (6) Individuals assigned for specific purpose of direct personal care to residents, including those conducting a training program to develop the resident's self-help and socialization skills. Does not include professionals performing duties related to their profession.

310:675-11-3. Qualified mental retardation intellectual disability professional

A person who has specialized training or one (1) year of experience in treating or working with the mentally retarded individuals with intellectual disabilities and is one of the following:

(1) A psychologist. (2) A licensed doctor of medicine or osteopathy. (3) An educator with a degree in education from an accredited program. (4) A social worker with a bachelor's degree in:

Page 29: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

14

(A) Social work from an accredited program; or (B) A field other than social work and at least three (3) years of social work experience under the supervision of a qualified social worker.

(5) A physical or occupational therapist. (6) A speech pathologist or audiologist. (7) A registered nurse. (8) A therapeutic recreation specialist who:

(A) Is a graduate of an accredited program; and (B) If the State has a licensing or registration procedure, is licensed or registered in the State.

(9) A rehabilitation counselor who is certified by the Committee of Rehabilitation Counselor Certification.

310:675-11-4. Occupancy

Residents selected for ICF/MR-16 ICF/IID-16 occupancy shall receive active treatment, and be capable of direction and emergency evacuation from the facility, as determined by a physician or nurse or qualified mental retardation intellectual disability professional. 310:675-11-5. Physical plant (a) ICF/IID-16 facilities shall be of one hour (minimum) fire resistant construction as approved by the Department and the State Fire Marshal, or shall be fully protected by an automatic sprinkler system approved by the Department and the State Fire Marshal. In addition, ICF/IID-16 facilities shall comply with the requirements of the National Fire Protection Association (NFPA) 101: Life Safety Code, 2012 Edition, adopted in 81 Federal Register 26871 by the Centers for Medicare & Medicaid Services on July 5, 2016 applicable to residential board and care occupancies for small facilities are incorporated by reference. For Medicare or Medicaid certified ICF/IID-16s, the Life Safety Code adopted by the Centers for Medicare & Medicaid Services prevails if there is a conflict between the Life Safety Code and this Chapter. (b) Prior to issuance of license, the essential operation functions of the physical plant shall be submitted to licensing agency for review and approval. This submittal shall be in such detail as will depict compliance with applicable codes, including emergency evacuation and day to day living accommodations. This submittal shall be accompanied by the applicant's written certification declaring the classification (prompt, slow, impractical) shown for "evacuation capabilities" Chapter 21, LSC 1985 Edition. The certified evacuation classification shall not change without written approval of State Fire Marshal and Licensing Agency. The Department shall receive, prior to each required survey, a written declaration by a physician or nurse or qualified intellectual disabilities professional, stating that each resident qualifies for the evacuation classification, as previously submitted and approved. (c) Each facility must have a license. Any facility licensed under this part shall consist of contiguous construction.

(1) Resident rooms. The following requirements shall be provided: (A) Capacity shall be a maximum of four (4) residents. (B) Minimum area shall be 80 square feet per occupant in multi-bed rooms and 100 square feet in single bed rooms. (C) Each resident shall have a minimum of three square feet of closet or locker space which shall contain at least a clothes rod and one adjustable shelf.

(2) Service areas. The following shall be provided:

Page 30: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

15

(A) Toilet and bathing facilities shall be provided in an arrangement similar to general domestic residential facilities, except that bathrooms combining toilet, lavatory, tub and/or shower shall be no less than 60 square feet in size. (B) Bathing and toilet facilities shall be provided on a ratio of one facility for each five residents. (C) Resident staff offices shall be provided at the facility in sufficient size and number to permit the safe storage and handling of prescription medications used by the individual residents, space for private counseling of residents, space for the business affairs of the ICF/IID-16 to be conducted in private, and space for the maintenance of records pertaining to resident care. (D) Linen and supply areas shall be provided in a manner which permits the separation of the clean and soiled materials. Clean linen and supplies shall be stored separately from the area in which the soiled materials are collected. (E) Meal service space shall be provided as follows:

(i) Kitchen. Space for conventional food preparation and baking with sufficient storage for maintaining at least a four day supply of all foods required for a general diet, including cold storage. (ii) Dining. There shall be 15 square feet per person allocated to permit residents and on-duty staff to dine at the same time. (iii)Warewashing shall be in accordance with the requirements of the care facilities as stated in Chapter 257 (relating to Food Service Establishments) of this Title.

(F) Housekeeping materials and supplies shall be maintained in a designated area which is apart from the food service and sleeping areas.

(3) Recreation, lounge and public areas. Each ICF/IID-16 shall provide interior lounge and recreation space at a rate of no less than 20 square feet per bed. If public visitation areas are included, the lounge and recreation space shall be no less than 25 square feet per bed. Outside recreation lounge areas shall be provided. These areas shall have sufficient lighting to permit utilization after sundown. (4) Natural lighting and ventilation of rooms. All habitable and occupiable rooms or spaces shall contain windows, skylights, monitors, glazed doors, transoms, glass block panels or other light transmitting media opening to the sky or on a public street, yard or court. The light transmitting properties and the area of the devices used shall be adequate to meet the minimum day lighting and ventilating requirements specified herein. (5) Window size. Windows and exterior doors may be used as a natural means of light and ventilation, and when so used their aggregate glass area shall amount to not less than eight percent of the floor area served, and with not less than one half of this required area available for unobstructed ventilation.

310:675-11-6. Institutional and operational relationships The ICF/MR-16 ICF/IID-16 may be free standing in a community or may be on campus with a parent institution. The ICF/MR-16 ICF/IID-16 may be an independent ownership and operation or may be part of a larger institutional ownership and operation. In any case, however, the ICF/MR-16 ICF/IID-16 may have an effective, continuous relationship with a full scope ICF/MR-16 ICF/IID-16 which allows all necessary support and professional services as well as the expeditious transfer of residents if and when necessary. 310:675-11-7. Staffing

Page 31: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

16

(a) The ICF/MR-16 ICF/IID-16 shall have available enough qualified staff and support personnel to carry out the residential living, professional and special programs and services for residents as required by their individual needs, and of sufficient size that the facility does not depend on residents or volunteers for services. (b) Each ICF/MR-16 ICF/IID-16 shall maintain at least the minimum direct-care-staff ratios specified in OAC 310:675-13-12(a). (c) In living units for the severely impaired client, the present and on duty direct care staff ratio would be:

(1) 1 to 4 from 7:00 a.m. to 3:00 p.m.; (2) 1 to 4 from 3:00 p.m. to 11:00 p.m.; and (3) 1 to 8 from 11:00 p.m. to 7:00 a.m.

(d) There should be sufficient dietary, nursing, housekeeping and administrative staff to serve the needs of the facility. 310:675-11-8. Administration

All sections of Subchapter 7 of this Chapter shall be applicable to the ICF/MR-16 ICF/IID-16 facilities and operations. 310:675-11-9. Resident care services

In accordance with the needs of the residents, Subchapter 9 of this Chapter shall be applicable to the ICF/MR-16 ICF/IID-16 .

SUBCHAPTER 13. STAFF REQUIREMENTS

310:675-13-12. Direct care staffing (a) Each facility shall maintain at least the minimum direct-care-staff-to-resident ratios specified in the Act at 63:1-1925.2. (b) A licensed nurse shall be on duty eight hours a day, seven days a week on the day shift. (c) If the director of nursing is a licensed practical nurse, a registered nurse shall be employed for at least eight hours per week as a consultant. (d) There shall be a licensed nurse on duty twenty-four hours per day; provided however, that a facility licensed as a specialized facility for the developmentally disabled individuals with intellectual disabilities shall only be required to provide 24 hour nursing when it has a resident who has a medical care plan. The department may waive this requirement when the facility demonstrates it has been unable, despite diligent effort, to recruit licensed nurses. The Department shall determine that a waiver of this requirement will not endanger the health or safety of the residents. (e) There shall be at least one certified medication aide on duty when any shift is not covered by a licensed nurse. (f) At least two direct care staff persons shall be on duty and awake at all times regardless of the number of residents. (g) Willful violation of the requirements regarding direct-care staff shall be determined based on a review of facility staffing records and interviews with staff, residents, resident family members and/or guardians, and other parties which may have information relevant to the investigation. The determination by the Department of Health will include, but will not be limited to, the following factors:

(1) The nature, circumstances and gravity of the violations;

Page 32: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

17

(2) The repetitive nature of the violations at the facility or others operated by the same or related entities; (3) The previous degree of difficulty in obtaining compliance with the rules at the facility or others operated by the same or related entities; and (4) Any substantial showing of good faith in attempting to achieve continuing compliance with the provisions of the Nursing Home Care Act.

310:675-13-14. Flexible staff-scheduling (a) Implementing flexible staff-scheduling. Each facility seeking to implement the flexible staff-scheduling provisions of 63:1-1925.2(B)(5) shall request in writing a determination from the Department that the facility is in compliance with the staffing requirements of 63:1-1925.2(B)(3). (b) Requirements for eligibility. Determination of flexible staff-scheduling privileges shall be based on compliance with the requirements at 63:1-1925.2(B)(6) and review of the staffing hours reported to the Oklahoma Health Care Authority. Reports shall be submitted to the Oklahoma Health Care Authority either though electronic mail or three and one-quarter inch diskette in an electronic format approved by that agency. The reviewed hours shall be for the previous three (3) calendar months from the date the request for determination is received. (c) Determination of compliance. A determination of compliance with the requirements at 63:1-1925.2(B)(6)(a)(2)-(4) will be based on staffing reports and surveys for the three (3) months preceding the date the request for determination is received by the Department. For intermediate care facilities for the mentally retarded individuals with intellectual disabilities loss of eligibility shall include findings of non-compliance with the Condition of Participation at 42 CFR 483.430, Facility Staffing. (d) Failure to meet the direct care service rate. Facilities that have been granted flexible staff-scheduling privileges and receive a determination they have not met the direct care service rate shall lose their flexible staff-scheduling privileges until the facility re-establishes their eligibility under the requirements at 63:1-1925.2(B)(6)(b) and (c). Facilities shall have the right to appeal and to the informal dispute resolution process with regard to penalties and sanctions imposed due to staffing noncompliance. [63:1-1925.2(E)]. (e) Loss of eligibility based on surveys or fraud. Facilities seeking to re-establish flexible staff-scheduling privileges after a loss of eligibility under 63:1-1925.2(B)(7) shall be subject to the requirements at OAC 310:675-13-14(a), (b) and (c). For intermediate care facilities for the mentally retarded individuals with intellectual disabilities loss of eligibility shall include findings of non-compliance with the Condition of Participation at 42 CFR 483.430, Facility Staffing. (f) Minimum staff in flexible staffing. A facility failing to meet the flexible staff-scheduling requirement at 63:1-1925.2(B)(5)(b) shall be ineligible for flexible staff-scheduling privileges until the facility re-establishes their eligibility under the requirements at 63:1-1925.2(B)(6)(b) and (c). (g) Notification requirements. The Department shall notify the facility and Oklahoma Health Care Authority on all decisions of eligibility. (h) Re-establishing eligibility. A facility seeking to re-establish eligibility shall submit a written request to the Department. A request to re-establish eligibility is subject to the requirements at OAC 310:675-13-14(b). (i) Shift-based ratios for noncompliant facilities. This paragraph implements 63:1-1925.2(F)(4).

(1) When the provisions of 63:1-1925.2(F)(1) are in effect, pursuant to 63:1-1925.2(B)(7), the following minimum direct-care-staff-to-resident ratios for non-compliant facilities shall apply in addition to other state and federal requirements related to the staffing of nursing facilities:

Page 33: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:675 Amendments

18

(A) From 7:00 a.m. to 3:00 p.m., one direct-care staff to every five residents, (B) From 3:00 p.m. to 11:00 p.m., one direct-care staff to every seven residents, and (C) From 11:00 p.m. to 7:00 a.m., one direct-care staff to every thirteen residents.

(2) When the provisions of 63:1-1925.2(F)(2) are in effect, pursuant to 63:1-1925.2(B)(7), the following minimum direct-care-staff-to-resident ratios for non-compliant facilities shall apply in addition to other state and federal requirements related to the staffing of nursing facilities:

(A) From 7:00 a.m. to 3:00 p.m., one direct-care staff to every five residents, (B) From 3:00 p.m. to 11:00 p.m., one direct-care staff to every six residents, and (C) From 11:00 p.m. to 7:00 a.m., one direct-care staff to every eleven residents.

(3) When the provisions of 63:1-1925.2(F)(3) are in effect, pursuant to 63:1-1925.2(B)(7), the following minimum direct-care-staff-to-resident ratios for non-compliant facilities shall apply in addition to other state and federal requirements related to the staffing of nursing facilities:

(A) From 7:00 a.m. to 3:00 p.m., one direct-care staff to every four residents, (B) From 3:00 p.m. to 11:00 p.m., one direct-care staff to every six residents, and (C) From 11:00 p.m. to 7:00 a.m., one direct-care staff to every eleven residents.

Page 34: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

1

INITIAL RULE IMPACT STATEMENT

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 677. NURSE AIDE TRAINING AND CERTIFICATION

1. DESCRIPTION:

This action will amend numerous sections within this chapter. The current Rule uses the terms “Mental Retardation”, “Mentally Retarded” and “Qualified Mental Retardation Professional”. These terms are outdated and derogatory. This proposal replaces the aforementioned terms with “Individuals with Intellectual Disabilities”, “Individuals with Developmental Disabilities”, or “Qualified Intellectual Disability Professional”. Pursuant to Title 25 O.S. § 40, statutes and administrative rules should avoid language that equates persons with their condition and should replace nonrespectful language by referring to persons with disabilities as persons first. Further, national organizations such as the Americans with Disabilities Act National Network, American Association on Intellectual and Developmental Disabilities and Centers for Medicare and Medicaid encourage use of more respectful language that has gained wide acceptance in recent disability laws.

2. DESCRIPTION OF PERSONS AFFECTED AND COST IMPACT RESPONSE: Persons directly affected will be residents of nursing and specialized facilities as well as their family members. Additionally, the proposed amendments have the potential to affect numerous other individuals by encouraging respectful language to be used by the general public.

3. DESCRIPTION OF PERSONS BENEFITING, VALUE OF BENEFIT AND EXPECTED

HEALTH OUTCOMES: Persons benefiting will include residents and their families as well as owners, operators, staff of nursing homes and specialized facilities and associated professionals. The amendments will encourage residents to be referred to in a more respectful manner. This change in language will promote respect and will have a positive impact on the perception of residents as well as their family members. The Oklahoma State Department of Health (OSDH) received correspondence from an individual who is concerned about the current language. The individual voiced the desire to have the offensive language removed from use and stated that the terminology is outrageous and unacceptable. Further, she asked if the OSDH could work to improve the way in which individuals with disabilities are referenced within the Oklahoma Administrative Code (OAC). In November 2006, 25 O.S. §40 was adopted and states that all new and revised administrative rules should replace nonrespectful language. Since 2006, only one section with disrespectful language has been amended to remove the language. In an effort to expedite this process, the OSDH proposes these rule changes to alter the language of all affected sections of the OAC at one time.

4. ECONOMIC IMPACT, COST OF COMPLIANCE AND FEE CHANGES: There is no anticipated economic impact or cost associated with compliance.

5. COST AND BENEFITS OF IMPLEMENTATION AND ENFORCEMENT TO THE AGENCY: The cost to the OSDH to implement the amendments will be approximately $784 to cover the costs of rule drafting, adoption, publication, distribution, and education. The proposed rules will be implemented and enforced by existing OSDH personnel and will not result in an increase in authorized full-time equivalent personnel. No impacts on other agencies are anticipated.

Page 35: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

2

6. IMPACT ON POLITICAL SUBDIVISIONS: There will be no impact on political subdivisions and it will not require their cooperation in implementing or enforcing the proposed amendment.

7. ADVERSE EFFECT ON SMALL BUSINESS:

There is no anticipated adverse effect on small business.

8. EFFORTS TO MINIMIZE COSTS OF RULE: The costs associated with this rule change are minimal and include only the costs of drafting, adoption, publication, distribution and education.

9. EFFECT ON PUBLIC HEALTH AND SAFETY:

This change will help foster inclusiveness and acceptance of individuals with disabilities by referring to them as individuals first. The language used in the updated rule is more respectful and will have a positive effect on individuals with intellectual and developmental disabilities.

10. DETRIMENTAL EFFECTS ON PUBLIC HEALTH AND SAFETY WITHOUT ADOPTION: If this change is not made, Oklahoma will continue to utilize outdated and nonrespectful language regarding individuals with disabilities. This language has an adverse effect on the individuals as well as their family members.

11. PREPARATION AND MODIFICATION DATES:

This rule impact statement was prepared on December 7, 2018.

Page 36: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

1

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 677. NURSE AIDE TRAINING AND CERTIFICATION

SUBCHAPTER 1. GENERAL PROVISIONS 310:677-1-2. Definitions The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. The singular includes the plural as necessary.

"Abuse" means any intentional physical or mental injury or sexual assault on a resident of a facility; by any person. [63 O.S. 1991 §1-1902].

"Certified medication aide" means a certified nurse aide who has passed a Department approved program for administering medications.

"Client" means an individual receiving services from a home care agency or employer. "Clinical skills observer" means a registered nurse, qualified mental retardation intellectual

disability professional, licensed practical nurse, registered pharmacist or other qualified professional who has at least one (1) year experience and has successfully completed a Department approved clinical skills observer training program.

"Commissioner" or "Commissioner of Health" means the Oklahoma State Commissioner of Health, the chief executive officer of the Department.

"Deemed" means meeting specified requirements to qualify for other categories of nurse aide certification.

"Department" means the State Department of Health. [63 O.S. 1991, § 1-1902(7)]. "Direct supervision" means a licensed nurse or other qualified individual actually observes a

trainee performing tasks. "Educational based program" means a nurse aide training and competency examination

program sponsored by a State approved educational entity including, but not limited to, vocational technical schools, schools of higher learning or State certified educational facilities.

"Employer" means any of the following entities: facilities, agencies or programs including, but not limited to, nursing facilities, specialized facilities, residential care homes, adult day care centers, assisted living centers, or a nurse registry or a home care agency.

"Employer based program" means a nurse aide training and competency examination program sponsored by, or offered in, a nursing facility, a residential care home, an adult day care center, a home care agency, or a specialized facility.

"Entity" means the provider of a Department-approved nurse aide training and competency evaluation program including but not limited to an employer based or an educational based program provider.

"Examination" means a competency examination that includes a written portion and/or a clinical skills portion.

"Health related services" means those services provided to patients, clients, or residents that include but are not limited to the following: personal hygiene, transferring, range of motion, supervision or assistance in activities of daily living, basic nursing care such as taking temperature, pulse or respiration, positioning, incontinent care, identification of signs and symptoms of disease, and behavior management.

"ICF/IID" means an Intermediate Care Facility for Individuals with Intellectual Disabilities. "Inservice education" means activities intended to assist the nurse aide to acquire, maintain,

and/or increase competence in fulfilling the assigned responsibilities specific to the employer's expectations.

Page 37: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

2

"Instructor" means a qualified professional who teaches in an approved training program. "Licensed health professional" means a physician, dentist, podiatrist, chiropractor, physician

assistant, nurse practitioner, pharmacist, physical, speech, or occupational therapist, registered nurse, licensed practical nurse, licensed social worker or licensed registered dietician.

"Licensed nurse" means a registered nurse or a licensed practical nurse that is currently licensed by the Oklahoma Board of Nursing.

"Misappropriation of property" means the taking, misapplication, deprivation, transfer, or attempted transfer to any person not entitled to receive any property, real or personal, or anything of value belonging to or under the legal control of a resident or client without the effective consent of the resident or client or other appropriate legal authority, or the taking of any action contrary to any duty imposed by federal or state law prescribing conduct relating to the custody or disposition of a resident's/client's property.

"Mistreatment" means a negligent act or personal wrong against a resident or client which causes the resident or client actual physical pain, discomfort or mental anguish. This type of personal wrong does not necessarily have to present external or visible signs of existence but does not include actions which are unavoidable.

"Neglect" means a failure to provide adequate medical or personal care or maintenance which results in physical or mental injury to a resident. [63 O.S. 1991, §1-1902.].

"Orientation" means the training for a particular job activity given to a new employee. "Performance record" means a list of the major duties and skills to be learned in a nurse aide

training program and the trainee's performance of each. "Qualified professional" means an individual qualified to perform training and skills testing in

an approved nurse aide training and competency program. "Reciprocity" means the process that allows a certified nurse aide from another state to be

listed in the Department's nurse aide registry. "Reconsideration" means a process that allows an applicant to obtain reconsideration of an

adverse decision on an application by submission of clarifying materials to the original decision-making body.

"Registry" means a Department maintained list of individuals who have successfully completed a nurse aide training and competency examination program or a competency examination program approved by the Department or who have been deemed or waived to meet the requirements.

"Specialized facility" means any home, establishment, or institution which offers or provides inpatient long-term care services on a twenty-four-hour basis to a limited category of persons requiring such services, including but not limited to a facility providing health or habilitation services for mentally retarded or developmentally disabled persons [individuals with intellectual or developmental disabilities]. [63:1-1902(11)]

"Supervised practical training" means training in a laboratory or other setting in which the trainee demonstrates knowledge while performing tasks on an individual.

"Trainee" means an individual who is enrolled in and has begun, but has not completed, a nurse aide training program.

"Trainer" means a qualified person who teaches in a nurse aide training and competency examination program.

"Training and competency examination program" means a program approved by the Department to teach and evaluate individuals to work as a nurse aide.

"Waiver" means a process that allows an individual with acceptable qualifications to be placed in the Department's registry without meeting other required qualifications.

Page 38: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

3

310:677-1-3. Applicability (a) This Chapter shall apply to specified employers, nurse aides, certified medication aides and other unlicensed employees providing health related services, and training and competency evaluation programs. (b) An employer shall not use an individual as a nurse aide unless the employer has consulted the Oklahoma Nurse Aide Registry to determine whether the individual is listed on the nurse aide registry and whether the individual has no confirmed findings of abuse, neglect or misappropriation of patient/resident/client property. (c) The Department shall grant an exception to the nurse aide training requirements in 310:677-9-4 for home health aides, 310:677-11-4 for long term care aides, 310:677-13-4 for certified medication aides, 310:677-15-3 for developmentally disabled direct ICF/IID care aides, 310:677-17-3 for residential care aides and 310:677-19-3 for adult day care aides, and allow an individual to sit for the competency examination if the individual submits all information specified on the Training Exception Application (ODH Form 832), which requires the following:

(1) Individual's full name and personal identifying information; (2) Telephone number and address to include street, city, state, and zip code; (3) Copy of official transcript documenting classroom and clinical training equal to or greater than the classroom and clinical training as prescribed in 310:677-9-4, 310:677-11-4, 310:677-13-4, 310:677-15-3, 310:677-17-3 and 310:677-19-3; and (4) Type of nurse aide training to be excepted.

(d) The Department shall grant to a graduate of an approved practical or registered nurse program located in the United States a waiver to be placed on the nurse aide registry if the following criteria are met:

(1) The individual submits all information specified on the Department's Nurse Aide Training and Competency Evaluation Program Waiver Application (ODH Form 844), which requires the following:

(A) Individual's full name and personal identifying information; (B) Telephone number and address to include street, city, state, and zip code; (C) Photocopy of diploma from an approved practical or registered nurse program; (D) Type of nurse aide training and competency testing requesting to be waived; and (E) Identification of all states, territories and districts of the United States and other countries where the individual has practiced or been licensed, certified or registered as a nurse; and

(2) The individual does not have a denied, revoked or suspended license or certificate or an administrative penalty or disciplinary action imposed by the Oklahoma Board of Nursing or similar agency in another state, territory or district of the United States or in another country, to be evidenced by the individual's attestation.

(e) The Department shall allow a graduate of an approved practical or registered nurse program located outside the United States a training exception and shall be authorized to sit for a nurse aide competency examination if the following criteria are met:

(1) The individual submits the Foreign Graduate Training Exception Application (ODH Form 843), which requires the following:

(A) Individual's full name; (B) Telephone number and address to include street, city, state, and zip code; (C) The location outside of the United States where the individual received their nursing education and licensing examination if applicable; (D) The type of nurse aide training requesting to be excepted;

Page 39: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

4

(E) Documentation verifying legal entry and resident status in the United States including but not limited to a photocopy of a Social Security Card, Visa, Green Card or naturalization papers; and (F) A photocopy of a certified, translated diploma and transcript in English; and

(2) The individual does not have a denied, revoked or suspended license or certificate or an administrative penalty or disciplinary action imposed by the Oklahoma Board of Nursing or similar agency in another state, territory or district of the United States, to be evidenced by the individual's attestation.

(f) An individual who has not completed an approved Oklahoma Nurse Aide Training program and is submitting an application to be included on the Oklahoma Nurse Aide Registry as a certified nurse aide shall submit the following nonrefundable fee with the required completed application:

(1) Deeming Application, fifteen dollar ($15.00) fee applicable to each of the following deeming applications except (A) of this paragraph;

(A) Home Health Aide Deemed deemed to Long Term Care Aide (ODH Form 755) with no fee required; (B) Home Health Aide Deemed deemed to Developmentally Disabled Direct ICF/IID Care Aide (ODH Form 836); (C) Home Health Aide Deemed deemed to residential Care Aide (ODH Form 837); (D) Home Health Aide Deemed deemed to Adult Day Care Aide (ODH Form 838); (E) Long Term Care Aide Deemed deemed to Developmentally Disabled Direct ICF/IID Care Aide (ODH Form 830); (F) Long Term Care Aide Deemed deemed to residential Residential Care Aide, (ODH Form 831); (G) Long Term Care Aide Deemed deemed to Adult Day Care Aide, (ODH Form 839); (H) Developmentally Disabled Direct ICF/IID Care Aide Deemed deemed to Residential Care Aide (ODH Form 834); and (I) Developmentally Disabled Direct ICF/IID Care Aide Deemed deemed to Adult Day Care Aide (ODH Form 835);

(2) Home Health Aide Reciprocity Application (ODH Form 735), $15.00 fee; (3) Training Exception Application (ODH Form 832), or Foreign Graduate Training Exception Application (ODH Form 843), $15.00 fee; or (4) Nurse Aide Training and Competency Evaluation Program Waiver Application (ODH Form 844), $15.00 fee. (5) The fees specified in (1) through (4) of this subsection apply to applications for home health aides, certified medication aides, developmentally disabled direct ICF/IID care aides, residential care aides, and adult day care aides. A fee shall not be charged on an application requesting certification as a long term care aide only.

(g) An individual who has previously completed a Department approved Nurse Aide Training and Competency Evaluation Program and is unable to renew certification may obtain approval to take a retest by filing a Certified Nurse Aide Retest Application (ODH Form 841) if any of the following criteria are met:

(1) The individual did not provide eight (8) hours of nursing or health related services for compensation during the twenty-four (24) months prior to expiration of the certification; (2) The individual did not provide eight (8) hours of nursing or health related services for compensation up to twenty-four (24) months after expiration; or (3) The individual's nurse aide certification has been expired for over two (2) years but less than three (3) years.

Page 40: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

5

(4) A Certified Nurse Aide Retest Application (ODH Form 841) submitted by a home health aide, developmentally disabled direct ICF/IID care aide, residential care aide, or adult day care aide shall be accompanied by a fifteen dollar ($15.00) nonrefundable fee. (5) An individual who fails the approved retest shall be required to retrain before taking any subsequent retests.

(h) An individual may request a duplicate or amended certification card by submitting a Duplicate or Amended Nurse Aide Card Application (ODH Form 738) with a nonrefundable ten dollar ($10.00) fee. A fee shall not be charged on an application requesting a duplicate or amended long term care aide certification card.

SUBCHAPTER 3. NURSE AIDE TRAINING AND COMPETENCY EXAMINATION PROGRAM

310:677-3-4. Program requirements (a) Before the Department approves a nurse aide training and competency examination program or a competency examination program, the Department shall determine whether the nurse aide training and competency examination program or the competency examination program meets the minimum requirements. (b) The Department shall not approve, or shall withdraw approval, of an employer based program when the employer has been assessed the following penalties or actions by the Department:

(1) License suspended or revoked or had a conditional license issued. (2) An administrative money penalty of five thousand dollars ($5,000) or more for deficiencies cited under state licensure. (3) Closed or had its residents or clients transferred pursuant to the Department's action. (4) Enforcement actions based on the Department's authority under Medicare and Medicaid certification programs, except for facilities certified as Intermediate Care Facilities for the Mentally Retarded individuals with intellectually disabilities. (5) For Intermediate Care Facilities for the Mentally Retarded Individuals with Intellectual Disabilities, repeated enforcement actions based on the Department's authority.

(c) The Department may withdraw approval of a nurse aide training and competency examination program sponsored by an entity when the following occurs:

(1) The entity has been determined by the Department to have a competency examination failure rate greater than fifty (50) per cent during a calendar year. (2) The entity no longer meets, at a minimum, the following requirements to be a certified program:

(A) The training program falls below the required clock hours of training; (B) The curriculum does not include at least the subjects specified under 310:677-9-4 Home Health Aides, 310:677-11-4 Long Term Care Aides, 310:677-13-4 Certified Medication Aides, 310:677-15-3 Developmentally Disabled Direct ICF/IID Care Aides, 310:677-17-3 Residential Care Aides, and or 310:677-19-3 Adult Day Care Aides; (C) A minimum of 16 hours of specified training for Long Term Care Aides is not provided prior to direct contact with residents; (D) At least sixteen (16) hours of supervised practical training under the direct supervision of a registered nurse or a licensed practical nurse. The sixteen (16) hours does not include the administration of the skills examination.

Page 41: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

6

(3) The entity uses an uncertified individual as a nurse aide for longer than four months. To use an uncertified individual as a nurse aide for four months or less, an entity must have a temporary emergency waiver approved pursuant to 63 O.S. Section 1-1950.3. (4) The onsite review determines the training program is out of compliance with the requirements of 63 O.S. Section 1-1950.1, 1-1950.3 or 1-1951, or OAC 310:677.

(d) The Department shall withdraw approval of a nurse aide training and competency evaluation program if:

(1) The entity refuses to permit the Department to make unannounced visits; or (2) The entity falsifies records of competency or training.

(e) Withdrawal of approval shall be for a period of two (2) years or until the Department is assured through review that the entity complies with the requirements. (f) If the Department withdraws approval of a nurse aide training and competency examination program, the Department shall:

(1) Notify the entity in writing, indicating the reason for withdrawal of approval. (2) Allow the trainees who have started a training and competency examination program to complete the program or allow the trainees who have started the program to transfer to another approved program.

(g) A program entity may request reconsideration of the Department's decision in accordance to Chapter 2 of this Title and appealed according to the Administrative Procedures Act. (h) The entity shall notify the trainee in writing, that successful completion of the nurse aide training and competency examination program shall result in the individual being listed in the Department's nurse aide registry and shall retain a copy of such notice, signed by the trainee, in the trainee's file. (i) A trainee shall not perform any services for which the trainee has not been trained and found proficient by an instructor.

SUBCHAPTER 5. NURSE AIDE REGISTRY

310:677-5-2. Registry operation (a) The Department shall maintain overall operation of the registry. (b) Only the Department may place in the registry findings of abuse, neglect, mistreatment or misappropriation of property. (c) The nurse aide registry shall indicate which individuals:

(1) Successfully completed a nurse aide training and competency examination; (2) Were given a training exception to bypass training requirements and sit for the competency examination; (3) Had the nurse aide training and competency examination program requirements waived; or (4) Were placed on the Oklahoma Nurse Aide Registry via reciprocity from another state.

(d) A home health aide, long term care aide, developmentally disabled direct ICF/IID care aide, residential care aide, and adult day care aide shall renew individual certification once every two (2) years. The individual certified as a home health aide, developmentally disabled direct ICF/IID care aide, residential care aide, or adult day care aide shall file a Recertification Application (ODH Form 717). The individual certified as a long term care aide shall file a Recertification Application for Long Term Care Aide (ODH Form 840). Each recertification application requires:

(1) Personal identifying and contact information for the applicant;

Page 42: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

7

(2) Documentation that the applicant has provided at least eight (8) hours of nursing or health related services for compensation during the preceding 24 months. On and after July 1, 2008, the documentation shall consist of one of the following:

(A) A statement signed by the administrator or the administrator's representative for the licensed nursing facility, specialized facility, residential care home, home health or home care agency, adult day care center, assisted living center, continuum of care facility, Oklahoma Department of Veterans Affairs nursing facility, or Oklahoma correctional facility where the applicant provided services; (B) A statement signed by a physician or nurse under whose supervision the applicant provided services; or (C) A check stub, IRS Form W-2 or similar proof of wages paid to the applicant by a licensed nursing facility, specialized facility, residential care home, home health or home care agency, adult day care center, assisted living center, continuum of care facility, Oklahoma Department of Veterans Affairs nursing facility, or Oklahoma correctional facility; and

(3) An oath of truthfulness and completeness to be signed by the applicant. (e) A home health aide, developmentally disabled direct ICF/IID care aide, residential care aide, or adult day care aide shall pay a ten dollar ($10.00) fee for the processing and renewal of certifications and for replacement of a wallet card for change of name or other reason.

SUBCHAPTER 13. CERTIFIED MEDICATION AIDES 310:677-13-1. General requirements (a) An individual shall be able to read, write, and speak English and be certified in good standing as a home health aide, a long term care aide, or a developmentally disabled direct ICF/IID care aide listed in the Department's Nurse Aide Registry, prior to admission to a State approved certified medication aide training program. The Department shall make available an attestation form that training programs may use for admission to certified medication aide training. (b) A certified medication aide shall complete at least eight (8) hours of continuing education every twelve (12) months, excluding the first year of certification, from a State approved program. A record of successful completion shall be kept in the certified medication aide's personnel file. (c) An employer shall not use as a certified medication aide any individual who does not comply with 63 O.S. Section 1-1950.3(E), OAC 310:677, and the employer's policies and procedures. (d) A certified medication aide shall renew certification every 12 months. Recertification requires the following: (1) Documentation of completion of at least eight (8) hours of continuing education every twelve (12) months, excluding the first year after certification as a medication aide. Classroom and supervised practical training hours completed by a CMA in a Department-approved advanced training program may count towards the eight required hours of continuing education; (2) Current certification as a long term care aide, home health aide or developmentally disabled direct ICF/IID care aide. CMAs may also be certified in the other two (2) categories in addition to the required certification as a long term care aide, home health aide and developmentally disabled direct ICF/IID care aide; and (3) Current listing in the nurse aide registry.

Page 43: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

8

(e) The Department shall approve certified medication aide training programs that meet the requirements of OAC 310:677-13-3 through 13-5, and 310:677-13-9. (f) The Department shall review, approve or disapprove a Certified Medication Aide Continuing Education Program application and notify the entity of its action within thirty (30) days of the request or receipt of additional information from the applicant. (g) The following words or terms when used in this subchapter shall have the following meaning unless the context clearly indicates otherwise: (1) "Stable diabetes" means diabetes associated with a blood glucose level consistently between 80 and 140 milligrams per deciliter (mg/dl) fasting and less than or equal to 180 mg/dl after a meal, and/or a Hemoglobin A1c (HbA1c) at or below 7.0 within the last three months. (2) "Unstable diabetes" means: (A) A non-acutely ill person with blood glucose levels more than three times over a six week period that are under 80 mg/dl or more than 140 mg/dl fasting, or more than 180 mg/dl two hours after a meal; (B) A person with diabetes who has prescriptions for both insulin and glucagon; (C) A person with Type I diabetes who experiences hypoglycemia unawareness; (D) A person who is newly diagnosed with diabetes and for whom insulin is prescribed; or (E) A person who has been previously diagnosed with diabetes and now requires insulin administration for management. They may be considered stable again when their glucose is maintained in the stable range specified in subsection (g)(1) of this section, which may include maintaining an HbA1c at or below 7.0. (3) "Newly diagnosed" means a person who now has a diagnosis of either Type I or Type II diabetes, has a new prescription for insulin, has not been diagnosed with diabetes in the past and who does not have stable diabetes.

SUBCHAPTER 15. DEVELOPMENTALLY DISABLED DIRECT ICF/IID CARE AIDES

310:677-15-1. Deemed to meet state certification requirements (a) A certified developmentally disabled ICF/IID care aide is deemed to meet the nurse aide certification requirements for the following employers after successful completion of at least sixteen (16) hours of orientation specific to the facility population. Documentation of the sixteen (16) hours of orientation shall be submitted to the Department and the certified developmentally disabled ICF/IID care aide will be placed on the registry as a certified residential care aide or a certified adult day care aide. The employers to which this subsection applies are:

(1) Residential care. (2) Adult day care.

(b) The Department shall deem a certified long term care aide or a home care aide who has at least sixteen (16) hours of training specific to the developmentally disabled client population individuals with intellectual or developmental disabilities to meet the requirements for a developmentally disabled direct an ICF/IID care aide. Documentation of the sixteen (16) hours of training shall be submitted to the Department and the certified long term care nurse aide or the certified home care nurse aide will be added to the registry as being certified as a developmentally disabled direct ICF/IID care aide. 310:677-15-2. Instructor qualifications

Page 44: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

9

(a) The instructor for training developmentally disabled direct ICF/IID care aides shall be a licensed nurse or a qualified mental retardation intellectual disability professional who has at least one (1) year experience in the provision of services in a facility for the developmentally disabled. (b) Other personnel from the health professions may supplement the instructor as required by the curriculum. 310:677-15-3. Curriculum (a) The developmentally disabled direct ICF/IID care aide training program shall include at least seventy-five (75) hours of classroom and supervised practical training or the equivalent. (b) The developmentally disabled direct ICF/IID care aide training program shall include, but is not limited to, each of the following subject areas:

(1) Ethical conduct. (2) Resident's rights. (3) Principles of safety. (4) Infection control techniques. (5) Nutrition and hydration. (6) Elements and changes of body functions. (7) Basic nursing skills. (8) Communication skills. (9) Mobility. (10) Hygiene, personal care, and comfort. (11) Terminology, principles, and concepts of cognitive impairment.

(A) Characteristics of cognitive impairment. (B) Discern between different levels of mental retardation intellectual disability. (C) Principles of assessment tools. (D) Terminology of active treatment.

(12) Psychosocial needs. (A) Behavioral management techniques. (B) Identification of psychosocial needs. (C) Death and dying. (D) Recognizing deviant behavior. (E) Socialization skills.

(13) Independent living skills. (A) Promoting physical and mental independence. (B) Promoting principles of normalization and community integration.

(14) Active treatment components. (A) Interdisciplinary team concepts and roles. (B) Components of individual program plans. (C) Using individual program plans. (D) Proper documentation techniques.

310:677-15-4. Competency and skills examination (a) The written or oral examination shall be administered by a Department approved program. The skills examination shall be performed in a facility or laboratory setting comparable to the setting in which the individual will function as a developmentally disabled direct ICF/IID care aide. (b) The clinical skills observer shall be a licensed nurse or a qualified mental retardation intellectual disability professional.

Page 45: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

December 7, 2018 Draft OAC 310:677 Amendments

10

310:677-15-5. Recertification (a) The training program shall inform the certified developmentally disabled direct ICF/IID care aide that they shall complete a new nurse aide training and competency examination or competency examination if, upon applying for renewal of certification, the nurse aide has not provided at least eight (8) hours of nursing or health related services for compensation during the previous twenty-four (24) months. (b) The specialized facility ICF/IID shall ensure that all certifications are current and not expired.

SUBCHAPTER 17. RESIDENTIAL CARE AIDES 310:677-17-1. Deemed to meet state certification requirements (a) The Department shall deem a certified residential care aide to meet the adult day care program aides certification requirements after successful completion of at least sixteen (16) hours of training specific to the facility population. (b) The Department shall deem a certified long term care aide, a certified home care aide or a certified developmentally disabled direct ICF/IID care aide who has at least sixteen (16) hours of training specific to the residential care population to meet the requirements for a certified residential care aide. Documentation of the sixteen (16) hours of training shall be submitted to the Department and the certified nurse aide will be listed on the registry as a certified residential care aide.

SUBCHAPTER 19. ADULT DAY CARE PROGRAM AIDES

310:677-19-1. Deemed to meet state certification requirements (a) The Department shall deem a certified adult day care program aide to meet the nurse aide certification requirements for a residential care employer after successful completion of at least sixteen (16) hours of training specific to the facility population. Documentation of the sixteen (16) hours shall be submitted to the Department and the certified adult day care aide will be placed on the registry as a certified residential care aide. (b) The Department shall deem a certified long term care aide, a certified home care aide or a certified developmentally disabled direct ICF/IID care aide who has at least sixteen (16) hours of training specific to the adult day care population to meet the requirements for certification as an adult day care aide. Documentation of the sixteen (16) hours of training shall be submitted to the Department and the certified long term care aide, certified home care aide or certified developmentally disabled direct ICF/IID care aide shall be certified as a certified adult day care aide.

Page 46: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

025019 PETERSBURG MEDICAL CENTER LTC PETERSBURG AK Government - City/county Y 7025032 SITKA COMMUNITY HOSPITAL-LTC SITKA AK Government - City Y 5015027 WETUMPKA HEALTH AND REHABILITATION, LLC WETUMPKA AL For profit - Corporation N 25015451 FLORALA HEALTH AND REHABILITATION LLC FLORALA AL For profit - Corporation N 24015336 LUVERNE HEALTH AND REHABILITATION, LLC LUVERNE AL For profit - Corporation N 22015045 EAMC LANIER NURSING HOME VALLEY AL Non profit - Other Y 21015187 MOUNDVILLE HEALTH AND REHABILITATION, LLC MOUNDVILLE AL For profit - Corporation N 21015182 GEORGIANA HEALTH AND REHABILITATION, LLC GEORGIANA AL For profit - Individual N 18015453 COLUMBIANA HEALTH AND REHABILITATION, LLC COLUMBIANA AL For profit - Corporation N 15015431 VALLEY VIEW HEALTH AND REHABILITATION, LLC MADISON AL For profit - Corporation N 1401A193 FATHER PURCELL MEMORIAL EXCEPTIONAL CHILDREN'S CTR MONTGOMERY AL Non profit - Corporation N 13015109 CIVIC CENTER HEALTH AND REHABILITATION, LLC BIRMINGHAM AL For profit - Corporation N 12015097 SOUTH HEALTH AND REHABILITATION, LLC BIRMINGHAM AL For profit - Corporation N 12015042 SUMTER HEALTH AND REHABILITATION, L L C YORK AL For profit - Corporation N 12015158 PERRY COUNTY NURSING HOME MARION AL Non profit - Other N 12015408 WALKER REHABILITATION CENTER, INC CARBON HILL AL For profit - Corporation N 11015076 FAIR HAVEN BIRMINGHAM AL Non profit - Other N 11015303 BLUE RIDGE HEALTHCARE BIRMINGHAM BIRMINGHAM AL For profit - Corporation N 11015208 OZARK HEALTH AND REHABILITATION, LLC OZARK AL For profit - Corporation N 10015440 HUNTSVILLE HEALTH & REHABILITATION, LLC HUNTSVILLE AL For profit - Corporation N 10015396 COLONIAL HAVEN CARE & REHABILITATION CENTER GREENSBORO AL For profit - Corporation N 9015178 GREENE COUNTY NURSING HOME EUTAW AL Government - County N 9015321 SOUTH HAVEN HEALTH AND REHABILITATION, LLC BIRMINGHAM AL For profit - Corporation N 9015044 CAREGIVERS OF PLEASANT GROVE, INC PLEASANT GROVE AL For profit - Corporation N 9015084 PARK PLACE SELMA AL For profit - Corporation N 9015117 OAK KNOLL HEALTH AND REHABILITATION, LLC BIRMINGHAM AL For profit - Corporation N 9015034 HUNTER CREEK HEALTH AND REHABILITATION, LLC NORTHPORT AL For profit - Corporation N 8015417 OAKWOOD-NORTH BALDWIN'S CENTER FOR LIVING BAY MINETTE AL Non profit - Corporation N 8015009 BURNS NURSING HOME, INC. RUSSELLVILLE AL For profit - Individual N 8015228 BLUE RIDGE HEALTHCARE MONTGOMERY MONTGOMERY AL For profit - Corporation N 7015407 HEALTH CARE INC ASHVILLE AL For profit - Individual N 7015456 GULF COAST HEALTH AND REHABILITATION, LLC MOBILE AL For profit - Corporation N 7015123 WASHINGTON COUNTY NURSING HOME CHATOM AL Government - County Y 7015189 DIVERSICARE OF PELL CITY PELL CITY AL For profit - Corporation N 6015331 PHENIX CITY HEALTH CARE, INC PHENIX CITY AL For profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 47: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

015388 EAST GLEN BIRMINGHAM AL Non profit - Corporation N 6015404 BARON HOUSE OF HUEYTOWN HUEYTOWN AL For profit - Corporation N 6015048 CULLMAN HEALTH CARE CENTER CULLMAN AL For profit - Corporation N 6015037 BLUE RIDGE HEALTHCARE WINDWOOD MONTGOMERY AL For profit - Corporation N 5015414 LAFAYETTE NURSING HOME LAFAYETTE AL For profit - Corporation N 5015391 JACKSONVILLE HEALTH AND REHABILITATION, LLC JACKSONVILLE AL For profit - Corporation N 5015197 LAFAYETTE EXTENDED CARE LAFAYETTE AL For profit - Corporation N 4015204 GOODWATER HEALTHCARE CENTER GOODWATER AL For profit - Individual N 4015210 OPP HEALTH AND REHABILITATION, LLC OPP AL For profit - Individual N 4015126 TRAYLOR RETIREMENT COMMUNITY ROANOKE AL For profit - Corporation N 4015419 HARTFORD HEALTH CARE HARTFORD AL For profit - Corporation N 4015103 ASHLAND PLACE HEALTH AND REHABILITATION, LLC MOBILE AL For profit - Corporation N 4015192 ARBOR SPRINGS HEALTH AND REHAB CENTER, LTD OPELIKA AL For profit - Corporation N 4015124 CLAY COUNTY NURSING HOME ASHLAND AL Non profit - Other Y 4015115 CORDOVA HEALTH AND REHABILITATION, LLC CORDOVA AL For profit - Corporation N 4015222 FAIRHOPE HEALTH & REHAB FAIRHOPE AL For profit - Corporation N 4015450 WILLOWBROOKE CT SKILLED CARE CTR AT MAGNOLIA TRACE HUNTSVILLE AL Non profit - Corporation N 4015460 CHARLTON PLACE REHAB AND HEALTHCARE CENTER DEATSVILLE AL For profit - Corporation N 4015452 OAK PARK AUBURN AL Non profit - Other Y 3015429 KENSINGTON HEALTH AND REHABILITATION MOBILE AL For profit - Partnership N 3015406 GRAND BAY CONVALESCENT HOME, INC. GRAND BAY AL For profit - Corporation N 3015089 EVERGREEN NURSING HOME EVERGREEN AL For profit - Corporation N 3015137 ALICEVILLE MANOR NURSING HOME ALICEVILLE AL For profit - Corporation N 3015145 DIVERSICARE OF RIVERCHASE BIRMINGHAM AL For profit - Corporation N 3015148 DIVERSICARE OF ARAB ARAB AL For profit - Corporation N 3015454 FAIRVIEW AT REDSTONE VILLAGE HUNTSVILLE AL Non profit - Corporation N 3015141 ARBOR WOODS HEALTH AND REHAB REFORM AL For profit - Partnership N 3015142 LINEVILLE HEALTH AND REHABILITATION, LLC LINEVILLE AL For profit - Corporation N 3015050 OAK TRACE CARE & REHABILITATION CENTER BESSEMER AL For profit - Corporation N 3015400 MEADOWVIEW NURSING CENTER PELL CITY AL For profit - Corporation N 3015196 DIVERSICARE OF LANETT LANETT AL For profit - Corporation N 3015166 DADEVILLE HEALTHCARE CENTER DADEVILLE AL For profit - Corporation N 2015139 TALLASSEE HEALTH AND REHABILITATION, LLC TALLASSEE AL For profit - Corporation N 2015171 SOUTHERN SPRINGS HEALTHCARE FACILITY UNION SPRINGS AL For profit - Corporation N 2015066 TERRACE MANOR NURSING & REHABILITATION CENTER, INC RUSSELLVILLE AL For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 48: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

015014 EASTVIEW REHABILITATION & HEALTHCARE CENTER BIRMINGHAM AL For profit - Corporation N 2015121 CROWNE HEALTH CARE OF CITRONELLE CITRONELLE AL For profit - Corporation N 2015448 SOUTH HAMPTON NURSING & REHABILITATION CENTER OWENS CROSS ROADS AL For profit - Corporation N 2015457 KIRKWOOD BY THE RIVER BIRMINGHAM AL Non profit - Church related N 2015156 CROWNE HEALTH CARE OF FT PAYNE FORT PAYNE AL For profit - Corporation N 2015119 BLUE RIDGE HEALTHCARE SELMA SELMA AL For profit - Corporation N 2015104 SOUTHLAND NURSING HOME MARION AL For profit - Corporation N 2015413 LIGHTHOUSE REHABILITATION & HEALTHCARE CENTER SELMA AL For profit - Corporation N 2015381 WILLOWBROOKE CT SKILLED CARE CTR WESTMINSTER VLG SPANISH FORT AL Non profit - Corporation N 2015382 CANTERBURY HEALTH CARE FACILITY PHENIX CITY AL For profit - Corporation N 2015129 ATMORE NURSING CENTER ATMORE AL For profit - Corporation N 2015206 DECATUR HEALTH & REHAB CENTER DECATUR AL For profit - Corporation N 1015060 TERRACE OAKS CARE & REHABILITATION CENTER BESSEMER AL For profit - Corporation N 1015065 PRATTVILLE HEALTH AND REHABILITATION, LLC PRATTVILLE AL For profit - Individual N 1015112 MAGNOLIA HAVEN HEALTH AND REHABILITATION CENTER TUSKEGEE AL For profit - Corporation N 1015179 PARKWOOD HEALTH CARE FACILITY PHENIX CITY AL For profit - Individual N 1015447 BLUE RIDGE HEALTHCARE MONTROSE BAY MONTROSE AL Non profit - Corporation N 1015133 MAGNOLIA RIDGE GARDENDALE AL For profit - Corporation N 1015134 BIRMINGHAM NURSING AND REHABILITATION CENTER EAST BIRMINGHAM AL For profit - Partnership N 1015136 FALKVILLE HEALTH CARE CENTER FALKVILLE AL For profit - Corporation N 1015138 HENDRIX HEALTH AND REHABILITATION DOUBLE SPRINGS AL For profit - Individual N 1015101 ALTOONA HEALTH & REHAB ALTOONA AL For profit - Corporation N 1015167 MARION REGIONAL NURSING HOME HAMILTON AL Non profit - Corporation Y 1015216 OAKVIEW MANOR HEALTH CARE CENTER OZARK AL Non profit - Corporation N 1015326 PARK MANOR HEALTH AND REHABILITATION, LLC NORTHPORT AL For profit - Corporation N 1015402 EL REPOSO NURSING FACILITY FLORENCE AL Non profit - Church related N 1045424 GREENE ACRES NURSING HOME PARAGOULD AR Non profit - Corporation N 90045228 SPRING PLACE HEALTHCARE & REHABILITATION CENTER, L HAZEN AR For profit - Corporation N 42045194 BENTLEY HEALTHCARE, LLC TEXARKANA AR For profit - Corporation N 28045144 DIAMOND COVE, LLC HORSESHOE BEND AR For profit - Corporation N 24045208 CABOT HEALTH AND REHAB, LLC CABOT AR For profit - Corporation N 23045242 BRIGHTON RIDGE EUREKA SPRINGS AR For profit - Corporation N 21045287 BEAR CREEK HEALTHCARE LLC DE QUEEN AR For profit - Corporation N 21045167 SPRINGDALE HEALTH AND REHABILITATION CENTER SPRINGDALE AR For profit - Corporation N 19045442 CAVALIER HEALTHCARE OF ENGLAND ENGLAND AR For profit - Corporation N 18

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 49: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

045391 THREE RIVERS HEALTHCARE AND REHABILITATION MARKED TREE AR Non profit - Corporation N 18045384 WOODBRIAR NURSING HOME HARRISBURG AR For profit - Corporation N 15045345 FORT SMITH HEALTH AND REHABILITATION CENTER FORT SMITH AR For profit - Corporation N 15045232 HOMESTEAD HEALTH AND REHABILITATION CENTER STAMPS AR For profit - Corporation N 14045385 NORTH LITTLE ROCK HEALTH AND REHABILITATION CENTER NORTH LITTLE ROCK AR For profit - Corporation N 14045404 LAKEWOOD HEALTHCARE, INC HOT SPRINGS AR Non profit - Corporation N 14045437 STONEGATE VILLA HEALTH AND REHABILITATION, LLC CROSSETT AR For profit - Corporation N 13045147 BROOKRIDGE COVE REHABILITATION AND CARE CENTER MORRILTON AR Non profit - Corporation N 13045098 HERITAGE OF HOT SPRINGS HEALTH AND REHAB HOT SPRINGS AR For profit - Corporation N 13045326 CRAWFORD HEALTHCARE AND REHABILITATION CENTER VAN BUREN AR For profit - Corporation N 11045411 SUMMIT HEALTH & REHAB CENTER TAYLOR AR For profit - Corporation N 10045350 COURTYARD GARDENS HEALTH AND REHABILITATION CENTER ARKADELPHIA AR For profit - Corporation N 10045143 CONCORDIA NURSING & REHAB, LLC BELLA VISTA AR For profit - Corporation N 10045155 ASH FLAT HEALTHCARE AND REHABILITATION CENTER ASH FLAT AR For profit - Corporation N 10045448 DEERVIEW, LLC OLA AR For profit - Corporation N 10045458 COTTAGE LANE HEALTH AND REHAB LITTLE ROCK AR For profit - Corporation N 10045449 CRESTPARK MARIANNA, L L C MARIANNA AR For profit - Corporation N 9045453 GREYSTONE NURSING AND REHAB, LLC CABOT AR For profit - Corporation N 9045446 MADISON HEALTHCARE AND REHABILITATION CENTER LITTLE ROCK AR For profit - Corporation N 9045197 HARRISON REHABILITATION AND HEALTH CENTER HARRISON AR For profit - Corporation N 9045148 CAVE CITY NURSING HOME, INC CAVE CITY AR Non profit - Corporation N 9045184 LAKE VILLAGE REHABILITATION AND CARE CENTER LAKE VILLAGE AR Non profit - Corporation N 9045361 PROMENADE HEALTH AND REHABILITATION ROGERS AR For profit - Corporation N 9045245 CONWAY HEALTHCARE AND REHABILITATION CENTER CONWAY AR For profit - Corporation N 9045382 OAKLAWN ESTATES, LLC HOPE AR For profit - Corporation N 9045455 HICKORY HEIGHTS HEALTH AND REHAB, LLC LITTLE ROCK AR For profit - Corporation N 8045259 HILLVIEW POST ACUTE AND REHABILITATION CENTER LITTLE ROCK AR For profit - Corporation N 8045269 GARDNER NURSING AND REHABILITATION STAR CITY AR For profit - Corporation N 8045199 HEARTLAND REHABILITATION AND CARE CENTER BENTON AR Non profit - Corporation N 8045307 JEFFERSON REGIONAL MEDICAL CENTER PINE BLUFF AR Non profit - Corporation Y 8045275 GRACE POINT, LLC EL DORADO AR For profit - Corporation N 8045369 MOUNTAIN MEADOWS HEALTH AND REHABILITATION BATESVILLE AR For profit - Corporation N 8045364 CHAPEL RIDGE HEALTH AND REHAB FORT SMITH AR For profit - Corporation N 7045392 SPRING CREEK HEALTH & REHAB CABOT AR For profit - Corporation N 7045244 LITTLE RIVER NURSING & REHAB ASHDOWN AR Government - County N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 50: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

045313 ST ANDREWS PLACE CONWAY AR For profit - Corporation N 7045178 GENERAL BAPTIST NURSING HOME OF PIGGOTT PIGGOTT AR Non profit - Corporation N 7045070 ROGERS HEALTH AND REHABILITATION CENTER ROGERS AR For profit - Corporation N 7045209 THE CROSSING AT RIVERSIDE HEALTH AND REHABILITATIO SEARCY AR For profit - Corporation N 6045220 FAYETTEVILLE HEALTH AND REHABILITATION CENTER FAYETTEVILLE AR For profit - Corporation N 6045172 DERMOTT CITY NURSING HOME DERMOTT AR Government - City N 6045332 ARLINGTON COVE HEALTHCARE LLC TRUMANN AR For profit - Corporation N 5045408 ALCOA PINES HEALTH AND REHABILITATION BENTON AR For profit - Corporation N 5045303 CRESTPARK STUTTGART, LLC STUTTGART AR For profit - Corporation N 5045218 GASSVILLE THERAPY AND LIVING GASSVILLE AR For profit - Corporation N 5045412 WILLOWBEND NURSING AND REHABILITATION MARION AR Non profit - Corporation N 5045366 HERITAGE SQUARE NURSING AND REHABILITATION CENTER, BLYTHEVILLE AR For profit - Corporation N 4045447 GREENHURST NURSING CENTER CHARLESTON AR For profit - Corporation N 4045440 OSCEOLA THERAPY AND LIVING OSCEOLA AR For profit - Corporation N 4045365 DEWITT NURSING HOME DE WITT AR Non profit - Corporation Y 4045327 RIDGECREST HEALTH AND REHABILITATION JONESBORO AR For profit - Corporation N 4045139 MCGEHEE HEALTH AND REHABILITATION CENTER MCGEHEE AR For profit - Corporation N 4045342 NASHVILLE NURSING AND REHAB, INC NASHVILLE AR For profit - Corporation N 3045177 CRESTPARK DEWITT, LLC DE WITT AR For profit - Corporation N 3045227 PLEASANT MANOR NURSING & REHAB ASHDOWN AR For profit - Corporation N 3045428 WALNUT GROVE NURSING AND REHABILITATION CENTER SPRINGDALE AR For profit - Corporation N 3045359 CAPITAL HEALTH AND REHABILITATION CENTER LITTLE ROCK AR For profit - Corporation N 3045417 ARKANSAS VETERANS HOME AT FAYETTEVILLE FAYETTEVILLE AR Government - State N 3045346 DIERKS HEALTHCARE & REHABILITATION CENTER, LLC DIERKS AR For profit - Corporation N 3045409 PRAIRIE GROVE HEALTH AND REHABILITATION, LLC PRAIRIE GROVE AR For profit - Corporation N 3045267 LEGACY HEALTH AND REHABILITATION CENTER FORT SMITH AR For profit - Corporation N 3045266 MONTGOMERY COUNTY NURSING HOME MOUNT IDA AR Government - County N 2045376 SHERWOOD NURSING & REHABILITATION CENTER, INC SHERWOOD AR For profit - Corporation N 2045305 SOUTHERN TRACE REHABILITATION AND CARE CENTER BRYANT AR Non profit - Corporation N 2045416 TIMBERLANE HEALTH & REHABILITATION EL DORADO AR For profit - Corporation N 2045439 GOSNELL THERAPY AND LIVING GOSNELL AR For profit - Corporation N 2045387 BRIARWOOD NURSING AND REHABILITATION CENTER,INC LITTLE ROCK AR For profit - Corporation N 2045334 LINDLEY HEALTHCARE AND REHABILITATION CENTER NEWPORT AR For profit - Corporation N 2045190 CROSSETT REHABILITATION AND HEALTH CENTER CROSSETT AR For profit - Corporation N 2045153 INDIAN ROCK VILLAGE HEALTH CENTER FAIRFIELD BAY AR For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 51: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

045357 PREMIER HEALTH AND REHABILITATION CENTER NORTH LITTLE ROCK AR For profit - Corporation N 2045436 PRESBYTERIAN VILLAGE, INC LITTLE ROCK AR Non profit - Corporation N 2045229 MENA MANOR MENA AR For profit - Corporation N 2045176 THE WOODS OF MONTICELLO HEALTH AND REHABILITATION MONTICELLO AR For profit - Corporation N 2045352 EAGLECREST NURSING AND REHAB ASH FLAT AR For profit - Corporation N 2045277 ARKANSAS CONVALESCENT CENTER PINE BLUFF AR For profit - Corporation N 2045289 LONOKE HEALTHCARE AND REHABILITATION FACILITY LONOKE AR For profit - Corporation N 1045302 INNISFREE HEALTH AND REHAB, LLC ROGERS AR For profit - Corporation N 1045246 PERRY COUNTY NURSING AND REHABILITATION CENTER PERRYVILLE AR For profit - Corporation N 1045256 SHERIDAN HEALTHCARE AND REHABILITATION CENTER SHERIDAN AR For profit - Corporation N 1045268 VAN BUREN HEALTHCARE AND REHABILITATION CENTER VAN BUREN AR For profit - Corporation N 1045356 SILOAM SPRINGS NURSING AND REHABILITATION CENTER SILOAM SPRINGS AR For profit - Corporation N 1045308 HERITAGE LIVING CENTER CONWAY AR For profit - Corporation N 1045311 DAVIS EAST PINE BLUFF AR Non profit - Corporation N 1045198 BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK LITTLE ROCK AR Non profit - Corporation Y 1045460 COLONEL GLENN HEALTH AND REHAB, LLC LITTLE ROCK AR For profit - Corporation N 1045358 RICH MOUNTAIN NURSING AND REHABILITATION CENTER MENA AR For profit - Corporation N 1045373 BRADFORD HOUSE NURSING AND REHAB, LLC BENTONVILLE AR For profit - Corporation N 1045390 PLEASANT VALLEY NURSING & REHABILITATION LITTLE ROCK AR Non profit - Corporation N 1045413 METHODIST HEALTH AND REHAB FORT SMITH AR Non profit - Corporation N 1045433 CORNING THERAPY AND LIVING CENTER CORNING AR For profit - Corporation N 1045168 JOHNSON COUNTY HEALTH AND REHAB, LLC CLARKSVILLE AR For profit - Corporation N 1045207 OUACHITA NURSING AND REHABILITATION CENTER CAMDEN AR For profit - Corporation N 1045142 CANYON SPRINGS HEALTH AND REHABILITATION CENTER HOT SPRINGS AR For profit - Corporation N 1045343 NURSING AND REHABILITATION CENTER AT GOOD SHEPHERD LITTLE ROCK AR For profit - Corporation N 1045406 HIRAM SHADDOX GERIATRIC HEALTH AND REHAB MOUNTAIN HOME AR For profit - Corporation N 1045394 RECTOR NURSING AND REHAB RECTOR AR For profit - Corporation N 1045441 HILLCREST HOME HARRISON AR For profit - Corporation N 1045321 LEXINGTON PLACE HEALTHCARE AND REHABILITATION, LLC JONESBORO AR For profit - Corporation N 1045250 GOOD SAMARITAN SOCIETY - MOUNTAIN HOME MOUNTAIN HOME AR Non profit - Corporation N 1045254 VILLAGE SPRINGS HEALTH AND REHABILITATION HOT SPRINGS AR For profit - Corporation N 1045280 TWIN LAKES THERAPY AND LIVING FLIPPIN AR For profit - Corporation N 1035169 DESERT HIGHLANDS CARE CENTER KINGMAN AZ For profit - Corporation N 26035267 THE RIVER GARDENS REHAB AND CARE CENTER BULLHEAD CITY AZ For profit - Partnership N 21035199 THE HEALTH CARE CENTER-FORUM TUCSON TUCSON AZ For profit - Corporation N 16

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 52: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

035288 COPPER HEALTH ORO VALLEY ORO VALLEY AZ For profit - Corporation N 15035097 THE LEGACY REHAB & CARE CENTER BULLHEAD CITY AZ For profit - Corporation N 12035107 HAVEN OF PHOENIX PHOENIX AZ For profit - Corporation N 8035247 MARYLAND GARDENS CARE CENTER PHOENIX AZ For profit - Corporation N 7035165 HAVEN OF TUCSON TUCSON AZ For profit - Corporation N 6035262 THE LINGENFELTER CENTER KINGMAN AZ For profit - Corporation N 5035106 WESTCHESTER CARE CENTER TEMPE AZ Non profit - Church related N 4035086 HAVEN OF SIERRA VISTA ,LLC SIERRA VISTA AZ For profit - Corporation N 4035004 SANTA ROSA CARE CENTER TUCSON AZ For profit - Corporation N 4035214 GOOD SAMARITAN SOCIETY-QUIBURI MISSION BENSON AZ Non profit - Corporation N 4035070 CASAS ADOBES POST ACUTE REHAB CENTER TUCSON AZ For profit - Corporation N 4035071 MISSION PALMS OF MESA HEALTH AND REHABILITATION CE MESA AZ For profit - Corporation N 3035180 HAVEN OF DOUGLAS DOUGLAS AZ For profit - Corporation N 3035003 THE TERRACES OF PHOENIX PHOENIX AZ Non profit - Corporation N 3035068 PUEBLO SPRINGS REHABILITATION CENTER TUCSON AZ For profit - Corporation N 2035216 CARING HOUSE SACATON AZ Non profit - Corporation N 2035111 LAKE PLEASANT POST ACUTE REHABILITATION CENTER PEORIA AZ For profit - Corporation N 2035117 PAYSON CARE CENTER PAYSON AZ For profit - Corporation N 2035285 WELLSPRINGS THERAPY CENTER OF GILBERT GILBERT AZ For profit - Corporation N 2035100 HAVASU NURSING CENTER LAKE HAVASU CITY AZ For profit - Corporation N 2035116 THE REHABILITATION CENTER AT THE PALAZZO PHOENIX AZ For profit - Corporation N 1035147 VILLA MARIA CARE CENTER TUCSON AZ For profit - Corporation N 1035083 HERITAGE COURT POST ACUTE OF SCOTTSDALE SCOTTSDALE AZ For profit - Corporation N 1035290 ALLEGIANT HEALTHCARE OF PHOENIX, LLC PHOENIX AZ For profit - Corporation N 1035272 VI AT GRAYHAWK, A VI AND PLAZA COMPANIES COMMUNITY SCOTTSDALE AZ For profit - Partnership N 1035192 WEYRICH HCC OF WESTMINSTER VLG SCOTTSDALE AZ Non profit - Corporation N 1035196 MESA CHRISTIAN HEALTH AND REHABILITATION CENTER MESA AZ For profit - Partnership N 1035249 THE GARDENS REHAB & CARE CENTER KINGMAN AZ For profit - Corporation N 1035254 WINSLOW CAMPUS OF CARE WINSLOW AZ For profit - Corporation N 1035143 LIFE CARE CENTER OF SCOTTSDALE SCOTTSDALE AZ For profit - Corporation N 1035260 FOUNTAIN VIEW VILLAGE FOUNTAIN HILLS AZ For profit - Corporation N 1035201 FORUM AT DESERT HARBOR, THE PEORIA AZ For profit - Corporation N 1035059 HAVEN OF SCOTTSDALE SCOTTSDALE AZ For profit - Partnership N 1055975 HILLCREST MANOR SANITARIUM NATIONAL CITY CA For profit - Corporation N 8705A429 PARK MERRITT CARE CENTER OAKLAND CA For profit - Corporation N 82

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 53: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

555127 THE OAKS POST ACUTE PETALUMA CA For profit - Corporation N 81555053 DELANO POSTACUTE CARE DELANO CA For profit - Corporation N 67555468 BEAR VALLEY COMMUNITY HOSPITAL BIG BEAR LAKE CA Government - Hospital district Y 56056286 MAYFLOWER GARDENS CONVALESCENT HOSPITAL LANCASTER CA For profit - Corporation N 5405A130 ALICE MANOR CONVALESCENT HOSPITAL FOWLER CA For profit - Corporation N 54555892 SELMA CONVALESCENT HOSPITAL SELMA CA For profit - Corporation N 53055935 CERES POSTACUTE CARE CERES CA For profit - Corporation N 52055677 PITTSBURG SKILLED NURSING CENTER PITTSBURG CA For profit - Corporation N 47555811 THE COVINGTON CARE CENTER ALISO VIEJO CA Non profit - Corporation N 46055078 PARKWAY HILLS NURSING & REHABILITATION LA MESA CA For profit - Corporation N 45055892 BERKELEY PINES SKILLED NURSING CENTER BERKELEY CA For profit - Corporation N 44055544 ROYAL CREST HEALTH CARE COVINA CA For profit - Corporation N 40555718 ROWNTREE GARDENS STANTON CA For profit - Corporation N 39055084 CENTRAL VALLEY POST ACUTE RIVERBANK CA For profit - Individual N 38555813 DEVONSHIRE OAKS NURSING CENTER REDWOOD CITY CA For profit - Corporation N 3505A331 LITTLE SISTERS OF THE POOR SAN PEDRO CA Non profit - Corporation N 34055464 TWO PALMS NURSING CENTER, INC PASADENA CA For profit - Corporation N 33055028 LOS BANOS NURSING & REHABILITATION CENTER LOS BANOS CA For profit - Corporation N 31055649 TULARE NURSING & REHABILITATION CENTER TULARE CA For profit - Corporation N 31056416 MAYERS MEMORIAL HOSPITAL FALL RIVER MILLS CA Government - Hospital district Y 30555354 DELTA NURSING & REHABILITATION CENTER VISALIA CA For profit - Corporation N 29555650 MONTE VISTA GROVE HOMES PASADENA CA Non profit - Corporation N 28056288 HANFORD POST ACUTE HANFORD CA For profit - Corporation N 28055299 LINDA VALLEY CARE CENTER LOMA LINDA CA For profit - Corporation N 28055658 TWILIGHT HAVEN FRESNO CA Non profit - Corporation N 28056279 SIERRA VIEW HOMES REEDLEY CA Non profit - Corporation N 27056423 PROVIDENCE VALLEY CARE CENTER PORTERVILLE CA For profit - Corporation N 26555780 DEL RIO GARDENS CARE CENTER BELL GARDENS CA For profit - Corporation N 26055192 PROVIDENCE ST ELIZABETH CARE CENTER NORTH HOLLYWOOD CA Non profit - Church related N 26555557 IMPERIAL HEIGHTS HEALTHCARE & WELLNESS CENTRE, LLC BRAWLEY CA For profit - Corporation N 25555625 CALIFORNIA PARK REHABILITATION HOSPITAL CHICO CA For profit - Corporation N 25055510 REDDING POST ACUTE REDDING CA For profit - Corporation N 25056138 STOLLWOOD CONVALESCENT HOSPITAL WOODLAND CA Non profit - Corporation N 24555735 VINTAGE ESTATES OF RICHMOND RICHMOND CA For profit - Corporation N 24555022 SENECA DISTRICT HOSPITAL D/P SNF CHESTER CA Government - Hospital district Y 24

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 54: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

555720 LOS GATOS SNF, LLC LOS GATOS CA For profit - Corporation N 23555715 COLONIAL GARDENS NURSING HOME PICO RIVERA CA For profit - Corporation N 23555682 MARYSVILLE POST-ACUTE MARYSVILLE CA For profit - Corporation N 2305A137 LAUREL PARK BEHAVIORAL HEALTH CENTER POMONA CA For profit - Corporation N 23055092 YUBA CITY POST ACUTE YUBA CITY CA For profit - Corporation N 2305A183 RAINTREE CONVALESCENT HOSPITAL FRESNO CA For profit - Corporation N 22555869 LAUREL HEIGHTS COMMUNITY CARE SAN FRANCISCO CA For profit - Corporation N 2205A024 CRESTWOOD MANOR - 112 MODESTO CA For profit - Corporation N 22555757 MILPITAS CARE CENTER MILPITAS CA For profit - Corporation N 21555798 WOODSIDE HEALTHCARE CENTER SACRAMENTO CA For profit - Corporation N 21555527 SOUTHERN INYO HOSPITAL D/P SNF LONE PINE CA Government - Hospital district Y 20555619 ARROYO GRANDE CARE CENTER ARROYO GRANDE CA For profit - Corporation N 20555144 ST. PAULS HEALTH CARE CENTER SAN DIEGO CA Non profit - Corporation N 20555157 PARADISE POST ACUTE PARADISE CA For profit - Corporation N 20055011 ACACIA PARK NURSING & REHAB CENTER MODESTO CA For profit - Corporation N 20555651 STANLEY HEALTHCARE CENTER WESTMINSTER CA For profit - Corporation N 19555521 RANCHO MESA CARE CENTER ALTA LOMA CA For profit - Corporation N 19555244 ANBERRY NURSING AND REHABILITATION CENTER ATWATER CA For profit - Corporation N 19055237 VICTORIA HEALTHCARE AND REHABILITATION CENTER COSTA MESA CA For profit - Corporation N 19555292 ALHAMBRA CONVALESCENT HOSPITAL MARTINEZ CA For profit - Individual N 18555499 REDWOOD HEALTHCARE CENTER LLC OAKLAND CA For profit - Corporation N 18555777 BISHOP CARE CENTER BISHOP CA For profit - Corporation N 18555857 OAKVIEW SKILLED NURSING THOUSAND OAKS CA For profit - Individual N 18055240 WATSONVILLE NURSING CENTER WATSONVILLE CA For profit - Corporation N 18055525 CRENSHAW NURSING HOME LOS ANGELES CA For profit - Corporation N 18055853 REDWOOD COVE HEALTHCARE CENTER UKIAH CA For profit - Corporation N 18055489 BRENTWOOD POST ACUTE RED BLUFF CA For profit - Corporation N 17555787 WHITTIER NURSING AND WELLNESS CENTER, INC WHITTIER CA For profit - Corporation N 17555350 TERRACINA POST ACUTE REDLANDS CA For profit - Corporation N 17055551 PROVIDENCE SUN VILLA PORTERVILLE CA For profit - Corporation N 16055809 ST ANTHONY CARE CENTER HAYWARD CA For profit - Partnership N 16056430 NORTHGATE POSTACUTE CARE SAN RAFAEL CA For profit - Corporation N 16055136 BERKLEY WEST CONV HOSP SANTA MONICA CA For profit - Corporation N 15555884 RIVERSIDE HEIGHTS HEALTHCARE CENTER, LLC RIVERSIDE CA For profit - Individual N 15555554 DANISH CARE CENTER ATASCADERO CA For profit - Corporation N 15

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 55: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

555485 KINGS NURSING & REHABILITATION CENTER HANFORD CA For profit - Corporation N 15555025 MILL CREEK MANOR MENTONE CA For profit - Corporation N 14056259 SANTA ROSA CONVALESCENT HOSP SANTA ROSA CA For profit - Corporation N 14056317 GLENOAKS CONVALESCENT HOSPITAL GLENDALE CA For profit - Corporation N 14055435 OUR LADY OF FATIMA VILLA SARATOGA CA For profit - Corporation N 14055684 THE CALIFORNIAN SANTA BARBARA CA For profit - Corporation N 13056353 ATTERDAG CARE CENTER SOLVANG CA Non profit - Corporation N 13055604 REDWOOD SPRINGS HEALTHCARE CENTER VISALIA CA For profit - Corporation N 13555067 PROVIDENCE MCCLURE OAKLAND CA For profit - Corporation N 13555896 ARROWHEAD HEALTHCARE CENTER, LLC SAN BERNARDINO CA For profit - Corporation N 1305A364 VILLA SIENA MOUNTAIN VIEW CA Non profit - Corporation N 12055448 DINUBA HEALTHCARE DINUBA CA For profit - Corporation N 12055036 MAPLE HEALTHCARE CENTER LOS ANGELES CA For profit - Corporation N 12555893 LEGACY CARE OF PASADENA PASADENA CA For profit - Corporation N 12555517 KERN VALLEY HEALTHCARE DISTRICT DP SNF LAKE ISABELLA CA Government - Hospital district Y 12555347 NORTH STARR POSTACUTE CARE TURLOCK CA For profit - Corporation N 12555605 GLENHAVEN HEALTHCARE GLENDALE CA For profit - Corporation N 11555792 SUNNYVALE POST-ACUTE CENTER SUNNYVALE CA For profit - Corporation N 11555862 VILLA SCALABRINI SPECIAL CARE SUN VALLEY CA Non profit - Church related N 11055704 ANGELS NURSING HEALTH CENTER LOS ANGELES CA For profit - Individual N 1105A371 CRESTWOOD WELLNESS AND RECOVERY CENTER REDDING CA For profit - Corporation N 11056425 VILLA ELENA HEALTHCARE CENTER NORWALK CA For profit - Corporation N 1105A192 THE ROYAL HOME EL CAJON CA For profit - Individual N 10055662 BETHANY HOME SOCIETY SAN JOAQUIN COUNTY RIPON CA Non profit - Corporation N 10055756 CLOVERDALE HEALTHCARE CENTER CLOVERDALE CA For profit - Corporation N 10056063 INFINITY CARE OF EAST LOS ANGELES LOS ANGELES CA For profit - Corporation N 10055196 MARYCREST MANOR CULVER CITY CA Non profit - Corporation N 10555841 GREENHILLS MANOR CAMPBELL CA For profit - Corporation N 10555168 FRIENDS HOUSE SANTA ROSA CA Non profit - Corporation N 10555211 EXTENDED CARE HOSP WESTMINSTER WESTMINSTER CA For profit - Partnership N 10555429 VILLA GARDENS HEALTH CARE UNIT PASADENA CA Non profit - Corporation N 10056449 PROVIDENCE SAN FRANCISCO SAN FRANCISCO CA For profit - Corporation N 10055861 PROVIDENCE OJAI OJAI CA For profit - Corporation N 10055541 ROYAL TERRACE HEALTHCARE DUARTE CA For profit - Corporation N 10555825 SAN MARINO MANOR SAN GABRIEL CA For profit - Corporation N 10

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 56: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

555781 DEL RIO CONVALESCENT CENTER BELL GARDENS CA For profit - Corporation N 10555368 CENTURY VILLA, INC INGLEWOOD CA For profit - Corporation N 10555424 THE DOROTHY & JOSEPH GOLDBERG HEALTHCARE CENTER ENCINITAS CA Non profit - Corporation N 9055807 SHASTA VIEW ESTATES WEED CA For profit - Corporation N 9056345 SAN LEANDRO HEALTHCARE CENTER SAN LEANDRO CA Non profit - Corporation N 9555106 SANTA FE LODGE EL MONTE CA For profit - Corporation N 9555894 FOOTHILL HEIGHTS CARE CENTER PASADENA CA For profit - Corporation N 9055417 SAYLOR LANE HEALTHCARE CENTER SACRAMENTO CA For profit - Corporation N 905A263 RIVERSIDE BEHAVIORAL HEALTHCARE CENTER RIVERSIDE CA For profit - Corporation N 905A208 SHANDIN HILLS BEHAVIOR THERAPY CENTER SAN BERNARDINO CA For profit - Corporation N 8056026 EMPRESS CARE CENTER, LLC SAN JOSE CA For profit - Individual N 8055734 UKIAH POST ACUTE UKIAH CA For profit - Corporation N 8555727 LAUREL CREEK HEALTH CENTER FAIRFIELD CA For profit - Individual N 8555295 REGENTS POINT - WINDCREST IRVINE CA Non profit - Corporation N 8056496 CARLSBAD BY THE SEA CARLSBAD CA Non profit - Corporation N 8056274 RED BLUFF HEALTH CARE CENTER RED BLUFF CA For profit - Corporation N 8055191 AVALON HEALTH CARE-MADERA MADERA CA For profit - Corporation N 8055156 ST PAULS TOWERS OAKLAND CA Non profit - Corporation N 8555283 CRYSTAL RIDGE CARE CENTER GRASS VALLEY CA For profit - Corporation N 8555342 SUNNY VIEW MANOR CUPERTINO CA Non profit - Corporation N 7555080 TRACY NURSING AND REHABILITATION CENTER TRACY CA For profit - Corporation N 7555085 CLAREMONT MANOR CARE CENTER CLAREMONT CA For profit - Corporation N 7555616 WINDSOR MANOR GLENDALE CA Non profit - Corporation N 7555761 WISTERIA CARE CENTER CASTRO VALLEY CA For profit - Corporation N 7055401 MEADOWBROOK HEALTH CARE CENTER HEMET CA For profit - Corporation N 7055303 CANTERBURY WOODS PACIFIC GROVE CA Non profit - Corporation N 7055331 SAN RAFAEL HEALTHCARE & WELLNESS CENTER, LP SAN RAFAEL CA For profit - Corporation N 7055869 VALLEY SUBACUTE & REHABILITATION CENTER MODESTO CA For profit - Individual N 7056313 PACIFIC VILLA, INC LONG BEACH CA For profit - Corporation N 7555420 MODOC MEDICAL CENTER D/P SNF ALTURAS CA Government - Hospital district Y 7555162 RIMROCK VILLA CONVALESCENT HOSPITAL BARSTOW CA For profit - Corporation N 7555849 VISTA DEL SOL CARE CENTER LOS ANGELES CA For profit - Corporation N 7555903 IDLE ACRE SANITARIUM & CONVALESCENT HOSPITAL EL MONTE CA For profit - Corporation N 7055410 HACIENDA REHABILITATION & HEALTH CARE CENTER HANFORD CA For profit - Corporation N 7055261 PILGRIM PLACE HEALTH SERVICES CENTER CLAREMONT CA Non profit - Corporation N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 57: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

055423 MANNING GARDENS CARE CENTER, INC FRESNO CA For profit - Corporation N 6055047 GOLDEN LIVING CENTER - CHOWCHILLA CHOWCHILLA CA For profit - Corporation N 6055826 COUNTRY OAKS CARE CENTER SANTA MARIA CA For profit - Corporation N 6056143 OSAGE HEALTHCARE & WELLNESS CENTRE INGLEWOOD CA For profit - Corporation N 6056364 SUMMERFIELD HEALTH CARE CENTER SANTA ROSA CA For profit - Corporation N 6555895 CREEKVIEW SKILLED NURSING PLEASANTON CA For profit - Corporation N 6555867 FOREST HILL MANOR HEALTH CENTER PACIFIC GROVE CA Non profit - Corporation N 6555071 SUNNYVIEW CARE CENTER LOS ANGELES CA For profit - Corporation N 6555461 MARINA GARDEN NURSING CENTER ALAMEDA CA For profit - Corporation N 6056190 CHANDLER CONVALESCENT HOSPITAL GLENDALE CA For profit - Corporation N 6056035 GOLDEN LIVINGCENTER - SHAFTER SHAFTER CA For profit - Corporation N 6055271 LA SIERRA CARE CENTER MERCED CA For profit - Corporation N 6555755 GREEN ACRES LODGE ROSEMEAD CA For profit - Corporation N 6555785 COURTYARD CARE CENTER SIGNAL HILL CA For profit - Corporation N 6555611 MORTON BAKAR CENTER HAYWARD CA For profit - Corporation N 6555878 GRANITE HILLS HEALTHCARE & WELLNESS CENTRE, LLC EL CAJON CA For profit - Corporation N 6555179 NORTHPOINTE HEALTHCARE CENTRE FRESNO CA For profit - Corporation N 6555199 COAST CARE CONVALESCENT CENTER BALDWIN PARK CA For profit - Corporation N 6555272 ATHERTON BAPTIST HOME ALHAMBRA CA Non profit - Corporation N 5555125 LINWOOD MEADOWS CARE CENTER VISALIA CA For profit - Corporation N 5555011 GOLDEN STATE COLONIAL HEALTHCARE CENTER NORTH HOLLYWOOD CA For profit - Corporation N 5555016 ST JOHN KRONSTADT CONVALESCENT CENTER CASTRO VALLEY CA Non profit - Church related N 5555836 BROOKDALE FOUNTAINGROVE SANTA ROSA CA For profit - Corporation N 5555842 JONES CONVALESCENT HOSPITAL SAN LEANDRO CA For profit - Corporation N 5555855 BAYWOOD COURT HEALTH CENTER CASTRO VALLEY CA Non profit - Corporation N 5555539 COALINGA REGIONAL MEDICAL CTR DP/SNF COALINGA CA Government - Hospital district Y 5555658 PORTERVILLE CONVALESCENT HOSPITAL PORTERVILLE CA For profit - Corporation N 5055914 PLYMOUTH VILLAGE REDLANDS CA Non profit - Corporation N 5055917 ST JUDE CARE CENTER MANTECA CA For profit - Corporation N 505A315 HAYES CONVALESCENT HOSPITAL SAN FRANCISCO CA For profit - Partnership N 5555306 KEI-AI SOUTH BAY HEALTHCARE CENTER GARDENA CA For profit - Corporation N 5555045 SHADOW HILLS CONV. HOSPITAL SUNLAND CA For profit - Corporation N 5555054 PACIFIC POST ACUTE SANTA MONICA CA For profit - Partnership N 5555010 LONG BEACH POST ACUTE LONG BEACH CA For profit - Partnership N 5056296 CRESCENT CITY SKILLED NURSING CRESCENT CITY CA For profit - Individual N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 58: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

056261 MERRITT MANOR CONVALESCENT HOSPITAL TULARE CA For profit - Corporation N 5056435 HYDE PARK CONVALESCENT HOSPITAL LOS ANGELES CA For profit - Corporation N 5055862 ROSE GARDEN CONVALESCENT CTR PASADENA CA For profit - Corporation N 5055830 VILLA MARIA HEALTHCARE CENTER SANTA MARIA CA For profit - Corporation N 5055671 PARKVIEW HEALTHCARE CENTER ANAHEIM CA For profit - Corporation N 5055060 COUNTRY VILLA WESTWOOD LOS ANGELES CA For profit - Partnership N 5055329 VILLA SERENA HEALTHCARE CENTER LONG BEACH CA For profit - Individual N 5055361 VISTA PACIFICA CONVALESCENT HOSPITAL RIVERSIDE CA For profit - Corporation N 5055499 ROCKY POINT CARE CENTER LAKEPORT CA For profit - Corporation N 4055846 THE TERRACES AT SAN JOAQUIN GARDENS VILLAGE FRESNO CA Non profit - Corporation N 4055617 EISENHOWER HEALTHCARE CENTER PASADENA CA For profit - Corporation N 4056167 CENTINELA SKILLED NURSING & WELLNESS CENTRE WEST INGLEWOOD CA For profit - Corporation N 405A290 ST. ANNE'S HOME SAN FRANCISCO CA Non profit - Corporation N 4056350 LAKE MERRITT HEALTHCARE CENTER LLC OAKLAND CA For profit - Corporation N 4056429 LAUREL CONVALESCENT HOSPITAL FONTANA CA For profit - Corporation N 4555170 EVERGREEN ARVIN HEALTHCARE ARVIN CA For profit - Individual N 4555374 MAYFLOWER CARE CENTER EL MONTE CA For profit - Corporation N 4555492 MIRAVILLA CARE CENTER CHERRY VALLEY CA For profit - Corporation N 4555630 MISSION HILLS HEALTH CARE, INC SAN DIEGO CA For profit - Corporation N 4555690 ALAMEDA CARE CENTER BURBANK CA For profit - Individual N 4555905 ST CHRISTOPHER CONVALESCENT HOSPITAL HAYWARD CA For profit - Corporation N 4056378 REGENCY OAKS POST ACUTE CARE CENTER LONG BEACH CA For profit - Corporation N 4056382 THE GROVE POST-ACUTE CARE CENTER SYLMAR CA For profit - Partnership N 405A147 MERCED BEHAVIORAL CENTER MERCED CA For profit - Corporation N 405A269 MEADOWBROOK BEHAVIORAL HEALTH CENTER LOS ANGELES CA For profit - Corporation N 4055916 KAWEAH MANOR CONVALESCENT HOSPITAL VISALIA CA For profit - Corporation N 4055259 MONROVIA POST ACUTE DUARTE CA For profit - Individual N 4055064 COTTONWOOD CANYON HEALTHCARE CENTER EL CAJON CA For profit - Corporation N 4555692 PLYMOUTH SQUARE STOCKTON CA Non profit - Corporation N 4555802 COUNTRY CREST POST ACUTE OROVILLE CA For profit - Individual N 4555805 BEL VISTA HEALTHCARE CENTER EAST LONG BEACH CA For profit - Corporation N 4555877 RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILI RIDGECREST CA Non profit - Corporation Y 4555897 MONTEREY HEALTHCARE & WELLNESS CENTRE, LP ROSEMEAD CA For profit - Individual N 4555160 SAINT CLAIRE'S NURSING CENTER SACRAMENTO CA For profit - Corporation N 4555089 MEADOWS RIDGE CARE CENTER COLTON CA For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 59: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

555341 REDWOOD CONVALESCENT HOSPITAL, INC CASTRO VALLEY CA For profit - Corporation N 4555268 SPRING LAKE VILLAGE SANTA ROSA CA Non profit - Corporation N 4555217 PACIFICA HOSPITAL OF THE VALLEY DP SNF SUN VALLEY CA For profit - Corporation Y 3555086 KINGSLEY MANOR CARE CENTER LOS ANGELES CA Non profit - Corporation N 3555826 THE REDWOODS, A COMMUNITY OF SENIORS MILL VALLEY CA Non profit - Corporation N 3555831 HERMAN HEALTH CARE CENTER SAN JOSE CA For profit - Corporation N 3555801 PINE CREEK CARE CENTER ROSEVILLE CA For profit - Corporation N 3555851 BAY AREA HEALTHCARE CENTER OAKLAND CA For profit - Partnership N 3555694 ALDERSLY SKILLED NURSING FACILITY SAN RAFAEL CA Non profit - Corporation N 3555786 SANTA MONICA CONV CTR I SANTA MONICA CA For profit - Corporation N 3555503 ROYAL OAKS MANOR-BRADBURY OAKS DUARTE CA Non profit - Corporation N 3555383 BLYTHE POST ACUTE LLC BLYTHE CA For profit - Corporation N 3055003 EUREKA REHABILITATION & WELLNESS CENTER, LP EUREKA CA For profit - Partnership N 3055504 COUNTRY VILLA SOUTH CONV CTR LOS ANGELES CA For profit - Corporation N 3056019 GARDENA CONVALESCENT CENTER GARDENA CA For profit - Corporation N 3056331 BEACON HEALTHCARE CENTER WEST COVINA CA For profit - Corporation N 3555881 CLEAR VIEW SANITARIUM GARDENA CA For profit - Corporation N 3555887 LAKESIDE SPECIAL CARE CENTER LAKESIDE CA For profit - Corporation N 3555677 HAWTHORNE HEALTHCARE & WELLNESS CENTRE, LP HAWTHORNE CA Non profit - Corporation N 3555712 HILLVIEW CONVALESCENT HOSPITAL MORGAN HILL CA For profit - Partnership N 3555613 THE GROVE CARE AND WELLNESS RIVERSIDE CA For profit - Corporation N 3555566 CORONA POST ACUTE CENTER CORONA CA For profit - Corporation N 3555421 STONEBROOK HEALTHCARE CENTER CONCORD CA For profit - Corporation N 3555313 THE REHABILITATION CENTER OF OAKLAND OAKLAND CA For profit - Corporation N 3555252 PINE VIEW CENTER PARADISE CA For profit - Corporation N 3555276 PROVIDENCE SAN BRUNO SAN BRUNO CA For profit - Corporation N 3555180 GOLD COUNTRY HEALTH CENTER PLACERVILLE CA Non profit - Corporation N 3056153 GOLDEN LIVINGCENTER - NAPA NAPA CA For profit - Corporation N 3055871 WINDSOR SKYLINE CARE CENTER SALINAS CA For profit - Corporation N 3055748 SANTA MONICA CONV CTR II SANTA MONICA CA For profit - Corporation N 3055608 PRIMROSE POST-ACUTE INGLEWOOD CA For profit - Corporation N 3055500 VALLE VISTA CONVALESCENT HOSPITAL ESCONDIDO CA For profit - Corporation N 3055505 ARROYO VISTA NURSING CENTER SAN DIEGO CA For profit - Corporation N 3055255 CORONA HEALTH CARE CENTER CORONA CA For profit - Corporation N 3055289 WINE COUNTRY CARE CENTER LODI CA For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 60: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

055167 VERNON HEALTHCARE CENTER LOS ANGELES CA For profit - Corporation N 3055170 PICO RIVERA HEALTHCARE CENTER PICO RIVERA CA For profit - Corporation N 3055135 MONTROSE HEALTHCARE CENTER MONTROSE CA For profit - Individual N 2055239 EAST BAY POST-ACUTE CASTRO VALLEY CA For profit - Corporation N 2055367 MONROVIA GARDENS HEALTHCARE CENTER MONROVIA CA For profit - Corporation N 2055360 OAKPARK HEALTHCARE CENTER TUJUNGA CA For profit - Corporation N 2055817 MONTE VISTA HEALTHCARE CENTER DUARTE CA For profit - Corporation N 2055856 HIGH VALLEY LODGE SUNLAND CA For profit - Corporation N 2055918 BEL TOOREN VILLA CONVALESCENT BELLFLOWER CA For profit - Corporation N 2056114 COUNTRY VILLA EAST NURSING CENTER LOS ANGELES CA For profit - Individual N 2056228 WEST HAVEN HEALTHCARE WEST COVINA CA For profit - Corporation N 2056372 BROOKSIDE HEALTHCARE CENTER REDLANDS CA For profit - Corporation N 2056379 OXNARD MANOR HEALTHCARE CENTER OXNARD CA For profit - Partnership N 2056294 GOLDEN LIVINGCENTER - BAKERSFIELD BAKERSFIELD CA For profit - Corporation N 205E119 TUSTIN CARE CENTER TUSTIN CA For profit - Corporation N 2555214 PROFESSIONAL POST ACUTE CENTER SAN RAFAEL CA For profit - Corporation N 2555222 EVERGREEN LAKEPORT HEALTHCARE LAKEPORT CA For profit - Corporation N 2555060 WINDSOR THE RIDGE REHABILITATION CENTER SALINAS CA For profit - Corporation N 2555096 GOLDEN CROSS HEALTH CARE PASADENA CA For profit - Corporation N 2555134 MOUNT MIGUEL COVENANT VILLAGE SPRING VALLEY CA Non profit - Corporation N 2555331 VALENCIA GARDENS HEALTH CARE CENTER RIVERSIDE CA For profit - Corporation N 2555333 LINCOLN MEADOWS CARE CENTER LINCOLN CA For profit - Corporation N 2555426 FRESNO POSTACUTE CARE FRESNO CA For profit - Corporation N 2555433 EASTERN PLUMAS HOSPITAL- PORTOLA CAMPUS DP/SNF PORTOLA CA Government - Hospital district Y 2555418 ST FRANCIS EXTENDED CARE HAYWARD CA For profit - Corporation N 2555304 TWIN OAKS POST ACUTE REHAB CHICO CA For profit - Corporation N 2555588 VIBRA HOSPITAL OF NORTHERN CALIFORNIA D/P SNF REDDING CA For profit - Corporation Y 2555208 WESTGATE GARDENS CARE CENTER VISALIA CA For profit - Corporation N 2555663 PROVIDENCE LINDSAY GARDENS LINDSAY CA For profit - Corporation N 2555880 CLEAR VIEW CONVALESCENT CENTER GARDENA CA For profit - Corporation N 2555834 SHEFFIELD CONVALESCENT HOSPITAL SAN FRANCISCO CA For profit - Corporation N 2056225 VALLEY HEALTHCARE CENTER FRESNO CA For profit - Corporation N 205A411 SAKURA INTERMEDIATE CARE FACILITY LOS ANGELES CA For profit - Corporation N 2055517 WOODLANDS HEALTHCARE CENTER LOS GATOS CA For profit - Corporation N 2055268 GOLDEN LIVINGCENTER - LONDON HOUSE SONOMA SONOMA CA For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 61: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

055356 PACIFIC GROVE CONVALESCENT HOSPITAL PACIFIC GROVE CA For profit - Corporation N 2055304 DYCORA TRANSITIONAL HEALTH - QUAIL LAKE STOCKTON CA For profit - Corporation N 2055685 BRIGHTON PLACE SPRING VALLEY SPRING VALLEY CA For profit - Corporation N 2055597 MAYWOOD ACRES HEALTHCARE OXNARD CA For profit - Corporation N 2055212 KINDRED NURSING AND HEALTHCARE - LIVERMORE LIVERMORE CA For profit - Corporation N 2055163 MONTECITO HEIGHTS HEALTHCARE & WELLNESS CENTRE, LP LOS ANGELES CA For profit - Partnership N 2555404 AFVW HEALTH CENTER RIVERSIDE CA Non profit - Corporation N 2555535 RIVER VALLEY CARE CENTER LIVE OAK CA For profit - Corporation N 2555578 HOLIDAY MANOR CARE CENTER CANOGA PARK CA For profit - Corporation N 2555773 SKY HARBOR CARE CENTER YUCCA VALLEY CA For profit - Partnership N 2555758 NEW BETHANY SKILLED NURSING LOS BANOS CA Non profit - Corporation N 2555874 SOUTHERN CALIFORNIA HOSP AT CULVER CITY D/P SNF CULVER CITY CA For profit - Corporation Y 2555030 COLLEGE VISTA CONVALESCENT HOSPITAL LOS ANGELES CA For profit - Corporation N 2555055 BALDWIN GARDENS NURSING CENTER TEMPLE CITY CA For profit - Corporation N 2555107 VICTORIA CARE CENTER BALDWIN PARK CA For profit - Partnership N 2555112 EL RANCHO VISTA HEALTH CARE CENTER PICO RIVERA CA For profit - Corporation N 2555141 TOWN AND COUNTRY MANOR SANTA ANA CA Non profit - Church related N 2555229 VALLEY CONVALESCENT HOSPITAL BAKERSFIELD CA For profit - Corporation N 2555338 BRIGHTON CARE CENTER PASADENA CA For profit - Corporation N 1555339 MANORCARE HEALTH SERVICES-PALM DESERT PALM DESERT CA For profit - Corporation N 1555226 THE SPRINGS AT THE CARLOTTA PALM DESERT CA For profit - Corporation N 1555227 VILLA MARIN SAN RAFAEL CA For profit - Corporation N 1555371 BAYSIDE CARE CENTER MORRO BAY CA For profit - Corporation N 1555355 VINTAGE FAIRE NURSING & REHABILITATION CENTER MODESTO CA For profit - Individual N 1555132 VALLEY VISTA NURSING AND TRANSITIONAL CARE LLC NORTH HOLLYWOOD CA For profit - Corporation N 1555065 VIEW PARK CONV HOSP LOS ANGELES CA For profit - Corporation N 1555034 SAN MATEO MEDICAL CENTER D/P SNF SAN MATEO CA Government - County Y 1555088 FIDELITY HEALTH CARE EL MONTE CA For profit - Corporation N 1555012 WINDSOR GARDENS HEALTHCARE OF THE VALLEY NORTH HOLLYWOOD CA For profit - Individual N 1555816 LAWNDALE HEALTHCARE & WELLNESS CENTRE LLC LAWNDALE CA For profit - Corporation N 1555819 ELMWOOD CARE CENTER BERKELEY CA For profit - Corporation N 1555797 GORDON LANE CARE CENTER FULLERTON CA For profit - Corporation N 1555668 NORWALK SKILLED NURSING & WELLNESS CENTRE, LLC NORWALK CA For profit - Corporation N 1555684 LEGACY NURSING AND REHABILITATION CENTER MARTINEZ CA For profit - Individual N 1555763 BROOKDALE SAN JUAN CAPISTRANO SAN JUAN CAPISTRANO CA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 62: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

555770 CAMARILLO HEALTHCARE CENTER CAMARILLO CA For profit - Corporation N 1555592 SAN LUIS TRANSITIONAL CARE SAN LUIS OBISPO CA For profit - Corporation N 1555542 PIONEER HOUSE SACRAMENTO CA Non profit - Corporation N 1555547 THE TERRACES OF LOS GATOS LOS GATOS CA Non profit - Corporation N 1055039 GOOD SAMARITAN REHAB AND CARE CENTER STOCKTON CA For profit - Corporation N 1055650 HIGHLAND CARE CENTER OF REDLANDS REDLANDS CA For profit - Corporation N 1055656 RIVERSIDE CONVALESCENT HOSPITAL CHICO CA For profit - Corporation N 1055693 HEALTHCARE CENTER OF BELLA VISTA ONTARIO CA For profit - Corporation N 1055850 PINE RIDGE CARE CENTER SAN RAFAEL CA For profit - Corporation N 1055890 MAGNOLIA POST ACUTE CARE EL CAJON CA For profit - Corporation N 1055287 VALLEY PALMS CARE CENTER N HOLLYWOOD CA For profit - Corporation N 1055519 DOWNEY CARE CENTER DOWNEY CA For profit - Corporation N 1055512 WOLF CREEK CARE CENTER GRASS VALLEY CA For profit - Corporation N 105A396 GARFIELD NEUROBEHAVIORAL CENTER OAKLAND CA For profit - Corporation N 1056466 SIERRA VIEW CARE CENTER BALDWIN PARK CA For profit - Corporation N 1056267 WINDSOR GARDENS CONV CENTER OF HAWTHORNE HAWTHORNE CA For profit - Corporation N 1056281 GOLDEN LIVING CENTER COUNTRY VIEW ALZHEIMERS CARE FRESNO CA For profit - Corporation N 1056104 ROSE VILLA HEALTH CARE CENTER BELLFLOWER CA For profit - Corporation N 1056111 GRIFFITH PARK HEALTHCARE CENTER GLENDALE CA For profit - Corporation N 1056144 HUNTINGTON PARK NURSING CENTER HUNTINGTON PARK CA For profit - Corporation N 1555861 TWIN OAKS REHABILITATION & NURSING CENTER TULARE CA For profit - Corporation N 1555740 PALM GROVE HEALTH CARE BEAUMONT CA For profit - Corporation N 1555775 BROOKDALE RANCHO MIRAGE RANCHO MIRAGE CA For profit - Corporation N 1555793 VI AT LA JOLLA VILLAGE SAN DIEGO CA For profit - Corporation N 1555703 WINDSOR CARE CENTER OF PETALUMA PETALUMA CA For profit - Corporation N 1555645 AUBURN RAVINE TERRACE AUBURN CA Non profit - Church related N 1555595 KINDRED TRANSITIONAL CARE AND REHAB - SMITH RANCH SAN RAFAEL CA For profit - Corporation N 1555281 OROVILLE HOSPITAL POST-ACUTE CENTER OROVILLE CA For profit - Corporation N 1555165 HIGHLAND PARK SKILLED NURSING AND WELLNESS CENTER LOS ANGELES CA For profit - Individual N 1555184 HEARTWOOD AVENUE HEALTHCARE VALLEJO CA For profit - Corporation N 105A264 VISTA PACIFICA CENTER RIVERSIDE CA For profit - Individual N 1056300 GRANADA REHABILITATION & WELLNESS CENTER, LP EUREKA CA For profit - Partnership N 1056413 TEMPLE CITY HEALTHCARE TEMPLE CITY CA For profit - Individual N 1056361 FORTUNA REHABILITATION AND WELLNESS CENTER, LP FORTUNA CA For profit - Partnership N 1056231 LASSEN NURSING & REHABILITATION CENTER SUSANVILLE CA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 63: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

056206 UNIVERSITY PARK HEALTHCARE CENTER LOS ANGELES CA For profit - Corporation N 1056215 NORTHBROOK HEALTHCARE CENTER WILLITS CA For profit - Corporation N 1056148 CASITAS CARE CENTER GRANADA HILLS CA For profit - Corporation N 1056120 EMPRES POST ACUTE REHABILITATION PETALUMA CA For profit - Corporation N 1056076 ANAHEIM TERRACE CARE CENTER ANAHEIM CA For profit - Limited Liability company N 1056078 LAKEVIEW TERRACE LOS ANGELES CA For profit - Corporation N 1055956 BRIARWOOD POST ACUTE SACRAMENTO CA For profit - Individual N 1055833 LA SALETTE HEALTH AND REHABILITATION CENTER STOCKTON CA For profit - Corporation N 1055818 ROYAL GARDENS HEALTHCARE ALHAMBRA CA For profit - Corporation N 1055454 GOLDEN LIVING CENTER-FOWLER FOWLER CA For profit - Corporation N 1055562 HILLSIDE SENIOR CARE FREMONT CA For profit - Corporation N 1055601 PARKVIEW JULIAN CONVALESCENT BAKERSFIELD CA For profit - Corporation N 1055539 ARTESIA CHRISTIAN HOME INC. ARTESIA CA Non profit - Corporation N 1055242 FAIRMONT REHABILITATION HOSPITAL LODI CA For profit - Corporation N 1055307 LANCASTER HEALTH CARE CENTER LANCASTER CA For profit - Corporation N 1055288 AUTUMN HILLS HEALTH CARE CENTER GLENDALE CA For profit - Corporation N 1055139 SANTA TERESITA MANOR DUARTE CA Non profit - Corporation N 1055183 HERITAGE GARDENS HEALTH CARE CENTER LOMA LINDA CA For profit - Corporation N 1055085 MORAGA POST ACUTE MORAGA CA For profit - Partnership N 1065244 GLENWOOD SPRINGS HEALTH CARE GLENWOOD SPRINGS CO For profit - Partnership N 5606A173 SEDGWICK COUNTY MEMORIAL NURSING HOME JULESBURG CO Government - County N 27065263 YUMA LIFE CARE CENTER YUMA CO For profit - Corporation N 22065408 LAKEWOOD VILLA LAKEWOOD CO For profit - Partnership N 22065399 RIO GRANDE INN LA JARA CO For profit - Corporation N 21065251 PAONIA CARE AND REHABILITATION CENTER PAONIA CO For profit - Corporation N 12065153 VISTA GRANDE INN CORTEZ CO For profit - Corporation N 11065309 WASHINGTON COUNTY NURSING HOME AKRON CO For profit - Corporation N 8065333 CRIPPLE CREEK CARE CENTER CRIPPLE CREEK CO Government - Hospital district N 8065258 HORIZONS CARE CENTER ECKERT CO Non profit - Church related N 806A050 COURTYARD CARE CENTER FRUITA CO Non profit - Corporation Y 8065351 HOLLY NURSING CARE CENTER HOLLY CO For profit - Individual N 7065302 REGENT PARK NURSING AND REHABILITATION HOLYOKE CO For profit - Corporation N 6065424 RIVER VALLEY INN NURSING HOME DEL NORTE CO For profit - Corporation N 5065219 KENTON MANOR GREELEY CO For profit - Corporation N 5065366 PINE RIDGE EXTENDED CARE CENTER PAGOSA SPRINGS CO For profit - Limited Liability company N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 64: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

065234 EVERGREEN NURSING HOME ALAMOSA CO For profit - Corporation N 306A185 SOUTHEAST COLORADO HOSPITAL LTC CENTER SPRINGFIELD CO Government - Hospital district Y 3065291 MONTE VISTA ESTATES LLC MONTE VISTA CO For profit - Corporation N 3065294 LAMAR ESTATES LLC LAMAR CO For profit - Corporation N 206A196 NAMASTE ALZHEIMER CENTER COLORADO SPRINGS CO Non profit - Church related N 2065174 STERLING LIVING CENTER STERLING CO For profit - Corporation N 2065150 DEVONSHIRE ACRES STERLING CO For profit - Corporation N 2065247 SPRINGS VILLAGE CARE CENTER COLORADO SPRINGS CO For profit - Corporation N 1065252 PARKMOOR VILLAGE HEALTHCARE CENTER COLORADO SPRINGS CO For profit - Corporation N 1065387 FOREST STREET COMPASSIONATE CARE CENTER DENVER CO For profit - Partnership N 1065285 CASTLE ROCK CARE CENTER CASTLE ROCK CO For profit - Corporation N 1065311 UPTOWN HEALTH CARE CENTER DENVER CO For profit - Corporation N 1065236 RIVERWALK POST ACUTE AND REHABILITATION PUEBLO CO For profit - Corporation N 1065239 SAN LUIS CARE CENTER ALAMOSA CO For profit - Corporation N 1065426 WELBROOK SENIOR LIVING GRAND JUNCTION LLC GRAND JUNCTION CO For profit - Corporation N 1065427 CENTER AT PARK WEST LLC, THE PUEBLO CO For profit - Partnership N 1065297 ALLISON CARE CENTER LAKEWOOD CO For profit - Corporation N 1065246 LAUREL MANOR CARE CENTER COLORADO SPRINGS CO Non profit - Church related N 1065271 CENTER AT PARKVIEW LLC PUEBLO CO For profit - Partnership N 1065284 GRACE MANOR CARE CENTER BURLINGTON CO For profit - Corporation N 1065286 EAGLE RIDGE AT GRAND VALLEY GRAND JUNCTION CO For profit - Corporation N 1065420 CASTLE PEAK SENIOR LIFE AND REHABILITATION EAGLE CO Non profit - Church related N 1065373 BROOKDALE BEAR CREEK COLORADO SPRINGS CO For profit - Corporation N 1065381 E DENE MOORE CARE CENTER RIFLE CO Government - Hospital district N 1075096 GROVE MANOR NURSING HOME, INC WATERBURY CT For profit - Corporation N 30075113 GREENTREE MANOR NURSING & REHA WATERFORD CT For profit - Partnership N 5075402 MANSFIELD CENTER FOR NURSING AND REHABILITATION MANSFIELD CT Non profit - Corporation N 5075365 CURTIS HOME ST ELIZABETH CENTER MERIDEN CT Non profit - Corporation N 4075414 HANCOCK HALL DANBURY CT For profit - Corporation N 4075017 MONTOWESE HEALTH & REHABILITATION CENTER NORTH HAVEN CT For profit - Corporation N 4075373 CHESHIRE HOUSE HEALTH CARE FAC WATERBURY CT For profit - Individual N 3075348 ADVANCED CENTER FOR NURSING & REHABILITATION NEW HAVEN CT For profit - Corporation N 3075074 FILOSA, FOR NURSING & REHABILITATION DANBURY CT For profit - Corporation N 1075432 MATTATUCK HEALTH CARE FAC WATERBURY CT For profit - Corporation N 1075105 REGALCARE AT TORRINGTON TORRINGTON CT For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 65: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

095030 SIBLEY MEM HOSP RENAISSANCE WASHINGTON DC For profit - Corporation Y 2085037 ATLANTIC SHORES REHABILITATION & HEALTH CENTER MILLSBORO DE For profit - Corporation N 308A011 FIVE STAR FOULK MANOR NORTH LLC WILMINGTON DE For profit - Corporation N 1105703 ARBOR TRAIL REHAB AND SKILLED NURSING CENTER INVERNESS FL For profit - Corporation N 29106109 KINDRED HOSPITAL SOUTH FLORIDA HOLLYWOOD HOLLYWOOD FL For profit - Corporation Y 24105832 GARDENS OF PORT ST LUCIE, THE PORT SAINT LUCIE FL For profit - Corporation N 23105057 PINES NURSING HOME MIAMI FL For profit - Corporation N 18105850 BARRINGTON TERRACE OF BOYNTON BEACH BOYNTON BEACH FL For profit - Corporation N 18105409 GOLFVIEW HEALTHCARE CENTER SAINT PETERSBURG FL For profit - Corporation N 17106070 DESOTO HEALTH AND REHAB ARCADIA FL For profit - Corporation N 17106032 MAGNOLIA HEALTH AND REHABILITATION CENTER SARASOTA FL For profit - Corporation N 14105616 CARRINGTON PLACE OF ST PETE SAINT PETERSBURG FL For profit - Corporation N 1210A436 LISENBY ON LAKE CAROLINE PANAMA CITY FL Non profit - Corporation N 12105890 BAYWOOD NURSING CENTER SAINT PETERSBURG FL Non profit - Corporation N 12105665 OAKTREE HEALTHCARE SOUTH DAYTONA FL For profit - Corporation N 12105827 FINNISH-AMERICAN VILLAGE LAKE WORTH FL Non profit - Corporation N 12105733 PALM GARDEN OF PINELLAS LARGO FL For profit - Corporation N 11105928 LIFE CARE CENTER OF ORANGE PARK ORANGE PARK FL For profit - Corporation N 11105959 KR AT COLLEGE HARBOR SAINT PETERSBURG FL For profit - Corporation N 11105697 EAST BAY REHABILITATION CENTER CLEARWATER FL For profit - Corporation N 11105664 SIGNATURE HEALTHCARE OF GAINESVILLE GAINESVILLE FL For profit - Corporation N 9106067 NURSING CENTER AT LA POSADA, THE PALM BEACH GARDENS FL For profit - Corporation N 9105297 BROOKSVILLE HEALTHCARE CENTER BROOKSVILLE FL Non profit - Corporation N 8105743 FLEET LANDING ATLANTIC BEACH FL Non profit - Corporation N 8105885 VIERA HEALTH AND REHABILITATION CENTER VIERA FL For profit - Corporation N 8105563 CENTRE POINTE HEALTH AND REHAB CENTER TALLAHASSEE FL For profit - Corporation N 8105326 CANTERBURY TOWERS INC TAMPA FL Non profit - Corporation N 8105469 GOLDEN GLADES NURSING AND REHABILITATION CENTER MIAMI FL For profit - Corporation N 7105472 VILLAGE ON THE ISLE VENICE FL Non profit - Church related N 6105826 EDGEWOOD NURSING CENTER JACKSONVILLE FL For profit - Corporation N 6105381 SIGNATURE HEALTHCARE OF ORANGE PARK ORANGE PARK FL For profit - Corporation N 6105597 SURREY PLACE CARE CENTER LIVE OAK FL For profit - Corporation N 5105764 CONSULATE HEALTH CARE OF TALLAHASSEE TALLAHASSEE FL For profit - Corporation N 5105963 LAFAYETTE NURSING AND REHABILITATION CENTER MAYO FL For profit - Corporation N 4105543 ST ANDREWS BAY SKILLED NURSING AND REHABILITATION PANAMA CITY FL For profit - Partnership N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 66: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

105323 OAKS OF CLEARWATER, THE CLEARWATER FL For profit - Corporation N 4105488 RIVERWOOD HEALTH & REHABILITATION CENTER STARKE FL For profit - Corporation N 4105460 NORTH FLORIDA REHABILITATION AND SPECIALTY CARE GAINESVILLE FL For profit - Corporation N 3105651 GOOD SAMARITAN SOCIETY-DAYTONA DAYTONA BEACH FL Non profit - Corporation N 3105758 STRATFORD COURT OF PALM HARBOR PALM HARBOR FL For profit - Corporation N 3105148 EMERALD SHORES HEALTH AND REHABILITATION CALLAWAY FL For profit - Corporation N 3105238 HERITAGE PARK REHABILITATION AND HEALTHCARE FORT MYERS FL For profit - Corporation N 3105387 SIGNATURE HEALTHCARE AT COLLEGE PARK FORT MYERS FL For profit - Corporation N 3105262 UNIVERSITY EAST REHABILITATION CENTER DELAND FL Non profit - Other N 3105274 CLEARWATER CENTER CLEARWATER FL Non profit - Corporation N 3105285 BAY CENTER PANAMA CITY FL Non profit - Corporation N 3106102 SARASOTA POINT REHABILITATION CENTER SARASOTA FL For profit - Corporation N 3106104 RENAISSANCE AT THE TERRACES BONITA SPRINGS FL Non profit - Corporation N 3105654 WESTCHESTER GARDENS HEALTH & REHABILITATION CLEARWATER FL For profit - Partnership N 3106068 REHABILITATION AND HEALTH CARE CENTER ALTOONA FL Non profit - Corporation N 3105166 MADISON POINTE CARE CENTER NEW PORT RICHEY FL For profit - Corporation N 3105952 GRAND OAKS HEALTH AND REHABILITATION CENTER PALM COAST FL For profit - Corporation N 3106116 LARGO HEALTH AND REHABILITATION CENTER LARGO FL For profit - Corporation N 2106081 ST JAMES HEALTH AND REHABILITATION CENTER CARRABELLE FL For profit - Corporation N 2106092 PLANTATION KEY NURSING CENTER TAVERNIER FL For profit - Corporation N 2105207 WAVE CREST HEALTH AND REHABILITATION CENTER MELBOURNE FL For profit - Corporation N 2105362 HARDEE MANOR HEALTHCARE CENTER WAUCHULA FL For profit - Corporation N 2105813 PARK RIDGE NURSING CENTER JACKSONVILLE FL For profit - Partnership N 2105739 OAKBRIDGE HEALTHCARE CENTER LAKELAND FL For profit - Corporation N 2105917 CONSULATE HEALTH CARE OF JACKSONVILLE JACKSONVILLE FL For profit - Corporation N 2105935 CONSULATE HEALTH CARE OF PENSACOLA PENSACOLA FL For profit - Corporation N 2105624 BONIFAY NURSING AND REHAB CENTER BONIFAY FL For profit - Corporation N 2105707 WEST JACKSONVILLE CARE AND REHABILITATION CENTER JACKSONVILLE FL For profit - Corporation N 2105321 OCALA HEALTH AND REHABILITATION CENTER OCALA FL For profit - Corporation N 2105529 HERITAGE PARK CARE AND REHABILITATION CENTER BRADENTON FL For profit - Corporation N 2106086 ASTORIA HEALTH AND REHABILITATION CENTER WINTER HAVEN FL For profit - Corporation N 2106041 HARBOURWOOD HEALTH AND REHAB CENTER CLEARWATER FL Non profit - Corporation N 2106112 TAMPA LAKES HEALTH AND REHABILITATION CENTER LUTZ FL For profit - Partnership N 2105153 PINECREST REHABILITATION CENTER NORTH MIAMI FL For profit - Corporation N 2105343 HEATHER HILL HEALTHCARE CENTER NEW PORT RICHEY FL Non profit - Other N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 67: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

105391 SEA BREEZE HEALTH CARE PANAMA CITY FL For profit - Corporation N 2105995 HARBORCHASE OF NAPLES NAPLES FL For profit - Corporation N 2105892 LAKE PARK OF MADISON NURSING AND REHABILITATION CE MADISON FL For profit - Corporation N 2105621 NORTH CAMPUS REHABILITATION AND NURSING CENTER LEESBURG FL For profit - Corporation N 2105503 PARK SUMMIT AT CORAL SPRINGS CORAL SPRINGS FL For profit - Corporation N 2105508 EAST RIDGE RETIREMENT VILLAGE INC CUTLER BAY FL Non profit - Corporation N 2105518 QUALITY HEALTH OF ORANGE COUNTY WINTER GARDEN FL For profit - Corporation N 2105566 PALM GARDEN OF WINTER HAVEN WINTER HAVEN FL For profit - Corporation N 1105584 SARASOTA MEMORIAL NURSING AND REHABILITATION CENTE SARASOTA FL Government - Hospital district N 1105586 OAK VIEW REHABILITATION CENTER ORANGE PARK FL For profit - Corporation N 1105603 RIVIERA PALMS REHABILITATION CENTER PALMETTO FL For profit - Corporation N 1105630 VICAR'S LANDING NURSING HOME PONTE VEDRA BEACH FL Non profit - Corporation N 1105478 ADVANCED CARE CENTER CLEARWATER FL For profit - Corporation N 1105658 ZEPHYR HAVEN HEALTH & REHAB CENTER, INC ZEPHYRHILLS FL Non profit - Church related N 1105895 CONSULATE HEALTH CARE OF ST PETERSBURG SEMINOLE FL For profit - Corporation N 1105849 WRIGHTS HEALTHCARE AND REHABILITATION CENTER SEMINOLE FL For profit - Corporation N 1105875 SAVANNAH COVE OF THE PALM BEACHES WEST PALM BEACH FL For profit - Corporation N 1106017 BRADENTON HEALTH CARE BRADENTON FL For profit - Partnership N 1106033 ST PETERSBURG NURSING & REHABILITATION SAINT PETERSBURG FL For profit - Individual N 1105962 LIFE CARE CENTER AT WELLS CROSSING ORANGE PARK FL For profit - Corporation N 1105790 SOLARIS SENIOR LIVING NORTH NAPLES NAPLES FL Non profit - Other N 1105805 CRESTWOOD NURSING CENTER PALATKA FL For profit - Corporation N 1105807 MADISON HEALTH AND REHABILITATION CENTER MADISON FL For profit - Corporation N 1105819 TIFFANY HALL NURSING AND REHAB CENTER PORT SAINT LUCIE FL For profit - Corporation N 1105672 GULF COAST VILLAGE CAPE CORAL FL Non profit - Corporation N 1105732 MEASE CONTINUING CARE DUNEDIN FL Non profit - Corporation N 1105384 CALUSA HARBOUR FORT MYERS FL For profit - Corporation N 1105248 OAK MANOR HEALTHCARE & REHABILITATION CENTER LARGO FL For profit - Corporation N 1105261 UNIVERSITY WEST REHABILITATION CENTER DELAND FL Non profit - Corporation N 1105149 NORTH REHABILITATION CENTER SAINT PETERSBURG FL For profit - Corporation N 1105332 WINTER PARK CARE & REHABILITATION CENTER WINTER PARK FL For profit - Corporation N 1105333 AVANTE AT MT DORA, INC MOUNT DORA FL For profit - Corporation N 1105012 HEALTH AND REHABILITATION CENTRE AT DOLPHINS VIEW SOUTH PASADENA FL For profit - Corporation N 1105029 COMMUNITY CONVALESCENT CENTER PLANT CITY FL Non profit - Corporation N 1105047 JUPITER MEDICAL CENTER PAVILION INC JUPITER FL Non profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 68: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

106114 BUFFALO CROSSING HEALTHCARE AND REHABILITATION CEN THE VILLAGES FL For profit - Corporation N 1106063 GLENRIDGE ON PALMER RANCH INC. SARASOTA FL Non profit - Corporation N 1106064 LIFE CARE CENTER OF JACKSONVILLE JACKSONVILLE FL For profit - Corporation N 1106080 VILLA MARIA WEST SKILLED NURSING FACILITY HIALEAH GARDENS FL Non profit - Church related N 1106105 SKYTOP VIEW REHABILITATION CENTER CLERMONT FL Non profit - Corporation Y 1105431 COURTYARDS OF ORLANDO CARE CENTER ORLANDO FL For profit - Corporation N 1105437 CYPRESS COVE CARE CENTER CRYSTAL RIVER FL Non profit - Corporation N 1105556 VILLAGE ON THE GREEN LONGWOOD FL Non profit - Corporation N 1105713 ALPINE HEALTH AND REHABILITATION CENTER SAINT PETERSBURG FL Non profit - Corporation N 1105724 OCALA OAKS REHABILITATION CENTER OCALA FL For profit - Corporation N 1105738 SOLARIS HEALTHCARE IMPERIAL NAPLES FL Non profit - Corporation N 1105693 CONSULATE HEALTH CARE OF LAKE PARKER LAKELAND FL For profit - Partnership N 1105870 LIFE CARE CENTER OF CITRUS COUNTY LECANTO FL For profit - Corporation N 1105878 PINELLAS POINT NURSING AND REHAB CENTER SAINT PETERSBURG FL For profit - Corporation N 1106075 GRACE REHABILITATION CENTER OF VERO BEACH VERO BEACH FL For profit - Corporation N 1106002 WEDGEWOOD HEALTHCARE CENTER LAKELAND FL For profit - Limited Liability company N 1106040 WESTMINSTER ST AUGUSTINE SAINT AUGUSTINE FL Non profit - Corporation N 1106046 TERRACE HEALTH & REHABILITATION CENTER GAINESVILLE FL For profit - Corporation N 1106050 LUTHERAN HAVEN NURSING HOME OVIEDO FL Non profit - Church related N 1106061 RIDGECREST NURSING AND REHABILITATION CENTER DELAND FL For profit - Corporation N 1105407 SPRINGWOOD CENTER SARASOTA FL For profit - Corporation N 1105286 BARTOW CENTER BARTOW FL Non profit - Corporation N 1105328 SANTA ROSA HEALTH & REHABILITATION CENTER MILTON FL For profit - Corporation N 1105352 KENILWORTH CARE & REHABILITATION CENTER SEBRING FL For profit - Corporation N 1105355 WILLOWBROOKE COURT AT ST ANDREWS BOCA RATON FL For profit - Corporation N 1105045 BRADEN RIVER REHABILITATION CENTER LLC BRADENTON FL For profit - Corporation N 1105050 SHORE ACRES CARE CENTER SAINT PETERSBURG FL For profit - Corporation N 1105159 GREENBRIAR REHABILITATION AND NURSING CENTER BRADENTON FL For profit - Corporation N 1106096 PAVILION FOR HEALTH CARE, THE PENNEY FARMS FL Non profit - Other N 1106101 STEWARD SEBASTIAN RIVER MEDICAL CENTER SEBASTIAN FL For profit - Corporation N 1115376 SOUTHLAND HEALTHCARE AND REHAB CENTER DUBLIN GA For profit - Corporation N 58115325 PRUITTHEALTH - WASHINGTON WASHINGTON GA For profit - Corporation N 42115703 GLENWOOD HEALTHCARE GLENWOOD GA For profit - Corporation N 30115592 COUNTRYSIDE HEALTH CENTER BUCHANAN GA For profit - Corporation N 29115730 OCEANSIDE HEALTH AND REHAB TYBEE ISLAND GA For profit - Corporation N 26

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 69: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

115321 WARRENTON HEALTH AND REHAB WARRENTON GA For profit - Corporation N 20115658 PRUITTHEALTH - GREENVILLE GREENVILLE GA For profit - Corporation N 20115582 MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER SAINT SIMONS ISLAND GA Non profit - Church related N 19115478 AZALEA TRACE NURSING CENTER COLUMBUS GA Non profit - Corporation Y 18115616 PRUITTHEALTH - FRANKLIN FRANKLIN GA For profit - Corporation N 17115604 BROWN'S HEALTH & REHAB CENTER STATESBORO GA For profit - Corporation N 16115523 ROBERTA HEALTH AND REHAB ROBERTA GA For profit - Partnership N 16115319 FIFTH AVENUE HEALTH CARE ROME GA For profit - Corporation N 15115564 PINEHILL NURSING CENTER BYROMVILLE GA For profit - Corporation N 14115555 BONTERRA TRANSITIONAL CARE & REHABILITATION EAST POINT GA For profit - Partnership N 13115636 FOUNTAIN BLUE REHAB AND NURSING MACON GA For profit - Partnership N 13115649 NAVICENT HEALTH OCONEE MILLEDGEVILLE GA Non profit - Other Y 12115727 ADVANCED HEALTH AND REHAB OF TWIGGS COUNTY JEFFERSONVILLE GA For profit - Corporation N 12115327 WILLOWWOOD NURSING CENTER FLOWERY BRANCH GA For profit - Corporation N 12115676 REHABILITATION CENTER OF SOUTH GEORGIA TIFTON GA For profit - Corporation N 12115409 PRUITTHEALTH - FORT OGLETHORPE FORT OGLETHORPE GA For profit - Corporation N 12115529 PRUITTHEALTH - GRIFFIN GRIFFIN GA For profit - Corporation N 12115575 TATTNALL HEALTHCARE CENTER REIDSVILLE GA For profit - Corporation N 12115477 CHAPLINWOOD NURSING HOME MILLEDGEVILLE GA Non profit - Other N 11115002 A.G. RHODES HOME WESLEY WOODS ATLANTA GA For profit - Corporation N 11115099 HABERSHAM HOME DEMOREST GA Government - City/county Y 11115680 CARLYLE PLACE MACON GA For profit - Corporation N 11115375 RIVERSIDE HEALTH CARE CENTER COVINGTON GA For profit - Corporation N 11115455 PRUITTHEALTH - TOOMSBORO TOOMSBORO GA For profit - Corporation N 10115685 HEARDMONT NURSING HOME ELBERTON GA For profit - Corporation N 10115711 MEMORIAL MANOR NURSING HOME BAINBRIDGE GA Government - Hospital district Y 10115471 HEART OF GEORGIA NURSING HOME EASTMAN GA For profit - Corporation N 10115570 CAMELLIA GARDENS OF LIFE CARE THOMASVILLE GA For profit - Corporation N 9115387 OXLEY PARK HEALTH AND REHABILITATION LYONS GA Non profit - Other N 911A200 GRACEWOOD NSG FACILITY(UNIT 9) GRACEWOOD GA Government - State Y 9115696 FORT GAINES HEALTH AND REHAB FORT GAINES GA For profit - Limited Liability company N 9115507 TAYLOR COUNTY HEALTH AND REHABILITATION BUTLER GA Non profit - Corporation N 9115533 PRUITTHEALTH - SWAINSBORO SWAINSBORO GA For profit - Corporation N 8115362 MACON REHABILITATION AND HEALTHCARE CENTER, LLC MACON GA For profit - Corporation N 8115487 NEW HORIZONS LIMESTONE GAINESVILLE GA Non profit - Corporation Y 8

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 70: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

115629 PRUITTHEALTH - SYLVESTER SYLVESTER GA For profit - Corporation N 7115558 DADE HEALTH AND REHAB TRENTON GA For profit - Individual N 7115429 CORDELE HEALTH AND REHABILITATION CORDELE GA Government - County Y 7115640 ST JOSEPH'S TRANSITIONAL CARE UNIT SAVANNAH GA For profit - Corporation Y 7115665 COASTAL MANOR LUDOWICI GA Government - Hospital district N 6115633 SAVANNAH BEACH HEALTH AND REHAB TYBEE ISLAND GA For profit - Corporation N 6115679 VERO HEALTH AND REHAB OF WADLEY WADLEY GA For profit - Corporation N 6115706 WILDWOOD HEALTH AND REHAB TALKING ROCK GA For profit - Corporation N 6115731 LANDMARK TRANSITIONAL RECOVERY UNIT SAVANNAH GA For profit - Corporation N 6115484 PROVIDENCE HEALTHCARE THOMASTON GA For profit - Limited Liability company N 6115554 GRACEMORE NURSING AND REHAB BRUNSWICK GA For profit - Corporation N 6115608 PRUITTHEALTH - OCILLA OCILLA GA For profit - Corporation N 6115684 SENIOR CARE CENTER - ST MARYS SAINT MARYS GA Non profit - Other Y 6115724 CHELSEY PARK HEALTH AND REHABILITATION DAHLONEGA GA Non profit - Other N 6115488 GREENE POINT HEALTH AND REHABILITATION UNION POINT GA Non profit - Other N 6115364 MONTEZUMA HEALTH CARE CENTER MONTEZUMA GA Non profit - Corporation N 6115293 PLACE AT POOLER, THE POOLER GA For profit - Corporation N 6115106 EFFINGHAM CARE CENTER SPRINGFIELD GA Non profit - Corporation Y 6115264 CALHOUN NURSING HOME EDISON GA Government - Hospital district N 5115132 ABERCORN REHABILITATION CENTER SAVANNAH GA For profit - Corporation N 5115298 FAIRBURN HEALTH CARE CENTER FAIRBURN GA For profit - Corporation N 5115578 GREEN ACRES HEALTH AND REHABILITATION MILLEDGEVILLE GA For profit - Corporation N 5115539 ARROWHEAD HEALTH AND REHAB JONESBORO GA For profit - Corporation N 5115544 SYL-VIEW HEALTH CARE CENTER SYLVANIA GA For profit - Corporation N 5115704 EMANUEL COUNTY NURSING HOME SWAINSBORO GA For profit - Corporation Y 5115677 PRUITTHEALTH - JASPER JASPER GA For profit - Corporation N 5115668 PRUITTHEALTH - SUNRISE MOULTRIE GA For profit - Corporation N 5115607 PINEWOOD NURSING CENTER WHIGHAM GA For profit - Corporation N 5115597 HERITAGE INN HEALTH AND REHABILITATION STATESBORO GA Non profit - Other N 5115618 EAGLE HEALTH & REHABILITATION STATESBORO GA Non profit - Other N 5115601 WESTWOOD NURSING CENTER STATESBORO GA For profit - Corporation N 5115524 BRANDON WILDE PAVILION EVANS GA Non profit - Corporation N 5115644 KEYSVILLE NURSING HOME & REHAB CENTER KEYSVILLE GA For profit - Individual N 5115689 GOLD CITY HEALTH AND REHAB DAHLONEGA GA For profit - Corporation N 4115531 PRUITTHEALTH - VIRGINIA PARK ATLANTA GA For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 71: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

115569 FOX GLOVE CENTER ATLANTA GA For profit - Corporation N 4115613 GIBSON HEALTH AND REHABILITATION GIBSON GA Non profit - Other N 4115490 PRESBYTERIAN VILLAGE AUSTELL GA Non profit - Corporation N 4115363 ROME HEALTH AND REHABILITATION CENTER ROME GA For profit - Corporation N 4115373 PRUITTHEALTH - LAKEHAVEN VALDOSTA GA For profit - Corporation N 4115339 PRUITTHEALTH - SAVANNAH SAVANNAH GA For profit - Corporation N 4115295 ZEBULON PARK HEALTH AND REHABILITATION MACON GA For profit - Corporation N 4115638 CARROLLTON MANOR, INCORPORATED CARROLLTON GA For profit - Corporation N 4115732 BOSTICK NURSING CENTER MILLEDGEVILLE GA For profit - Limited Liability company N 4115540 TWIN VIEW HEALTH AND REHAB TWIN CITY GA For profit - Corporation N 4115534 AZALEALAND NURSING HOME SAVANNAH GA For profit - Corporation N 4115479 BRYANT HEALTH AND REHABILITATION CENTER COCHRAN GA For profit - Corporation N 4115322 BRIARWOOD HEALTH AND REHABILITATION CENTER TUCKER GA For profit - Corporation N 4115272 JOE-ANNE BURGIN NURSING HOME CUTHBERT GA Government - Hospital district Y 4115012 NORTH DECATUR HEALTH AND REHABILITATION CENTER DECATUR GA For profit - Corporation N 4115044 AZALEA HEALTH AND REHABILITATION CENTER AUGUSTA GA For profit - Corporation N 3115275 A.G. RHODES HOME, INC, THE ATLANTA GA Non profit - Corporation N 3115329 HARBORVIEW HEALTH SYSTEMS THOMASTON THOMASTON GA For profit - Corporation N 3115334 PRUITTHEALTH - AUGUSTA AUGUSTA GA For profit - Corporation N 3115482 EAST LAKE ARBOR DECATUR GA For profit - Partnership N 3115495 PREMIER ESTATES OF DUBLIN, LLC DUBLIN GA For profit - Corporation N 3115418 PRUITTHEALTH - FORSYTH FORSYTH GA For profit - Corporation N 3115424 LAKE CROSSING HEALTH CENTER APPLING GA For profit - Corporation N 3115546 SAVANNAH SQUARE HEALTH CENTER SAVANNAH GA For profit - Corporation N 3115552 LODGE, THE WARNER ROBINS GA For profit - Corporation N 3115553 WOODLANDS HEALTH CARE MIDWAY GA For profit - Corporation N 3115577 ALTAMAHA HEALTHCARE CENTER JESUP GA For profit - Corporation N 3115522 ORCHARD HEALTH AND REHABILITATION PULASKI GA For profit - Corporation N 3115566 RIVER TOWNE CENTER COLUMBUS GA For profit - Partnership N 3115599 MAGNOLIA MANOR OF MARION COUNTY BUENA VISTA GA Non profit - Church related N 3115722 ANSLEY PARK HEALTH AND REHABILITATION NEWNAN GA Non profit - Other N 3115384 OAKS - CARROLLTON SKILLED NURSING, THE CARROLLTON GA For profit - Corporation N 3115452 PRUITTHEALTH - SHEPHERD HILLS LA FAYETTE GA For profit - Corporation N 3115506 PRUITTHEALTH - FAIRBURN FAIRBURN GA For profit - Corporation N 3115411 PLEASANT VIEW NURSING CENTER METTER GA For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 72: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

115585 LEGACY TRANSITIONAL CARE & REHABILITATION ATLANTA GA For profit - Partnership N 3115622 EASTMAN HEALTHCARE & REHAB EASTMAN GA For profit - Corporation N 2115611 VISTA PARK HEALTH AND REHABILITATION DOUGLAS GA Non profit - Other N 2115536 WINDER HEALTH CARE & REHAB CTR WINDER GA For profit - Corporation N 2115466 GRAY HEALTH AND REHABILITATION GRAY GA Non profit - Other N 2115474 LYNN HAVEN HEALTH AND REHABILITATION GRAY GA For profit - Corporation N 2115480 GLENN-MOR NURSING HOME THOMASVILLE GA Non profit - Other N 2115481 FOUR COUNTY HEALTH AND REHABILITATION RICHLAND GA Non profit - Other N 2115515 ROSS MEMORIAL HEALTH CARE CTR KENNESAW GA For profit - Corporation N 2115496 LEGACY HEALTH AND REHABILITATION GREENSBORO GA Non profit - Corporation N 2115385 PRUITTHEALTH - CRESTWOOD VALDOSTA GA For profit - Corporation N 2115393 OAKS - SCENIC VIEW SKILLED NURSING, THE BALDWIN GA For profit - Corporation N 2115382 SPARTA HEALTH AND REHABILITATION SPARTA GA Non profit - Other N 2115351 MUSCOGEE MANOR & REHABILITATION CTR COLUMBUS GA Government - City/county N 2115005 PARK PLACE NURSING FACILITY MONROE GA For profit - Corporation N 2115719 PRUITTHEALTH - ROME ROME GA For profit - Corporation N 2115700 PRUITTHEALTH - BETHANY MILLEN GA For profit - Corporation N 2115681 PRUITTHEALTH - OLD CAPITOL LOUISVILLE GA For profit - Corporation N 2115588 PRUITTHEALTH - COVINGTON COVINGTON GA For profit - Corporation N 2115651 FORT VALLEY HEALTH AND REHAB FORT VALLEY GA For profit - Corporation N 2115652 CHERRY BLOSSOM HEALTH AND REHABILITATION MACON GA Non profit - Other N 2115631 PRUITTHEALTH - GRANDVIEW ATHENS GA For profit - Corporation N 2115543 MAPLE RIDGE HEALTH CARE CENTER CARTERSVILLE GA For profit - Partnership N 2115129 NURSE CARE OF BUCKHEAD ATLANTA GA For profit - Partnership N 2115431 HARALSON NSG & REHAB CENTER BREMEN GA For profit - Corporation N 2115505 PRUITTHEALTH - MOULTRIE MOULTRIE GA For profit - Corporation N 2115391 PRUITTHEALTH - EASTSIDE MACON GA For profit - Corporation N 2115308 PLACE AT MARTINEZ, THE AUGUSTA GA For profit - Corporation N 2115296 LENBROOK ATLANTA GA Non profit - Other N 2115150 AMARA HEALTHCARE & REHAB AUGUSTA GA For profit - Corporation N 1115324 BAINBRIDGE HEALTH AND REHAB BAINBRIDGE GA For profit - Corporation N 1115397 PROVIDENCE OF SPARTA HEALTH AND REHAB SPARTA GA For profit - Individual N 1115404 LUMBER CITY NURSING & REHABILITATION CENTER LUMBER CITY GA For profit - Corporation N 1115336 UNIVERSITY EXTENDED CARE/WESTW EVANS GA Non profit - Corporation N 1115345 PRUITTHEALTH - TOCCOA TOCCOA GA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 73: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

115276 PRUITTHEALTH - MARIETTA MARIETTA GA For profit - Corporation N 1115090 BROWN HEALTH AND REHABILITATION ROYSTON GA Non profit - Other N 1115120 SIGNATURE HEALTHCARE OF SAVANNAH SAVANNAH GA For profit - Corporation N 1115004 MAGNOLIA MANOR METHODIST NSG C AMERICUS GA Non profit - Corporation N 1115502 GRANDVIEW HEALTH CARE CENTER JASPER GA For profit - Corporation N 1115503 JESUP HEALTH AND REHAB JESUP GA For profit - Corporation N 1115427 THOMASVILLE HEALTH & REHAB, LLC THOMASVILLE GA For profit - Corporation N 1115423 CHESTNUT RIDGE NSG & REHAB CTR CUMMING GA For profit - Corporation N 1115381 CEDAR SPRINGS HEALTH AND REHAB CEDARTOWN GA For profit - Corporation N 1115556 BRIGHTMOOR HEALTH CARE, INC GRIFFIN GA For profit - Corporation N 1115551 CUMMING NURSING CENTER CUMMING GA For profit - Corporation N 1115576 OAK VIEW HOME, INC WAVERLY HALL GA Non profit - Other N 1115586 PINEWOOD MANOR NURSING HOME & REHABILITATION CNTR HAWKINSVILLE GA Non profit - Corporation Y 1115619 GLENVUE HEALTH AND REHAB GLENNVILLE GA For profit - Corporation N 1115655 COOK SENIOR LIVING CENTER ADEL GA Non profit - Other Y 1115641 RIVERVIEW HEALTH & REHAB CTR SAVANNAH GA Non profit - Other N 1115610 CANDLER SKILLED NURSING UNIT SAVANNAH GA For profit - Corporation Y 1115600 PRUITTHEALTH - LANIER BUFORD GA For profit - Corporation N 1115670 ROCKDALE HEALTHCARE CENTER CONYERS GA For profit - Partnership N 1115671 SCOTT HEALTH & REHABILITATION ADRIAN GA Non profit - Other N 1115667 COBBLESTONE REHABILITATION AND HEALTHCARE CTR, LLC MOULTRIE GA For profit - Corporation N 1115695 UNION COUNTY NURSING HOME BLAIRSVILLE GA Non profit - Other Y 1115713 PALEMON GASKINS MEM NSG HOME OCILLA GA Government - County N 1115771 CAMBRIDGE POST ACUTE CARE CENTER SNELLVILLE GA For profit - Partnership N 1115145 ANDERSON MILL HEALTH AND REHABILITATION CENTER AUSTELL GA For profit - Corporation N 1115146 ORCHARD VIEW REHABILITATION & SKILLED NURSING CTR COLUMBUS GA Government - City/county N 1115287 CHULIO HILLS HEALTH AND REHAB ROME GA For profit - Corporation N 1115289 COMER HEALTH AND REHABILITATION COMER GA Non profit - Other N 1115357 OCONEE HEALTH AND REHABILITATION OCONEE GA Non profit - Other N 1115304 PRUITTHEALTH - LAFAYETTE LAFAYETTE GA For profit - Corporation N 1115401 PRUITTHEALTH - SPRING VALLEY ELBERTON GA For profit - Corporation N 1115501 ROSE CITY HEALTH AND REHABILITATION CENTER THOMASVILLE GA For profit - Corporation N 1115430 SUMMERHILL ELDERLIVING HOME & CARE PERRY GA For profit - Corporation N 1115449 HART CARE CENTER HARTWELL GA For profit - Individual N 1115559 FRIENDSHIP HEALTH AND REHAB CLEVELAND GA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 74: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

115628 PRUITTHEALTH - PALMYRA ALBANY GA For profit - Corporation N 1115595 EATONTON HEALTH AND REHABILITATION EATONTON GA Non profit - Other N 1115694 PEBBLEBROOK HEALTH CENTER AT PARK SPRINGS STONE MOUNTAIN GA For profit - Corporation N 1115702 WASHINGTON CO EXTENDED CARE FA SANDERSVILLE GA Government - County Y 1115710 HILL HAVEN NURSING HOME COMMERCE GA For profit - Corporation N 1115716 SPRING HARBOR AT GREEN ISLAND COLUMBUS GA Non profit - Corporation N 1115672 PRUITTHEALTH - AUGUSTA HILLS AUGUSTA GA For profit - Corporation N 1115687 WILLOWBROOKE COURT AT LANIER VILLAGE ESTATES GAINESVILLE GA Non profit - Corporation N 1125031 KOHALA HOSPITAL KAPAAU HI Government - State Y 1165295 MONTEZUMA SPECIALTY CARE MONTEZUMA IA Non profit - Corporation N 47165188 WEST BRIDGE CARE & REHABILITATION WINTERSET IA For profit - Corporation N 3316E728 MERCY MEDICAL CENTER-CENTERVILLE CENTERVILLE IA Non profit - Church related Y 31165438 STACYVILLE COMMUNITY NURSING HOME STACYVILLE IA Non profit - Corporation N 2916E050 BUCHANAN COUNTY HEALTH CENTER INDEPENDENCE IA Government - County Y 26165381 SIGOURNEY HEALTH CARE SIGOURNEY IA For profit - Corporation N 26165313 OAKWOOD SPECIALTY CARE ALBIA IA Non profit - Corporation N 20165206 MORNINGSIDE HEALTHCARE COMMUNITY IDA GROVE IA For profit - Corporation N 17165225 CENTERVILLE SPECIALTY CARE CENTERVILLE IA Non profit - Corporation N 17165548 ARBOR SPRINGS OF WEST DES MOINES L L C WEST DES MOINES IA For profit - Corporation N 17165314 LAMONI SPECIALTY CARE LAMONI IA Non profit - Corporation N 15165445 PEARL VALLEY REHABILITATION AND NURSING AT LAKE PA LAKE PARK IA For profit - Corporation N 15165435 ACCURA HEALTHCARE OF SIOUX CITY, LLC SIOUX CITY IA For profit - Corporation N 15165033 MANORCARE HEALTH SERVICES DAVENPORT IA For profit - Corporation N 14165336 REHABILITATION CENTER OF ALLISON ALLISON IA For profit - Corporation N 14165241 GRUNDY CARE CENTER GRUNDY CENTER IA For profit - Corporation N 14165546 TABOR MANOR CARE CENTER TABOR IA For profit - Corporation N 14165305 CHARITON SPECIALTY CARE CHARITON IA Non profit - Corporation N 13165203 WESTMONT HEALTHCARE COMMUNITY LOGAN IA For profit - Corporation N 13165451 ACCURA HEALTHCARE OF MARSHALLTOWN MARSHALLTOWN IA For profit - Corporation N 13165304 MONTROSE HEALTH CENTER MONTROSE IA For profit - Corporation N 13165494 TRIPOLI NURSING & REHAB TRIPOLI IA Non profit - Other N 13165290 NORTH CREST LIVING CENTER COUNCIL BLUFFS IA For profit - Corporation N 11165330 CHEROKEE SPECIALTY CARE CHEROKEE IA Non profit - Corporation N 11165368 LITTLE FLOWER HAVEN EARLING IA For profit - Corporation N 11165531 GARDEN VIEW CARE CENTER SHENANDOAH IA For profit - Individual N 11

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 75: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

165534 QHC HUMBOLDT SOUTH, LLC HUMBOLDT IA For profit - Corporation N 10165391 ELKADER CARE CENTER ELKADER IA Non profit - Corporation N 10165406 ROCKWELL COMMUNITY NURSING HOM ROCKWELL IA For profit - Corporation N 10165285 CORNING SPECIALTY CARE CORNING IA Non profit - Corporation N 10165224 MOUNT AYR HEALTH CARE CENTER MOUNT AYR IA For profit - Corporation N 9165455 ACCURA HEALTHCARE OF CARROLL CARROLL IA For profit - Corporation N 9165179 NORWALK NURSING AND REHABILITATION CENTER NORWALK IA For profit - Corporation N 9165404 NEW LONDON SPECIALTY CARE NEW LONDON IA Non profit - Corporation N 9165230 OAKLAND MANOR OAKLAND IA For profit - Partnership N 9165262 TRU REHAB OF GRINNELL GRINNELL IA For profit - Corporation N 9165413 PLEASANT VIEW HOME ALBERT CITY IA For profit - Corporation N 9165601 MANORCARE HEALTH SERVICES -WEST DES MOINES WEST DES MOINES IA For profit - Corporation N 8165264 QHC MITCHELLVILLE, LLC MITCHELLVILLE IA For profit - Corporation N 8165217 CARING ACRES NURSING & REHAB CENTER ANITA IA For profit - Corporation N 8165310 HERITAGE SPECIALTY CARE CEDAR RAPIDS IA Non profit - Corporation N 8165499 BLACKHAWK LIFE CARE CENTER LAKE VIEW IA For profit - Corporation N 8165610 PRAIRIE VISTA VILLAGE ALTOONA IA For profit - Partnership N 8165375 ANAMOSA CARE CENTER ANAMOSA IA For profit - Individual N 8165294 AVOCA SPECIALTY CARE AVOCA IA Non profit - Corporation N 8165374 MILL VALLEY CARE CENTER BELLEVUE IA For profit - Corporation N 7165527 PATTY ELWOOD CENTER CRESCO IA Non profit - Corporation N 716F001 DAVIS CENTER BLOOMFIELD IA For profit - Corporation N 7165292 BEDFORD SPECIALTY CARE BEDFORD IA Non profit - Corporation N 7165382 ACCURA HEALTHCARE OF KNOXVILLE, LLC KNOXVILLE IA For profit - Corporation N 7165231 REGENCY PARK NURSING & REHAB CENTER OF CARROLL CARROLL IA For profit - Corporation N 7165275 CREST HAVEN CARE CENTRE CRESTON IA For profit - Corporation N 6165555 ADEL ACRES ADEL IA For profit - Partnership N 6165599 CEDAR MANOR NURSING HOME TIPTON IA For profit - Corporation N 6165463 CRESTVIEW NURSING & REHAB WEBSTER CITY IA For profit - Corporation N 6165351 GRISWOLD REHABILITATION & HEALTH CARE CENTER GRISWOLD IA For profit - Corporation N 6165293 SOUTHERN HILLS SPECIALTY CARE OSCEOLA IA Non profit - Corporation N 6165254 OAKVIEW, INC. CONRAD IA For profit - Corporation N 6165180 ODEBOLT SPECIALTY CARE ODEBOLT IA Non profit - Corporation N 6165187 GOOD SAMARITAN SOCIETY - WEST UNION WEST UNION IA Non profit - Corporation N 5165161 TOUCHSTONE HEALTHCARE COMMUNITY SIOUX CITY IA For profit - Corporation N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 76: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

165263 MECHANICSVILLE SPECIALTY CARE MECHANICSVILLE IA Non profit - Corporation N 5165309 SHELL ROCK SENIOR LIVING SHELL ROCK IA For profit - Corporation N 5165312 FONDA SPECIALTY CARE FONDA IA Non profit - Corporation N 5165191 GOOD SAMARITAN SOCIETY - RED OAK RED OAK IA Non profit - Corporation N 5165198 IOWA CITY REHAB & HEALTH CARE IOWA CITY IA For profit - Corporation N 516E016 VIRGINIA GAY HOSPITAL VINTON IA Non profit - Corporation Y 5165274 NORTHERN MAHASKA SPECIALTY CARE OSKALOOSA IA Non profit - Corporation N 5165222 CORYDON SPECIALTY CARE CORYDON IA Non profit - Corporation N 5165457 CLEARVIEW HOME CLEARFIELD IA For profit - Partnership N 5165356 VALLEY VIEW COMMUNITY GREENE IA For profit - Corporation N 5165379 EDGEWOOD CONVALESCENT HOME EDGEWOOD IA For profit - Corporation N 5165535 SUNSET KNOLL CARE AND REHAB CENTER AURELIA IA For profit - Corporation N 5165521 NELSON MANOR NEWTON IA For profit - Corporation N 4165443 GRAND JI VANTE ACKLEY IA Non profit - Church related N 4165572 BURLINGTON CARE CENTER BURLINGTON IA For profit - Corporation N 4165612 TRINITY CENTER AT LUTHER PARK DES MOINES IA Non profit - Church related N 4165367 HERITAGE CARE AND REHABILITATION CENTER MASON CITY IA For profit - Corporation N 4165458 PEARL VALLEY REHABILITATION AND NURSING AT SUTHERL SUTHERLAND IA For profit - Corporation N 4165460 KAREN ACRES CARE CENTER URBANDALE IA For profit - Corporation N 4165401 SIBLEY SPECIALTY CARE SIBLEY IA Non profit - Corporation N 4165606 PERRY LUTHERAN HOME PERRY IA Non profit - Corporation N 4165362 CLARION WELLNESS AND REHABILITATION CENTER CLARION IA For profit - Corporation N 4165349 BELLE PLAINE SPECIALTY CARE BELLE PLAINE IA Non profit - Corporation N 4165452 WAPELLO SPECIALTY CARE WAPELLO IA Non profit - Corporation N 4165170 POLK CITY NURSING & REHABILITATION CENTER POLK CITY IA For profit - Corporation N 4165189 GOOD SAMARITAN SOCIETY - VILLISCA VILLISCA IA Non profit - Church related N 4165181 ROCK RAPIDS HEALTH CENTRE ROCK RAPIDS IA For profit - Corporation N 4165155 SALEM LUTHERAN HOME ELK HORN IA Non profit - Corporation N 3165453 PEARL VALLEY REHABILITATION & HEALTHCARE CENTER O WASHINGTON IA For profit - Corporation N 3165426 PEARL VALLEY REHABILITATION AND NURSING AT PERRY, PERRY IA Non profit - Corporation N 3165412 EXIRA CARE CENTER EXIRA IA For profit - Corporation N 3165369 WESTVIEW OF INDIANOLA CARE CENTER INDIANOLA IA For profit - Corporation N 3165326 BLOOMFIELD CARE CENTER BLOOMFIELD IA For profit - Corporation N 3165334 GUTTENBERG CARE CENTER GUTTENBERG IA For profit - Corporation N 3165175 GENESIS SENIOR LIVING DES MOINES IA For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 77: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

165220 PRAIRIE RIDGE CARE & REHABILIT MEDIAPOLIS IA For profit - Corporation N 3165233 REGENCY PARK NURSING & REHAB CENTER OF JEFFERSON JEFFERSON IA For profit - Corporation N 3165238 DENISON CARE CENTER DENISON IA For profit - Corporation N 3165281 ON WITH LIFE AT GLENWOOD GLENWOOD IA Non profit - Corporation N 3165259 THORNTON MANOR LANSING IA Non profit - Corporation N 3165578 PREMIER ESTATES OF MUSCATINE MUSCATINE IA For profit - Corporation N 3165579 MAQUOKETA CARE CENTER MAQUOKETA IA For profit - Corporation N 3165570 CRYSTAL HEIGHTS CARE CENTER OSKALOOSA IA For profit - Corporation N 3165533 QHC HUMBOLDT NORTH, LLC HUMBOLDT IA For profit - Corporation N 3165482 UNITED PRESBYTERIAN HOME WASHINGTON IA Non profit - Corporation N 3165361 ROLLING GREEN VILLAGE CARE CEN NEVADA IA For profit - Corporation N 3165344 PEARL VALLEY REHABILITATION AND NURSING AT GOWRIE, GOWRIE IA For profit - Corporation N 3165327 SUNRISE TERRACE NURSING & REHABILITATION CENTER WINFIELD IA For profit - Corporation N 3165331 MORNING SUN CARE CENTER MORNING SUN IA For profit - Corporation N 3165614 ROSE HAVEN NURSING HOME MARENGO IA For profit - Individual N 3165491 EVANS MEMORIAL HOME CRESCO IA Non profit - Corporation N 3165495 CLARKSVILLE SKILLED NURSING & REHAB CENTER CLARKSVILLE IA For profit - Corporation N 3165611 WILTON RETIREMENT COMMUNITY WILTON IA Non profit - Corporation N 3165621 THE GARDENS OF CEDAR RAPIDS CEDAR RAPIDS IA For profit - Corporation N 3165510 DAVENPORT LUTHERAN HOME DAVENPORT IA Non profit - Church related N 2165513 LUTHER MANOR COMMUNITIES DUBUQUE IA Non profit - Church related N 2165617 REHABILITATION CENTER OF LISBON LISBON IA For profit - Corporation N 2165607 THE COTTAGES PELLA IA Non profit - Corporation N 216E069 MANNING REGIONAL HEALTHCARE CE MANNING IA Non profit - Corporation N 2165340 GRANDVIEW HEALTHCARE CENTER OELWEIN IA For profit - Corporation N 2165297 NEW HAMPTON NURSING & REHAB CE NEW HAMPTON IA For profit - Corporation N 2165347 NORA SPRINGS CARE CENTER NORA SPRINGS IA For profit - Corporation N 2165402 ACCURA HEALTHCARE OF MILFORD MILFORD IA For profit - Corporation N 2165405 HAPPY SIESTA NURSING HOME REMSEN IA Non profit - Corporation N 2165383 GREENFIELD REHABILITATION & HEALTH CARE CENTER GREENFIELD IA For profit - Corporation N 2165386 COLONIAL MANOR OF ELMA ELMA IA For profit - Corporation N 2165376 RIVERVIEW MANOR HEALTHCARE, LLC PLEASANT VALLEY IA For profit - Corporation N 2165462 SUNNY HILL CARE CENTER TAMA IA For profit - Corporation N 2165472 SCENIC MANOR IOWA FALLS IA For profit - Corporation N 2165213 GOOD SAMARITAN SOCIETY - FOREST CITY FOREST CITY IA Non profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 78: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

165485 LUTHERAN RETIREMENT HOME NORTHWOOD IA Non profit - Church related N 2165516 CRESTRIDGE CARE CENTER MAQUOKETA IA For profit - Corporation N 2165541 RICEVILLE FAMILY CARE AND THERAPY CENTER RICEVILLE IA Non profit - Corporation N 2165598 JEFFERSON PLACE PELLA IA Non profit - Corporation N 2165590 CLARENCE NURSING HOME CLARENCE IA Non profit - Corporation N 2165605 KENNYBROOK VILLAGE GRIMES IA For profit - Corporation N 216E718 HUMBOLDT COUNTY MEMORIAL HOSPI HUMBOLDT IA Government - County Y 2165260 DONNELLSON HEALTH CENTER DONNELLSON IA For profit - Corporation N 2165249 GOOD SAMARITAN SOCIETY - NEWELL NEWELL IA Non profit - Corporation N 2165307 COUNTRY VIEW WATERLOO IA Government - County N 2165223 RIDGEWOOD SPECIALTY CARE OTTUMWA IA Non profit - Corporation N 2165209 SOUTHRIDGE SPECIALTY CARE MARSHALLTOWN IA Non profit - Corporation N 2165346 MAPLE MANOR VILLAGE APLINGTON IA For profit - Corporation N 2165366 LAKE MILLS CARE CENTER LAKE MILLS IA For profit - Corporation N 2165358 THOMAS REST HAVEN COON RAPIDS IA Government - City N 2165398 ACCURA HEALTHCARE OF BAXTER, LLC BAXTER IA For profit - Corporation N 2165440 WINSLOW HOUSE CARE CENTER MARION IA Non profit - Corporation N 2165146 KAHL HOME FOR THE AGED & INFIRMED DAVENPORT IA Non profit - Corporation N 2165171 WILLOW GARDENS CARE CENTER MARION IA Non profit - Corporation N 2165006 IOWA JEWISH SENIOR LIFE CENTER DES MOINES IA Non profit - Corporation N 2165019 CHAUTAUQUA GUEST HOME #2 CHARLES CITY IA For profit - Corporation N 1165174 CASA DE PAZ HEALTH CARE CENTER SIOUX CITY IA For profit - Corporation N 1165185 RED OAK HEALTHCARE COMMUNITY RED OAK IA For profit - Corporation N 1165446 WESTBROOK ACRES GLADBROOK IA For profit - Corporation N 1165470 PLEASANTVIEW HOME KALONA IA Non profit - Church related N 1165399 REGENCY CARE CENTER NORWALK IA For profit - Corporation N 1165421 ACCURA HEALTHCARE OF NEWTON EAST, LLC NEWTON IA For profit - Corporation N 1165390 STATE CENTER SPECIALTY CARE STATE CENTER IA Non profit - Corporation N 1165364 CONCORD CARE CENTER GARNER IA For profit - Corporation N 1165365 OAKWOOD CARE CENTER CLEAR LAKE IA For profit - Corporation N 1165341 OELWEIN HEALTH CARE CENTER OELWEIN IA For profit - Corporation N 1165333 HALLMARK CARE CENTER MOUNT VERNON IA For profit - Corporation N 1165215 LYON SPECIALTY CARE ROCK RAPIDS IA Non profit - Corporation N 1165207 GOOD SAMARITAN SOCIETY - HOLSTEIN HOLSTEIN IA Non profit - Corporation N 1165193 DUNLAP SPECIALTY CARE DUNLAP IA Non profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 79: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

165197 CEDAR FALLS HEALTH CARE CENTER CEDAR FALLS IA For profit - Corporation N 1165228 DUBUQUE SPECIALTY CARE DUBUQUE IA Non profit - Corporation N 1165286 SUNRISE HILL CARE CENTER TRAER IA For profit - Corporation N 1165253 PANORA SPECIALTY CARE PANORA IA Non profit - Corporation N 1165282 VALLEY VIEW SPECIALTY CARE ELDORA IA Non profit - Corporation N 1165270 STRATFORD SPECIALTY CARE STRATFORD IA Non profit - Corporation N 1165602 SUNNY BROOK LIVING CARE CENTER FAIRFIELD IA For profit - Corporation N 116E277 STORY COUNTY HOSPITAL LTC NEVADA IA Government - County Y 116E681 WASHINGTON COUNTY HOSPITAL WASHINGTON IA Government - State Y 1165615 PIONEER VALLEY LIVING AND REHAB SERGEANT BLUFF IA For profit - Corporation N 1165593 SCOTTISH RITE PARK INC DES MOINES IA Non profit - Corporation N 1165587 NORTHBROOK MANOR CARE CENTER CEDAR RAPIDS IA For profit - Corporation N 1165525 THE NEW HOMESTEAD GUTHRIE CENTER IA Non profit - Corporation N 1165514 RAMSEY VILLAGE DES MOINES IA Non profit - Corporation N 1165515 SUNNYCREST NURSING CENTER DYSART IA For profit - Corporation N 1165489 GOLDENROD MANOR CLARINDA IA For profit - Partnership N 1165490 ACCURA HEALTHCARE OF CRESCO CRESCO IA For profit - Corporation N 1165576 OSSIAN SENIOR HOSPICE OSSIAN IA Non profit - Corporation N 1165226 MANLY SPECIALTY CARE MANLY IA Non profit - Corporation N 1165158 WESTRIDGE QUALITY CARE & REHAB CLARINDA IA For profit - Corporation N 1165186 GOOD SAMARITAN SOCIETY - INDIANOLA INDIANOLA IA Non profit - Corporation N 1165280 BETTENDORF HEALTH CARE CENTER BETTENDORF IA For profit - Corporation N 1165284 SUNNY KNOLL CARE CENTRE ROCKWELL CITY IA For profit - Corporation N 1165232 FRIENDSHIP HOME ASSOCIATION AUDUBON IA Non profit - Corporation N 1165236 GOOD SAMARITAN SOCIETY - MANSON MANSON IA Government - County N 1165247 GOOD SAMARITAN SOCIETY - GEORGE GEORGE IA Non profit - Corporation N 1165252 WESTVIEW ACRES CARE CENTER LEON IA For profit - Corporation N 1165481 MAYFLOWER HOME GRINNELL IA Non profit - Church related N 1165483 HALCYON HOUSE WASHINGTON IA Non profit - Other N 1165486 RUTHVEN COMMUNITY CARE CENTER RUTHVEN IA Non profit - Corporation N 1165408 ACCURA HEALTHCARE OF BANCROFT BANCROFT IA For profit - Corporation N 1165318 COLONIAL MANOR OF AMANA AMANA IA For profit - Corporation N 1165320 ZEARING HEALTH CARE, LLC ZEARING IA For profit - Corporation N 1165372 ELM CREST RETIREMENT COMMUNITY HARLAN IA Non profit - Church related N 1165306 PARKVIEW CARE CENTER FAIRFIELD IA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 80: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

165343 PARK VIEW REHABILITATION CENTER SAC CITY IA For profit - Corporation N 116E170 FRANKLIN GENERAL HOSPITAL HAMPTON IA Government - City/county Y 116E263 SANFORD SENIOR CARE SHELDON SHELDON IA Non profit - Corporation Y 1165609 NEWTON VILLAGE HEALTH CARE CENTER NEWTON IA Non profit - Corporation N 1165589 OSKALOOSA CARE CENTER OSKALOOSA IA For profit - Corporation N 1165604 KEYSTONE NURSING CARE CENTER INC KEYSTONE IA For profit - Corporation N 1165524 BETHANY LUTHERAN HOME COUNCIL BLUFFS IA Non profit - Church related N 1165554 COUNTRY VIEW MANOR INC SIBLEY IA For profit - Corporation N 1165492 LAKESIDE LUTHERAN HOME EMMETSBURG IA Non profit - Church related N 1165428 CAREAGE HILLS REHABILITATION AND HEALTHCARE CHEROKEE IA For profit - Corporation N 1135058 GOOD SAMARITAN SOCIETY - SILVER WOOD VILLAGE SILVERTON ID Non profit - Corporation N 21135141 TERRACES OF BOISE, THE BOISE ID Non profit - Corporation N 20135052 COEUR D'ALENE OF CASCADIA COEUR D'ALENE ID For profit - Corporation N 20135084 OAK CREEK REHABILITATION CENTER OF KIMBERLY KIMBERLY ID For profit - Corporation N 8135097 ASHTON MEMORIAL LIVING CENTER ASHTON ID Non profit - Corporation N 8135110 KARCHER POST-ACUTE & REHABILITATION CENTER NAMPA ID For profit - Corporation N 6135006 ST LUKE'S ELMORE LONG TERM CARE MOUNTAIN HOME ID Non profit - Corporation Y 6135004 BOUNDARY COUNTY NURSING HOME BONNERS FERRY ID Government - County Y 5135070 BEAR LAKE MEMORIAL SKILLED NURSING FACILITY MONTPELIER ID Government - County Y 5135064 COUNTRYSIDE CARE & REHABILITATION RUPERT ID Government - County Y 4135010 WEISER OF CASCADIA WEISER ID For profit - Corporation N 4135066 POWER COUNTY NURSING HOME AMERICAN FALLS ID Government - Hospital district Y 4135111 SYRINGA CHALET NURSING FACILITY BLACKFOOT ID Government - State Y 3135116 ROYAL PLAZA HEALTH & REHABILITATION LEWISTON ID For profit - Corporation N 3135056 LINCOLN COUNTY CARE CENTER SHOSHONE ID Government - County N 2135139 RIVERVIEW REHABILITATION BOISE ID For profit - Corporation N 2135015 PAYETTE CENTER PAYETTE ID For profit - Corporation N 2135105 REXBURG CARE & REHABILITATION CENTER REXBURG ID For profit - Corporation N 2135137 PROMONTORY POINT REHABILITATION AMMON ID For profit - Limited Liability company N 1135060 CARIBOU MEMORIAL LIVING CENTER SODA SPRINGS ID Government - City/county Y 1135018 MONTE VISTA HILLS HEALTHCARE CENTER POCATELLO ID For profit - Corporation N 1135019 ORCHARDS OF CASCADIA, THE NAMPA ID For profit - Corporation N 1135051 CANYON WEST OF CASCADIA CALDWELL ID For profit - Corporation N 1135129 DISCOVERY REHABILITATION AND LIVING SALMON ID For profit - Partnership N 1135104 TWIN FALLS CENTER TWIN FALLS ID For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 81: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

145948 BEMENT HEALTH CARE CENTER BEMENT IL For profit - Corporation N 89146176 GLEN SAINT ANDREW LIVING COMM NILES IL For profit - Corporation N 76145981 SWANSEA REHAB HEALTH CARE SWANSEA IL For profit - Corporation N 63146023 ARTHUR HOME, THE ARTHUR IL Non profit - Corporation N 5314E361 ASPEN REHAB & HEALTH CARE SILVIS IL For profit - Corporation N 52145979 GIBSON COMMUNITY HSP ANNEX GIBSON CITY IL Non profit - Other Y 43146084 PLEASANT VIEW REHAB & HCC MORRISON IL For profit - Corporation N 35145266 FONDULAC REHABILITATION & HCC EAST PEORIA IL For profit - Corporation N 35145774 HAVANA HEALTH CARE CENTER HAVANA IL For profit - Corporation N 34145905 JONESBORO REHAB & HCC JONESBORO IL For profit - Corporation N 32145497 THREE SPRINGS LODGE NURSING HOME, LLC CHESTER IL For profit - Individual N 30146039 EASTVIEW TERRACE SULLIVAN IL For profit - Individual N 29146121 BENTON REHAB & HCC BENTON IL For profit - Corporation N 29145418 ROYAL OAKS CARE CENTER KEWANEE IL For profit - Corporation N 28145953 PRAIRIEVIEW LUTHERAN HOME DANFORTH IL Non profit - Corporation N 25145836 SHELBYVILLE REHAB & HLTH C CTR SHELBYVILLE IL For profit - Individual N 23145411 PRAIRIE ROSE HEALTH CARE CTR PANA IL For profit - Corporation N 23146157 ROCK FALLS REHAB & HLTH CARE C ROCK FALLS IL For profit - Corporation N 23145964 MCLEANSBORO REHAB & HLTH C CTR MCLEANSBORO IL For profit - Corporation N 21146117 CASEY HEALTHCARE CENTER CASEY IL For profit - Corporation N 21145406 RANDOLPH COUNTY CARE CENTER SPARTA IL Government - County N 20146111 GOLDEN GOOD SHEPHERD HOME GOLDEN IL Non profit - Corporation N 19145866 HICKORY NURSING PAVILION HICKORY HILLS IL For profit - Corporation N 19146092 INTEGRITY HC OF HERRIN HERRIN IL For profit - Individual N 18145664 WESTSIDE REHAB & CARE CENTER WEST FRANKFORT IL For profit - Corporation N 18145235 LAKEFRONT NURSING & REHAB CTR CHICAGO IL For profit - Corporation N 18145503 DOUGLAS NURSING & REHAB CENTER MATTOON IL For profit - Corporation N 17145921 HITZ MEMORIAL HOME ALHAMBRA IL Non profit - Church related N 17145806 WARREN PARK HEALTH & LIVING CTR CHICAGO IL For profit - Corporation N 17146058 APERION CARE EVANSTON EVANSTON IL For profit - Corporation N 17145478 NOKOMIS REHAB & HEALTH CARE CENTER NOKOMIS IL For profit - Corporation N 17145968 KEWANEE CARE HOME KEWANEE IL For profit - Corporation N 16145877 APERION CARE DOLTON DOLTON IL For profit - Individual N 14145502 TAYLORVILLE CARE CENTER TAYLORVILLE IL For profit - Corporation N 14145631 NEWMAN REHAB & HEALTH CARE CTR NEWMAN IL For profit - Corporation N 14

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 82: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

145879 TRI-STATE NURSING & REHAB CTR LANSING IL For profit - Corporation N 14145757 INTEGRITY HC OF CARBONDALE CARBONDALE IL For profit - Individual N 14145713 MOMENCE MEADOWS NURSING & REHAB MOMENCE IL For profit - Corporation N 13146120 LAHARPE DAVIER HEALTH CARE CTR LA HARPE IL For profit - Corporation N 13145323 CARRIER MILLS NSG & REHAB CTR CARRIER MILLS IL For profit - Corporation N 13145832 RIDGEVIEW REHAB & NURSING CENTER CHICAGO IL For profit - Partnership N 13146106 SCOTT COUNTY NURSING CENTER WINCHESTER IL Government - County N 12146018 LITTLE VILLAGE NRSG & RHB CTR CHICAGO IL For profit - Corporation N 11146135 PLEASANT HILL VILLAGE GIRARD IL Non profit - Church related N 11145924 HELIA HEALTHCARE OF CHAMPAIGN CHAMPAIGN IL For profit - Corporation N 11145987 APERION CARE GALESBURG GALESBURG IL For profit - Corporation N 11145610 BLOOMINGTON REHABILITATION & HCC BLOOMINGTON IL For profit - Corporation N 11145581 AUTUMN MEADOWS OF CAHOKIA CAHOKIA IL For profit - Corporation N 10146002 APERION CARE CAIRO CAIRO IL Non profit - Corporation N 10146032 FAIRVIEW NURSING CENTER DU QUOIN IL For profit - Corporation N 10146103 HENDERSON COUNTY RET CENTER STRONGHURST IL Non profit - Other N 10145765 PARK VIEW REHAB CENTER CHICAGO IL For profit - Corporation N 1014A247 MADO HEALTHCARE - UPTOWN CHICAGO IL For profit - Individual N 10146156 ENFIELD REHAB & HEALTH CARE CT ENFIELD IL For profit - Corporation N 1014E264 APERION CARE LITCHFIELD LITCHFIELD IL For profit - Corporation N 10145939 WATERFRONT TERRACE CHICAGO IL For profit - Corporation N 9146075 GRANITE NURSING & REHABILITATION GRANITE CITY IL For profit - Partnership N 9145367 HERITAGE HEALTH-GILLESPIE GILLESPIE IL For profit - Corporation N 9145947 APERION CARE MIDLOTHIAN MIDLOTHIAN IL For profit - Partnership N 9145785 APERION CARE MASCOUTAH MASCOUTAH IL For profit - Corporation N 9146021 NATURE TRAIL HEALTH CARE CENTER MOUNT VERNON IL For profit - Corporation N 9146013 BERKELEY NURSING & REHAB CENTER OAK PARK IL For profit - Corporation N 8145837 PITTSFIELD MANOR PITTSFIELD IL Non profit - Corporation N 8145660 WESTCHESTER HEALTH & REHABILITATION WESTCHESTER IL For profit - Corporation N 8145719 GENERATIONS AT LINCOLN LINCOLN IL For profit - Corporation N 8145008 DUQUOIN NURSING AND REHAB DU QUOIN IL For profit - Corporation N 8145160 APERION CARE CAPITOL SPRINGFIELD IL For profit - Corporation N 8146057 MONMOUTH NURSING HOME MONMOUTH IL For profit - Corporation N 8145820 HERITAGE HEALTH-MOUNT STERLING MOUNT STERLING IL For profit - Corporation N 8145903 VANDALIA REHAB & HEALTH CARE C VANDALIA IL For profit - Individual N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 83: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

145476 OREGON LIVING AND REHABILITATION CENTER OREGON IL For profit - Corporation N 7145717 INTEGRITY HC OF COLUMBIA COLUMBIA IL For profit - Corporation N 7145728 MANOR COURT OF MARYVILLE MARYVILLE IL Non profit - Corporation N 7146017 ILLINI HERITAGE REHAB & HC CHAMPAIGN IL For profit - Corporation N 7146161 SOUTHVIEW MANOR NURSING CENTER CHICAGO IL For profit - Individual N 7145136 AUBURN REHAB & HCC AUBURN IL For profit - Corporation N 7145658 APERION CARE PLUM GROVE PALATINE IL For profit - Corporation N 6146147 WAVERLY PLACE OF STOCKTON STOCKTON IL For profit - Partnership N 6145417 UNITED METHODIST VILLAGE, THE LAWRENCEVILLE IL Non profit - Corporation N 6146115 NEW ATHENS HOME FOR THE AGED NEW ATHENS IL Non profit - Church related N 6146123 ST JOSEPH NURSING HOME LACON IL Non profit - Church related N 6146124 CARMI MANOR REHAB & NRSG CTR CARMI IL For profit - Partnership N 6146170 ASBURY GARDENS NSG & REHAB NORTH AURORA IL For profit - Corporation N 614E579 ROCK RIVER GARDENS STERLING IL For profit - Corporation N 6146146 HAMILTON MEMORIAL REHAB & HCC MCLEANSBORO IL For profit - Corporation N 6146134 SALINE CARE NURSING & REHAB HARRISBURG IL For profit - Corporation N 5145918 APERION CARE BRIDGEPORT BRIDGEPORT IL For profit - Partnership N 5145857 APERION CARE ST ELMO ST ELMO IL For profit - Corporation N 5145413 APERION CARE TOLUCA TOLUCA IL For profit - Corporation N 5145620 MERCY REHAB AND CARE CENTER SWANSEA IL For profit - Corporation N 5145430 CHRISTIAN NURSING HOME LINCOLN IL Non profit - Corporation N 5145400 WESTMINSTER VILLAGE BLOOMINGTON IL Non profit - Corporation N 5145248 APERION CARE MORTON VILLA MORTON IL For profit - Individual N 5145414 PRAIRIE CROSSING LVG & REHAB SHABBONA IL For profit - Corporation N 4145387 ST ANTHONY'S NRSG & REHAB CENTER ROCK ISLAND IL For profit - Corporation N 4145316 APERION CARE WILMINGTON WILMINGTON IL For profit - Partnership N 4145518 MAR KA NURSING HOME MASCOUTAH IL For profit - Corporation N 4145978 SHAWNEE ROSE CARE CENTER HARRISBURG IL For profit - Corporation N 4146089 GOOD SAMARITAN - FLANAGAN FLANAGAN IL Non profit - Corporation N 4146056 PRESENCE HERITAGE VILLAGE KANKAKEE IL Non profit - Church related N 4145965 GENERATIONS AT MCKINLEY COURT DECATUR IL For profit - Corporation N 4145886 ALEDO REHAB & HEALTH CARE CENTER ALEDO IL For profit - Partnership N 414E717 BETHALTO CARE CENTER BETHALTO IL For profit - Corporation N 414E257 INTEGRITY HC OF SMITHTON SMITHTON IL For profit - Individual N 4145371 APERION CARE BLOOMINGTON BLOOMINGTON IL For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 84: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

145273 JACKSONVILLE SKILLED NURSING & REHAB JACKSONVILLE IL For profit - Corporation N 4145862 HILLTOP SKILLED NURSING AND REHABILITATION CHARLESTON IL For profit - Corporation N 4145922 INTEGRITY HC OF COBDEN COBDEN IL For profit - Individual N 4145891 ROSEWOOD CARE CENTER OF ROCKFORD ROCKFORD IL For profit - Corporation N 4146051 BARRY COMMUNITY CARE CENTER BARRY IL For profit - Individual N 4146042 H & J VONDERLIETH LVG CTR, THE MOUNT PULASKI IL Non profit - Corporation N 4146142 MERIDIAN VILLAGE CARE CENTER GLEN CARBON IL Non profit - Church related N 414E392 WEST CHICAGO TERRACE NH WEST CHICAGO IL For profit - Partnership N 4146175 PINCKNEYVILLE NURSING & REHAB PINCKNEYVILLE IL For profit - Corporation N 314E847 APERION CARE SPRINGFIELD SPRINGFIELD IL For profit - Partnership N 3145909 GREENVILLE NURSING & REHAB GREENVILLE IL For profit - Corporation N 3146088 HELIA HEALTHCARE OF BENTON BENTON IL For profit - Corporation N 3146104 FARMER CITY REHAB & HEALTHCARE FARMER CITY IL For profit - Corporation N 3145880 HILLVIEW HEALTH CARE CENTER VIENNA IL Non profit - Church related N 3145818 ROCK RIVER HEALTH CARE ROCKFORD IL For profit - Corporation N 3145628 EVERGREEN NURSING & REHAB CENTER EFFINGHAM IL For profit - Corporation N 3145640 CHURCH CREEK ARLINGTON HTS IL For profit - Corporation N 3145289 HELIA HEALTHCARE OF BELLEVILLE BELLEVILLE IL For profit - Corporation N 3145942 OAK LAWN RESPIRATORY & REHAB OAK LAWN IL For profit - Corporation N 3145671 VILLA AT SOUTH HOLLAND, THE SOUTH HOLLAND IL For profit - Partnership N 3146020 ROSEVILLE REHAB & HEALTH CARE ROSEVILLE IL For profit - Corporation N 314E095 BATAVIA REHABILITATION & HEALTH CARE CENTER BATAVIA IL For profit - Corporation N 3146080 COUNTRYVIEW CARE CENTER-MACOMB MACOMB IL For profit - Corporation N 3145294 PRAIRIE VILLAGE HEALTHCARE CTR JACKSONVILLE IL For profit - Corporation N 3145410 BREESE NURSING HOME BREESE IL For profit - Corporation N 2145267 HERITAGE HEALTH-PANA PANA IL For profit - Corporation N 2145278 CITADEL OF STERLING,THE STERLING IL For profit - Partnership N 2145471 MONTEBELLO HEALTHCARE CENTER HAMILTON IL For profit - Corporation N 2145479 ATRIUM HEALTH CARE CENTER CHICAGO IL For profit - Corporation N 2145508 HIGHLAND HEALTH CARE CENTER HIGHLAND IL For profit - Corporation N 2145514 EFFINGHAM REHAB & HEALTH CARE CTR EFFINGHAM IL For profit - Corporation N 2145515 FREEBURG CARE CENTER FREEBURG IL For profit - Corporation N 2145613 BRIA OF CAHOKIA CAHOKIA IL For profit - Corporation N 2145601 AVISTON COUNTRYSIDE MANOR AVISTON IL For profit - Individual N 2145173 HEATHER HEALTH CARE CENTER HARVEY IL For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 85: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

146174 MERCY CIRCLE CHICAGO IL Non profit - Church related N 2146131 CISNE REHABILITATION & HEALTH CENTER CISNE IL For profit - Corporation N 2146140 GALENA STAUSS NURSING HOME GALENA IL Non profit - Corporation N 2145769 FRIENDSHIP SKILLED NSG & REHAB CARLINVILLE IL For profit - Corporation N 2145828 ESTATES OF HYDE PARK, THE CHICAGO IL For profit - Partnership N 2145850 CITY VIEW MULTICARE CENTER CICERO IL For profit - Partnership N 2145722 UNITED METHODIST VILLAGE, NORTH CAMPUS LAWRENCEVILLE IL Non profit - Corporation N 2145661 SYMPHONY OF CHICAGO WEST CHICAGO IL For profit - Partnership N 2145440 GENERATIONS AT NEIGHBORS BYRON IL For profit - Partnership N 2145483 MONTGOMERY NURSING & REHAB CTR HILLSBORO IL For profit - Corporation N 2145564 TRINITY MEDICAL CENTER - WEST ROCK ISLAND IL Non profit - Corporation Y 2145827 BRITISH HOME, THE BROOKFIELD IL Non profit - Corporation N 2146078 PERSHING GARDENS HEALTHCARE CENTER STICKNEY IL For profit - Corporation N 2146054 GALLATIN MANOR RIDGWAY IL For profit - Individual N 2146010 ACCOLADE HEALTHCARE OF PONTIAC PONTIAC IL For profit - Corporation N 2146048 MEADOW MANOR SKILLED NURSING & REHAB TAYLORVILLE IL For profit - Corporation N 2146040 WILLOW ROSE REHAB & HEALTH JERSEYVILLE IL For profit - Corporation N 2146041 APERION CARE MOLINE EAST MOLINE IL For profit - Corporation N 1146030 HEARTLAND CHRISTIAN VILLAGE NEOGA IL Non profit - Church related N 1146038 PRAIRIE CITY REHAB & H C PRAIRIE CITY IL For profit - Corporation N 1146043 FRIENDSHIP MANOR HEALTH CARE NASHVILLE IL For profit - Corporation N 1145906 DIXON REHAB & HCC DIXON IL For profit - Individual N 1145967 WINDSOR ESTATES NSG & REHAB COUNTRY CLUB HILLS IL For profit - Individual N 1146005 ACCOLADE HEALTHCARE OF PAXTON PAXTON IL For profit - Corporation N 1146068 SUNNY ACRES NURSING HOME PETERSBURG IL Government - County N 1145834 GENERATIONS AT COLUMBUS PARK CHICAGO IL For profit - Partnership N 1145789 GOOD SAMARITAN SOCIETY - GENESEO VILLAGE GENESEO IL Non profit - Church related N 1145928 APERION CARE JACKSONVILLE JACKSONVILLE IL For profit - Corporation N 1145930 GOOD SAMARITAN - PONTIAC PONTIAC IL Non profit - Other N 1145427 INTEGRITY HC OF ALTON ALTON IL For profit - Individual N 1145431 SELECT POST ACUTE CARE EUREKA IL For profit - Corporation N 1145663 ELMWOOD TERRACE HEALTHCARE CTR AURORA IL For profit - Corporation N 1145744 HERITAGE HEALTH-MINONK MINONK IL For profit - Corporation N 1145654 LAKEVIEW REHAB & NURSING CENTER CHICAGO IL For profit - Corporation N 1146139 REGENCY CARE SPRINGFIELD IL For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 86: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

14A289 LITTLE SISTERS OF THE POOR CHICAGO IL Non profit - Corporation N 114E247 JOLIET TERRACE NURSING CENTER JOLIET IL For profit - Individual N 1145384 EDEN VILLAGE CARE CENTER GLEN CARBON IL Non profit - Corporation N 1145388 HELIA HEALTHCARE OF OLNEY OLNEY IL For profit - Corporation N 1145416 HEARTLAND MANOR NURSING CENTER CASEY IL Non profit - Corporation N 1145347 GILMAN HEALTHCARE CENTER GILMAN IL For profit - Corporation N 1145200 FRANKLIN GROVE LIVING AND REHAB FRANKLIN GROVE IL For profit - Corporation N 1145213 WYNSCAPE HEALTH & REHAB WHEATON IL For profit - Corporation N 1145222 CROSSROADS CARE CTR WOODSTOCK WOODSTOCK IL For profit - Corporation N 1145239 CORNERSTONE REHAB & HC PEORIA HEIGHTS IL For profit - Corporation N 1145247 DOCTORS NURSING AND REHAB CENTER SALEM IL For profit - Corporation N 1145271 HERITAGE HEALTH-LITCHFIELD LITCHFIELD IL For profit - Corporation N 1145885 MAYFIELD HEALTH CENTER CHICAGO IL For profit - Corporation N 1145838 PETERSON PARK HEALTH CARE CTR CHICAGO IL For profit - Corporation N 1145897 LEBANON CARE CENTER LEBANON IL For profit - Corporation N 1145933 APOSTOLIC CHRISTIAN SKYLINES PEORIA IL Non profit - Church related N 1145729 CARLYLE HEALTHCARE CENTER CARLYLE IL For profit - Corporation N 1145720 ST CLARA'S REHAB & SENIOR CARE LINCOLN IL Non profit - Corporation N 1145674 LEROY MANOR LE ROY IL Non profit - Corporation N 1145686 APERION CARE MORTON TERRACE MORTON IL For profit - Corporation N 1145688 PRINCETON REHAB & HCC CHICAGO IL For profit - Corporation N 1145692 FLORA REHAB & HEALTH CARE CTR FLORA IL For profit - Corporation N 1145703 ILLINI RESTORATIVE CARE SILVIS IL Non profit - Corporation N 1145714 PARAMOUNT OAK PARK R & N CTR OAK PARK IL For profit - Corporation N 1145715 WHEATON CARE CENTER WHEATON IL For profit - Partnership N 1146168 WINFIELD WOODS HEALTHCARE CTR WINFIELD IL For profit - Corporation N 114E212 FRANKFORT TERRACE NURSING CTR FRANKFORT IL For profit - Corporation N 1146129 MARIANJOY REHABILITATION HOSPITAL-SNF WHEATON IL Non profit - Corporation Y 1146113 CUMBERLAND REHAB & HEALTH CC GREENUP IL For profit - Individual N 1146114 LENA LIVING CENTER LENA IL For profit - Corporation N 1146119 MEADOWOOD GRAYVILLE IL For profit - Corporation N 1145975 ROCHELLE REHAB & HEALTH CARE CENTER ROCHELLE IL For profit - Corporation N 1146060 FAITH CARE CENTER HIGHLAND IL Non profit - Corporation N 1146095 EVENGLOW LODGE PONTIAC IL Non profit - Church related N 1146049 IROQUOIS RESIDENT HOME, THE WATSEKA IL Non profit - Corporation Y 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 87: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

145219 BURGESS SQUARE HEALTHCARE CTR WESTMONT IL For profit - Partnership N 1145234 PEARL PAVILION FREEPORT IL For profit - Corporation N 1145603 HEARTLAND OF PAXTON PAXTON IL For profit - Corporation N 1145657 PROVIDENCE DOWNERS GROVE DOWNERS GROVE IL Non profit - Corporation N 1145546 HERITAGE HEALTH-MOUNT ZION MOUNT ZION IL For profit - Corporation N 1145585 CASEYVILLE NURSING & REHAB CTR CASEYVILLE IL For profit - Corporation N 1145486 APERION CARE SPRING VALLEY SPRING VALLEY IL For profit - Corporation N 1145449 ACCOLADE PAXTON SENIOR LIVING PAXTON IL For profit - Individual N 1145456 HERITAGE HEALTH-CARLINVILLE CARLINVILLE IL For profit - Corporation N 1145464 HAMMOND-HENRY DISTRICT HSP GENESEO IL Government - Hospital district Y 1145319 HERITAGE HEALTH-EL PASO EL PASO IL For profit - Corporation N 1145370 SULLIVAN REHAB & HLTH CARE CTR SULLIVAN IL For profit - Corporation N 1155019 GARDEN VILLA - BLOOMINGTON BLOOMINGTON IN Non profit - Corporation N 80155847 SILVER MEMORIES HEALTH CARE VERSAILLES IN Non profit - Corporation N 39155388 CORE OF BEDFORD BEDFORD IN Non profit - Corporation N 30155266 LIFE CARE CENTER OF FORT WAYNE FORT WAYNE IN For profit - Corporation N 26155359 PREMIER HEALTHCARE OF FORT WAYNE FORT WAYNE IN Non profit - Corporation N 25155630 FLATROCK RIVER LODGE RUSHVILLE IN Government - City/county N 25155729 ADAMS HERITAGE MONROEVILLE IN Government - City/county N 24155665 PREMIER HEALTHCARE OF NORTH VERNON NORTH VERNON IN For profit - Corporation N 24155721 LAWRENCE MANOR HEALTHCARE CENTER INDIANAPOLIS IN Government - Hospital district N 23155625 ARBOR GROVE VILLAGE GREENSBURG IN Non profit - Corporation N 23155636 HARRISON TERRACE INDIANAPOLIS IN Government - County N 22155571 MILLER'S MERRY MANOR DUNKIRK IN For profit - Corporation N 22155135 WESTVIEW NURSING AND REHABILITATION CENTER BEDFORD IN Government - County N 22155428 MERIDIAN NURSING AND REHABILITATION CENTER INDIANAPOLIS IN Government - County N 21155741 FAIRWAY VILLAGE INDIANAPOLIS IN Government - County N 2015E064 BROOKSIDE HAVEN HEALTH CARE CENTER MUNCIE IN For profit - Corporation N 19155322 RENAISSANCE VILLAGE FORT WAYNE IN For profit - Corporation Y 19155501 SIGNATURE HEALTHCARE OF BLUFFTON BLUFFTON IN For profit - Corporation N 19155389 WESTPARK A WATERS COMMUNITY INDIANAPOLIS IN Government - County N 19155149 HARCOURT TERRACE NURSING AND REHABILITATION INDIANAPOLIS IN For profit - Corporation N 18155851 ORCHARD POINTE HEALTH CAMPUS KENDALLVILLE IN For profit - Corporation N 17155362 GOLDEN LIVING CENTER-MERRILLVILLE MERRILLVILLE IN For profit - Corporation N 17155234 WESTRIDGE HEALTH CARE CENTER TERRE HAUTE IN Government - County N 17

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 88: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155029 COMMUNITY NURSING AND REHABILITATION CENTER INDIANAPOLIS IN For profit - Corporation N 16155496 VALLEY VIEW HEALTHCARE CENTER ELKHART IN Non profit - Corporation N 16155061 WOODLAND HILLS CARE CENTER LAWRENCEBURG IN Government - County N 16155267 LAKE POINTE VILLAGE SCOTTSBURG IN For profit - Corporation N 15155176 GLENBROOK REHABILITATION & SKILLED NURSING CENTER FORT WAYNE IN Government - County N 15155627 MILLER'S MERRY MANOR WABASH IN For profit - Corporation N 14155839 SUMMIT CONVALESCENT CENTER SUMMITVILLE IN For profit - Corporation N 14155159 SUMMIT CITY NURSING AND REHABILITATION FORT WAYNE IN Government - County N 14155719 GEORGE ADE MEMORIAL HEALTH CARE CENTER BROOK IN Government - County N 14155124 VERMILLION CONVALESCENT CENTER CLINTON IN Government - County N 13155352 ELKHART REHABILITATION CENTER ELKHART IN Government - Hospital district N 13155219 SIGNATURE HEALTHCARE OF SOUTH BEND SOUTH BEND IN For profit - Corporation N 13155325 MEADOW VIEW HEALTH AND REHABILITATION SALEM IN Government - County N 13155343 LIFE CARE CENTER OF LAGRANGE LAGRANGE IN For profit - Corporation N 12155443 WATERS OF MUNCIE, THE MUNCIE IN Government - City/county N 12155109 GOLDEN LIVING CENTER-MISHAWAKA MISHAWAKA IN Government - County N 12155727 STONEBRIDGE HEALTH CAMPUS BEDFORD IN For profit - Corporation N 12155162 AUTUMN RIDGE REHABILITATION CENTRE WABASH IN Government - County N 12155711 CAPITOL VILLAGE INDIANAPOLIS IN For profit - Corporation N 12155681 AUTUMN WOODS HEALTH CAMPUS NEW ALBANY IN Government - County N 12155581 MILLER'S MERRY MANOR SYRACUSE IN Government - County N 11155521 ALEXANDRIA CARE CENTER ALEXANDRIA IN Government - County N 11155400 LIBERTY VILLAGE MUNCIE IN Government - County N 11155480 BROOKVILLE HEALTHCARE CENTER BROOKVILLE IN Government - County N 11155855 MCGIVNEY HEALTH CARE CENTER CARMEL IN Non profit - Other N 11155402 HERITAGE HEALTHCARE WEST LAFAYETTE IN For profit - Corporation N 11155804 SPRENGER HEALTH CARE OF MISHAWAKA MISHAWAKA IN For profit - Corporation N 11155507 WHITEWATER COMMONS SENIOR LIVING LIBERTY IN Non profit - Corporation N 11155444 NORWOOD HEALTH AND REHABILITATION CENTER HUNTINGTON IN For profit - Corporation N 10155568 WILLIAMSPORT NURSING AND REHABILITATION WILLIAMSPORT IN Government - County N 10155392 HICKORY CREEK AT KENDALLVILLE KENDALLVILLE IN Government - County N 10155383 WASHINGTON HEALTHCARE CENTER INDIANAPOLIS IN Non profit - Corporation N 10155249 SIGNATURE HEALTHCARE OF FORT WAYNE FORT WAYNE IN For profit - Corporation N 10155527 PINEKNOLL REHABILITATION CENTRE WINCHESTER IN Non profit - Corporation N 10155699 BRIDGEWATER REHABILITATION CENTRE HARTFORD CITY IN Government - County N 10

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 89: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155717 ALPHA HOME - A WATERS COMMUNITY INDIANAPOLIS IN Government - County N 9155650 LINCOLNSHIRE HEALTH & REHABILITATION CENTER MERRILLVILLE IN For profit - Corporation N 9155655 PEABODY RETIREMENT COMMUNITY NORTH MANCHESTER IN Non profit - Other N 9155511 TERRE HAUTE NURSING AND REHABILITATION CENTER TERRE HAUTE IN Non profit - Other N 9155358 MEADOWS MANOR EAST TERRE HAUTE IN Government - County N 9155526 PERSIMMON RIDGE REHABILITATION CENTRE PORTLAND IN Government - County N 9155850 BELLTOWER HEALTH & REHABILITATION CENTER GRANGER IN For profit - Corporation N 9155328 PARK TERRACE VILLAGE EVANSVILLE IN Government - County N 9155120 GOLDEN LIVING CENTER-BRANDYWINE GREENFIELD IN For profit - Corporation N 9155254 SUGAR CREEK REHABILITATION AND CONVALESCENT CENTER GREENFIELD IN For profit - Corporation N 9155283 WINTERSONG VILLAGE KNOX IN Government - County N 8155211 WATERS OF LEBANON, THE LEBANON IN Government - County N 8155327 UNIVERSITY HEIGHTS HEALTH AND LIVING COMMUNITY INDIANAPOLIS IN Non profit - Corporation N 8155508 TRANSCENDENT HEALTHCARE OF BOONVILLE BOONVILLE IN For profit - Individual N 8155822 CEDAR CREEK HEALTH CAMPUS LOWELL IN Government - County Y 8155531 OAKBROOK VILLAGE HUNTINGTON IN Government - County N 8155495 LAKELAND REHABILITATION AND HEALTHCARE CENTER MILFORD IN Government - County N 8155766 MAPLE MANOR CHRISTIAN HOME INC SELLERSBURG IN Non profit - Corporation N 8155132 DANVILLE REGIONAL REHABILITATION DANVILLE IN Government - County N 8155567 UNIVERSITY PARK HEALTH AND REHABILITATION CENTER FORT WAYNE IN For profit - Corporation N 8155546 BETHEL POINTE HEALTH AND REHAB MUNCIE IN For profit - Corporation N 8155477 LANE HOUSE CRAWFORDSVILLE IN For profit - Corporation N 8155473 CHALET VILLAGE HEALTH AND REHABILITATION CENTER BERNE IN Government - County N 8155695 RIVERSIDE VILLAGE ELKHART IN Non profit - Corporation N 8155767 SPRINGHURST HEALTH CAMPUS GREENFIELD IN For profit - Corporation N 8155746 PARKVIEW HAVEN FRANCESVILLE IN Government - City/county N 7155816 ARLINGTON PLACE HEALTH CAMPUS INDIANAPOLIS IN Government - County N 7155854 NORTH RIVER HEALTH CAMPUS EVANSVILLE IN For profit - Corporation N 7155688 FREELANDVILLE COMMUNITY HOME FREELANDVILLE IN Non profit - Corporation N 7155738 MILTON HOME, THE SOUTH BEND IN For profit - Individual N 7155676 MILNER COMMUNITY HEALTH CARE ROSSVILLE IN Non profit - Corporation N 7155464 ROCKVILLE NURSING AND REHABILITATION CENTER ROCKVILLE IN For profit - Corporation N 7155530 SOUTH SHORE HEALTH & REHABILITATION CENTER GARY IN Government - County N 7155419 HICKORY CREEK AT CRAWFORDSVILLE CRAWFORDSVILLE IN For profit - Corporation N 7155580 APERION CARE TOLLESTON PARK GARY IN Government - City/county N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 90: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155483 WATERS OF RISING SUN, THE RISING SUN IN Government - County N 7155270 CORE OF DALE DALE IN Non profit - Other N 7155387 CAROLETON MANOR CONNERSVILLE IN For profit - Corporation N 6155572 APERION CARE DEMOTTE DEMOTTE IN For profit - Corporation N 6155690 LINDBERG CROSSING SENIOR LIVING ANDERSON IN Government - County N 6155704 WALDRON HEALTH AND REHAB CENTER WALDRON IN For profit - Corporation N 6155799 MARION REHABILITATION AND ASSISTED LIVING CENTER MARION IN For profit - Corporation N 6155331 LIFE CARE CENTER OF VALPARAISO VALPARAISO IN For profit - Corporation N 6155332 HERITAGE HOUSE REHABILITATION & HEALTH CARE CENTER CONNERSVILLE IN Government - County N 6155459 HICKORY CREEK AT NEW CASTLE NEW CASTLE IN Non profit - Corporation N 6155448 LOWELL HEALTHCARE LOWELL IN Government - County N 6155682 WOODMONT HEALTH CAMPUS BOONVILLE IN Non profit - Other N 6155791 BLAIR RIDGE HEALTH CAMPUS PERU IN Government - County N 6155838 STONECROFT HEALTH CAMPUS BLOOMINGTON IN For profit - Corporation N 5155661 OWEN VALLEY HEALTH CAMPUS SPENCER IN Non profit - Corporation N 5155486 MIDDLETOWN NURSING AND REHABILITATION CENTER MIDDLETOWN IN For profit - Corporation N 5155570 PLEASANT VIEW LODGE MC CORDSVILLE IN Government - County N 5155338 MANORCARE HEALTH SERVICES - PRESTWICK AVON IN For profit - Corporation N 5155329 ROSEWALK VILLAGE INDIANAPOLIS IN Government - City/county N 5155118 MILLER'S MERRY MANOR LAGRANGE IN For profit - Corporation N 5155815 CLEARVISTA LAKE HEALTH CAMPUS INDIANAPOLIS IN For profit - Corporation N 5155852 HARRISON SPRINGS HEALTH CAMPUS CORYDON IN For profit - Corporation N 5155831 BRIARCLIFF HEALTH & REHABILITATION CENTER SOUTH BEND IN Non profit - Corporation N 5155846 GREEN HOUSE COTTAGES OF CARMEL CARMEL IN For profit - Partnership N 5155687 GOLDEN LIVING CENTER-MUNCIE MUNCIE IN For profit - Corporation N 5155298 PYRAMID POINT POST-ACUTE REHABILITATION CENTER INDIANAPOLIS IN For profit - Corporation N 5155361 AMBER MANOR CARE CENTER PETERSBURG IN For profit - Corporation N 5155233 WATERS OF BATESVILLE, THE BATESVILLE IN Non profit - Corporation N 5155236 AVON HEALTH & REHABILITATION CENTER AVON IN Non profit - Corporation N 5155128 MILLER'S AT OAK POINTE COLUMBIA CITY IN For profit - Corporation N 5155206 BROWNSBURG HEALTH CARE CENTER BROWNSBURG IN Non profit - Corporation N 5155148 NORTH PARK NURSING CENTER EVANSVILLE IN Government - County N 4155406 HICKORY CREEK AT PERU PERU IN Government - County N 4155430 HICKORY CREEK AT ROCHESTER ROCHESTER IN Government - County N 4155512 PRESENCE SACRED HEART HOME AVILLA IN Non profit - Church related N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 91: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155458 HIGHLAND NURSING AND REHABILITATION CENTER HIGHLAND IN For profit - Corporation N 4155620 ZIONSVILLE MEADOWS ZIONSVILLE IN Government - County N 4155736 MILL POND HEALTH CAMPUS GREENCASTLE IN For profit - Corporation N 4155842 SPRINGS OF MOORESVILLE, THE MOORESVILLE IN For profit - Corporation N 4155811 WELLBROOKE OF AVON INDIANAPOLIS IN For profit - Corporation N 4155183 WATERS OF MARTINSVILLE, THE MARTINSVILLE IN Non profit - Corporation N 4155188 GREENFIELD HEALTHCARE CENTER GREENFIELD IN Non profit - Corporation N 4155423 HAMMOND-WHITING CARE CENTER WHITING IN For profit - Corporation N 4155312 INDIAN CREEK HEALTHCARE CENTER CORYDON IN For profit - Corporation N 4155379 LIFE CARE CENTER OF ROCHESTER ROCHESTER IN For profit - Corporation N 4155557 MILLER'S MERRY MANOR INDIANAPOLIS IN For profit - Corporation N 4155401 BEN HUR HEALTH AND REHABILITATION CRAWFORDSVILLE IN Government - County N 4155474 SIGNATURE HEALTHCARE OF BREMEN BREMEN IN For profit - Corporation N 4155848 ENMOTION RECOVERY CARE DANVILLE IN Government - County Y 4155805 ADDISON POINTE HEALTH & REHABILITATION CENTER CHESTERTON IN Non profit - Corporation N 415E683 MORGANTOWN HEALTH CARE MORGANTOWN IN Government - City/county N 3155475 TOWNE HOUSE RETIREMENT COMMUNITY FORT WAYNE IN Non profit - Corporation N 3155427 HICKORY CREEK AT MADISON MADISON IN Government - County N 3155434 HICKORY CREEK AT CONNERSVILLE CONNERSVILLE IN Government - County N 3155578 MILLER'S MERRY MANOR NEW CARLISLE IN For profit - Corporation N 3155685 GOLDEN LIVING CENTER-ELKHART ELKHART IN For profit - Corporation N 3155381 HARBOUR MANOR HEALTH & LIVING COMMUNITY NOBLESVILLE IN For profit - Corporation N 3155378 SIGNATURE HEALTHCARE AT PARKWOOD LEBANON IN For profit - Corporation N 3155385 CAMELOT CARE CENTER LOGANSPORT IN Government - County N 3155271 MILLER'S SENIOR LIVING COMMUNITY INDIANAPOLIS IN For profit - Corporation N 3155215 PLAINFIELD HEALTH CARE CENTER PLAINFIELD IN Non profit - Corporation N 3155166 VALPARAISO CARE & REHABILITATION VALPARAISO IN Non profit - Corporation N 3155754 HUBBARD HILL ESTATES INC ELKHART IN Non profit - Corporation N 3155826 EVERGREEN CROSSING AND THE LOFTS INDIANAPOLIS IN For profit - Corporation N 315A011 ESPECIALLY KIDZ HEALTH & REHAB SHELBYVILLE IN Government - County N 3155772 COBBLESTONE CROSSINGS HEALTH CAMPUS TERRE HAUTE IN Government - County N 3155710 CHASE CENTER LOGANSPORT IN Government - County N 3155368 TODD-DICKEY NURSING AND REHABILITATION LEAVENWORTH IN Government - County N 3155208 HANOVER NURSING CENTER HANOVER IN Government - County N 3155237 BETHANY VILLAGE INDIANAPOLIS IN Government - County N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 92: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155253 MEADOWOOD HEALTH PAVILION BLOOMINGTON IN For profit - Corporation N 3155275 WATERS OF PRINCETON, THE PRINCETON IN For profit - Corporation N 2155263 LOOGOOTEE NURSING CENTER LOOGOOTEE IN Government - City/county N 2155269 EAST LAKE NURSING & REHABILITATION CENTER ELKHART IN Government - County N 2155295 CLINTON HOUSE HEALTH AND REHAB CENTER FRANKFORT IN For profit - Corporation N 2155376 PREMIER HEALTHCARE OF SHERIDAN SHERIDAN IN For profit - Corporation N 2155417 HICKORY CREEK AT SCOTTSBURG SCOTTSBURG IN Government - County N 2155323 LAKEVIEW VILLAGE SENIOR LIVING MONTICELLO IN Government - County N 2155472 HOOSIER VILLAGE INDIANAPOLIS IN Non profit - Corporation N 2155503 EXCEPTIONAL LIVING CENTER OF BRAZIL BRAZIL IN Non profit - Corporation N 2155506 SANCTUARY AT HOLY CROSS SOUTH BEND IN Non profit - Corporation N 2155519 GENTLECARE OF VINCENNES VINCENNES IN Government - County N 2155432 ALBANY HEALTH CARE & REHABILITATION CENTER ALBANY IN Government - City/county N 2155488 ROLLING HILLS HEALTHCARE CENTER NEW ALBANY IN Non profit - Corporation N 2155680 HOMEWOOD HEALTH CAMPUS LEBANON IN Non profit - Corporation N 2155686 GOLDEN LIVING CENTER-KNOX KNOX IN For profit - Corporation N 2155774 MILLER'S MERRY MANOR LOGANSPORT IN For profit - Corporation N 2155779 PRAIRIE LAKES HEALTH CAMPUS NOBLESVILLE IN Non profit - Corporation N 2155535 WILLOW CROSSING HEALTH & REHABILITATION CENTER COLUMBUS IN Government - County N 2155604 SAINT ANTHONY REHAB AND NURSING CENTER LAFAYETTE IN For profit - Corporation N 2155617 MILLER'S MERRY MANOR CHESTERFIELD IN For profit - Corporation N 215E247 ST PAUL HERMITAGE LLC BEECH GROVE IN Non profit - Church related N 2155806 WELLBROOKE OF WABASH WABASH IN For profit - Corporation N 2155807 RURAL HEALTH CARE CENTER INDIANAPOLIS IN For profit - Corporation N 2155823 SOUTHPOINTE HEALTHCARE CENTER INDIANAPOLIS IN For profit - Corporation N 2155160 STONEBROOKE REHABILITATION CENTER NEW CASTLE IN Government - County N 2155022 HERITAGE HOUSE OF SHELBYVILLE SHELBYVILLE IN Government - City/county N 2155038 WATERS EDGE VILLAGE MUNCIE IN Government - County N 2155291 EAGLE VALLEY MEADOWS INDIANAPOLIS IN Government - County N 2155355 WEST BEND NURSING AND REHABILITATION SOUTH BEND IN Non profit - Corporation N 2155375 GOLDEN LIVING CENTER-PETERSBURG PETERSBURG IN For profit - Corporation N 2155697 CLARK REHABILITATION AND SKILLED NURSING CENTER CLARKSVILLE IN For profit - Corporation N 2155740 TIMBERCREST CHURCH OF THE BRETHREN HOME NORTH MANCHESTER IN Non profit - Church related N 2155543 HICKORY CREEK AT HUNTINGTON HUNTINGTON IN Government - County N 2155679 BETHLEHEM WOODS NURSING AND REHABILITATION FORT WAYNE IN Government - State N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 93: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155583 MILLER'S MERRY MANOR GARRETT IN For profit - Corporation N 2155587 SUMMERFIELD HEALTH CARE CENTER CLOVERDALE IN For profit - Corporation N 2155607 BETHEL MANOR EVANSVILLE IN Government - County N 2155573 MILLER'S MERRY MANOR MIDDLETOWN IN For profit - Corporation N 2155489 PARKER HEALTH CARE & REHABILITATION CENTER PARKER CITY IN Government - City/county N 2155522 COMMUNITY PARKVIEW HEALTH AND LIVING ELWOOD IN Non profit - Corporation N 2155757 ROSEGATE VILLAGE INDIANAPOLIS IN Government - County N 2155760 WATERFORD CROSSING GOSHEN IN Government - County N 2155764 SPRING MILL HEALTH CAMPUS MERRILLVILLE IN For profit - Corporation N 2155849 RIVER TERRACE HEALTH CAMPUS MADISON IN For profit - Corporation N 2155833 WELLBROOKE OF CARMEL CARMEL IN For profit - Partnership N 1155751 MEADOW LAKES MOORESVILLE IN Non profit - Corporation N 1155810 VERNON HEALTH & REHABILITATION WABASH IN Non profit - Corporation N 1155768 EVANSVILLE PROTESTANT HOME INC EVANSVILLE IN Non profit - Corporation N 1155523 RICHLAND BEAN BLOSSOM HEALTH CARE CENTER ELLETTSVILLE IN Non profit - Corporation N 1155539 BERTHA D GARTEN KETCHAM MEMORIAL CENTER ODON IN Non profit - Other N 1155494 WATERS OF SCOTTSBURG, THE SCOTTSBURG IN For profit - Corporation N 1155561 GOOD SAMARITAN HOME & REHABILITATIVE CENTER OAKLAND CITY IN For profit - Corporation N 1155564 MILLER'S MERRY MANOR MOORESVILLE IN For profit - Corporation N 1155549 WILLOWBEND LIVING CENTER MUNCIE IN Government - County N 1155436 HICKORY CREEK AT WINAMAC WINAMAC IN For profit - Corporation N 1155441 CORYDON NURSING AND REHABILITATION CENTER CORYDON IN For profit - Corporation N 1155449 NORTHERN LAKES NURSING AND REHABILITATION CENTER ANGOLA IN Government - Hospital district N 1155469 SEBO'S NURSING AND REHABILITATION CENTER HOBART IN Government - City N 1155481 ARBOR TRACE HEALTH & LIVING COMMUNITY RICHMOND IN For profit - Corporation N 1155657 HARRISON HEALTHCARE CENTER CORYDON IN Non profit - Corporation N 1155675 MORNING BREEZE RETIREMENT COMMUNITY AND HEALTHCARE GREENSBURG IN Non profit - Corporation N 1155582 MILLER'S MERRY MANOR WAKARUSA IN For profit - Corporation N 1155653 LAKE COUNTY NURSING AND REHABILITATION CENTER EAST CHICAGO IN For profit - Corporation N 1155745 HOLY CROSS VILLAGE AT NOTRE DAME INC NOTRE DAME IN Non profit - Corporation N 1155728 MANDERLEY HEALTH CARE CENTER OSGOOD IN Government - City/county N 1155691 MORRISTOWN MANOR MORRISTOWN IN For profit - Corporation N 1155373 BLUFFTON REGIONAL MEDICAL CENTER CARE CENTER BLUFFTON IN For profit - Individual Y 1155424 HICKORY CREEK AT COLUMBUS COLUMBUS IN Government - County N 1155330 SALEM CROSSING SALEM IN Non profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 94: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155349 SAINT ANNE HOME FORT WAYNE IN Non profit - Church related N 1155294 FORUM AT THE CROSSING INDIANAPOLIS IN For profit - Corporation N 1155299 MILLER'S MERRY MANOR PORTAGE IN For profit - Corporation N 1155304 WATERS OF NEW CASTLE, THE NEW CASTLE IN For profit - Corporation N 1155290 ST ELIZABETH HEALTHCARE CENTER DELPHI IN Government - County N 1155064 APERION CARE KOKOMO KOKOMO IN For profit - Partnership N 1155073 PILGRIM MANOR PLYMOUTH IN Government - County N 1155181 CARMEL HEALTH & LIVING COMMUNITY CARMEL IN For profit - Corporation N 1155223 WATERS OF COVINGTON, THE COVINGTON IN Government - County N 1155241 FOREST CREEK VILLAGE INDIANAPOLIS IN For profit - Corporation N 1155827 SAGE BLUFF HEALTH & REHAB CENTER FORT WAYNE IN Non profit - Corporation N 1155669 RIVERVIEW TCU NOBLESVILLE IN Government - County Y 1155677 BELL TRACE HEALTH AND LIVING CENTER BLOOMINGTON IN Government - County N 1155631 WHITE RIVER LODGE BEDFORD IN Government - City/county N 1155654 ENGLEWOOD HEALTH & REHABILITATION CENTER FORT WAYNE IN Government - City/county N 1155659 SELLERSBURG HEALTHCARE CENTER SELLERSBURG IN For profit - Corporation N 1155606 WESTSIDE RETIREMENT VILLAGE INDIANAPOLIS IN For profit - Corporation N 1155614 LINCOLN HILLS OF NEW ALBANY NEW ALBANY IN Non profit - Corporation N 1155769 MORRISON WOODS HEALTH CAMPUS MUNCIE IN Government - County N 1155753 HAMPTON OAKS HEALTH CAMPUS SCOTTSBURG IN For profit - Corporation N 1155732 RIVEROAKS HEALTH CAMPUS PRINCETON IN Government - Hospital district N 1155734 THORNTON TERRACE HEALTH CAMPUS HANOVER IN Government - County N 1155725 UNIVERSITY PLACE HEALTH CENTER AND ASSISTED LIVING WEST LAFAYETTE IN Non profit - Church related N 1155703 BROOKSIDE VILLAGE INC JASPER IN For profit - Corporation N 1155491 PREMIER HEALTHCARE OF CONNERSVILLE CONNERSVILLE IN Government - State N 1155493 SCENIC HILLS CARE CENTER FERDINAND IN Government - County N 1155446 COVINGTON MANOR HEALTH AND REHABILITATION CENTER FORT WAYNE IN Government - County N 1155510 CENTURY VILLA HEALTH CARE GREENTOWN IN Government - County N 1155324 MITCHELL MANOR MITCHELL IN For profit - Corporation N 1155341 EASTGATE MANOR NURSING AND REHABILITATION WASHINGTON IN Government - County N 1155409 WATERS OF INDIANAPOLIS, THE INDIANAPOLIS IN Non profit - Corporation N 1155414 LINTON NURSING AND REHABILITATION CENTER LINTON IN Government - City/county N 1155289 COLONIAL OAKS HEALTH CARE CENTER MARION IN Non profit - Corporation N 1155265 WEDGEWOOD HEALTHCARE CENTER CLARKSVILLE IN For profit - Partnership N 1155217 WATERS OF HUNTINGBURG, THE HUNTINGBURG IN For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 95: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

155218 GREAT LAKES HEALTHCARE CENTER DYER IN Non profit - Corporation N 1155196 ALTENHEIM HEALTH & LIVING COMMUNITY INDIANAPOLIS IN For profit - Corporation N 1155198 MARQUETTE INDIANAPOLIS IN Non profit - Corporation N 1155220 DYER NURSING AND REHABILITATION CENTER DYER IN For profit - Corporation N 1155224 COLUMBIA HEALTHCARE CENTER EVANSVILLE IN For profit - Corporation N 1155228 HERITAGE HOUSE OF RICHMOND RICHMOND IN Government - County N 1155171 FRANKLIN MEADOWS FRANKLIN IN Government - County N 1155126 SPRINGS VALLEY MEADOWS FRENCH LICK IN Non profit - Other N 1155076 GOLDEN LIVING CENTER-BROOKVIEW INDIANAPOLIS IN Government - County N 117E015 GRISELL MEMORIAL HOSPITAL LTCU RANSOM KS Government - Hospital district Y 86175332 OTTAWA RETIREMENT VILLAGE OTTAWA KS Non profit - Corporation N 3417E591 VALLEY HEALTH CARE CENTER VALLEY FALLS KS For profit - Corporation N 3217A019 SMITH COUNTY MEMORIAL HOSPITAL LTCU SMITH CENTER KS Non profit - Corporation Y 28175492 PARK VILLA CLYDE KS For profit - Corporation N 2317E597 KIOWA HOSPITAL DISTRICT MANOR KIOWA KS Government - Hospital district Y 23175418 PROVIDENCE LIVING CENTER TOPEKA KS For profit - Individual N 18175540 NOTTINGHAM HEALTH AND REHABILITATION OLATHE KS For profit - Corporation N 17175415 ELMHAVEN EAST PARSONS KS For profit - Corporation N 16175403 BETHESDA HOME GOESSEL KS Non profit - Corporation N 16175499 BRIGHTON GARDENS OF PRAIRIE VILLAGE PRAIRIE VILLAGE KS For profit - Corporation N 16175369 LOCUST GROVE VILLAGE LA CROSSE KS Non profit - Corporation N 15175512 THE CENTENNIAL HOMESTEAD WASHINGTON KS For profit - Corporation N 14175401 BONNER SPRINGS NURSING & REHABILITATION CENTER BONNER SPRINGS KS For profit - Partnership N 14175219 KAW RIVER CARE & REHABILITATION CENTER, LLC EDWARDSVILLE KS For profit - Corporation N 14175113 LEGACY ON 10TH AVENUE TOPEKA KS For profit - Corporation N 14175100 VIA CHRISTI VILLAGE MANHATTAN, INC MANHATTAN KS Non profit - Corporation N 13175218 WESTVIEW OF DERBY DERBY KS For profit - Corporation N 12175411 COUNTRY CARE, INC EASTON KS For profit - Corporation N 12175463 TANGLEWOOD NURSING & REHABILITATION TOPEKA KS For profit - Corporation N 1217E445 STANTON COUNTY HEALTH CARE FACILITY LTCU JOHNSON KS Government - County Y 12175335 CHERRYVALE NURSING AND REHABILITATION CENTER CHERRYVALE KS For profit - Corporation N 1217E071 GREELEY COUNTY HOSPITAL LTCU TRIBUNE KS Government - Hospital district Y 11175426 CRESTVIEW NURSING & RESIDENTIAL LIVING SENECA KS For profit - Corporation N 10175480 LOGAN MANOR COMMUNITY HEALTH SERVICES LOGAN KS Government - City N 10175501 FAMILY HEALTH & REHABILITATION CENTER WICHITA KS For profit - Corporation N 9

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 96: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

175429 THE HOMESTEAD HEALTH & REHAB CENTER GARDEN CITY KS For profit - Corporation N 917E637 SOLOMON VALLEY MANOR STOCKTON KS Government - City N 9175077 LIFE CARE CENTER OF OSAWATOMIE OSAWATOMIE KS For profit - Corporation N 9175162 MEDICALODGES LEAVENWORTH LEAVENWORTH KS For profit - Corporation N 9175434 OSWEGO OPERATOR, LLC OSWEGO KS For profit - Corporation N 817E625 NESS COUNTY HOSPITAL LTCU DBA CEDAR VILLAGE NESS CITY KS Government - Hospital district Y 817A029 ST LUKE LIVING CENTER MARION KS Government - Hospital district Y 8175519 PRESCOTT COUNTRY VIEW NURSING HOME PRESCOTT KS Government - Hospital district N 7175317 NEODESHA CARE & REHABILITATION CENTER, LLC NEODESHA KS For profit - Corporation N 7175008 MEDICALODGES WICHITA WICHITA KS For profit - Corporation N 7175229 PARKWAY CARE & REHABILITATION CENTER, LLC EDWARDSVILLE KS For profit - Corporation N 7175254 DIVERSICARE OF SEDGWICK SEDGWICK KS For profit - Corporation N 717E197 ROOKS CO SENIOR SERVICES INC DBA REDBUD VILLAGE PLAINVILLE KS Government - County N 6175327 WINFIELD SENIOR LIVING COMMUNITY WINFIELD KS For profit - Partnership N 6175357 SUMNER OPERATOR, LLC WELLINGTON KS For profit - Corporation N 6175224 MORAN MANOR MORAN KS For profit - Corporation N 6175231 GOOD SAMARITAN SOCIETY - ELLSWORTH VILLAGE ELLSWORTH KS Non profit - Church related N 6175173 HOLIDAY RESORT EMPORIA KS For profit - Individual N 6175534 CARITAS CENTER, INC WICHITA KS Non profit - Corporation N 6175546 MISSION VILLAGE LIVING CENTER, INC HORTON KS Non profit - Corporation N 5175554 CITIZENS MEDICAL CENTER LTCU COLBY KS Non profit - Corporation Y 5175419 LINCOLN PARK MANOR INC LINCOLN KS For profit - Corporation N 517E585 DOOLEY CENTER ATCHISON KS Non profit - Corporation N 5175380 THE CEDARS MCPHERSON KS Non profit - Corporation N 5175282 GOOD SAMARITAN SOCIETY - MINNEAPOLIS MINNEAPOLIS KS Non profit - Church related N 5175361 GOOD SAMARITAN SOCIETY - SHERMAN COUNTY GOODLAND KS Non profit - Church related N 5175509 SANDSTONE HEIGHTS LITTLE RIVER KS Government - Hospital district N 5175477 LEONARDVILLE NURSING HOME LEONARDVILLE KS Non profit - Church related N 5175481 MOUNT HOPE NURSING CENTER MOUNT HOPE KS Non profit - Corporation N 5175524 WALLACE COUNTY COMMUNITY CARE CENTER, INC SHARON SPRINGS KS Non profit - Corporation N 5175275 MEDICALODGES KINSLEY KINSLEY KS For profit - Corporation N 5175236 HUTCHINSON OPERATOR, LLC HUTCHINSON KS For profit - Corporation N 5175305 LAWRENCE PRESBYTERIAN MANOR LAWRENCE KS Non profit - Corporation N 4175281 LIFE CARE CENTER OF KANSAS CITY KANSAS CITY KS For profit - Individual N 4175286 WHEATLAND NURSING & REHABILITATION CENTER RUSSELL KS For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 97: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

175287 EUREKA NURSING CENTER EUREKA KS For profit - Corporation N 4175273 WICHITA CARE & REHABILITATION CENTER, LLC WICHITA KS For profit - Corporation N 417E528 COUNTRYSIDE HEALTH CENTER TOPEKA KS Government - State N 4175433 PARKVIEW HEIGHTS GARNETT KS For profit - Corporation N 4175439 LIFE CARE CENTER OF SENECA SENECA KS For profit - Corporation N 4175455 ESKRIDGE CARE & REHABILITATION CENTER, LLC ESKRIDGE KS For profit - Corporation N 4175315 PRATT OPERATOR, LLC PRATT KS For profit - Corporation N 4175301 WICHITA PRESBYTERIAN MANOR WICHITA KS Non profit - Corporation N 4175114 DIVERSICARE OF HUTCHINSON HUTCHINSON KS For profit - Individual N 4175440 MEDICALODGES GIRARD GIRARD KS For profit - Corporation N 4175526 FOWLER RESIDENTIAL CARE FOWLER KS Government - Hospital district N 4175529 LEISURE HOMESTEAD AT ST JOHN ST JOHN KS Non profit - Corporation N 3175490 LEGACY AT HERINGTON HERINGTON KS For profit - Corporation N 3175506 ANDBE HOME, INC NORTON KS Government - County N 3175511 MONTGOMERY PLACE NURSING CENTER INDEPENDENCE KS For profit - Corporation N 3175558 IRON HORSE HEALTHCARE, INC, DBA THE HEALTHCARE RES LEAWOOD KS For profit - Corporation N 3175539 VIA CHRISTI VILLAGE RIDGE WICHITA KS Non profit - Church related N 317E630 ANTHONY COMMUNITY CARE CENTER ANTHONY KS For profit - Partnership N 3175123 TRINITY NURSING & REHABILITATION CENTER INC MERRIAM KS Non profit - Corporation N 3175348 HILLTOP LODGE NURSING HOME BELOIT KS For profit - Individual N 3175338 BALDWIN HEALTHCARE & REHAB CENTER, LLC BALDWIN CITY KS For profit - Corporation N 3175291 GREAT BEND HEALTH & REHAB CENTER GREAT BEND KS For profit - Corporation N 3175322 GOOD SAMARITAN SOCIETY - HAYS HAYS KS Non profit - Corporation N 3175221 FOUNTAINVIEW NURSING & REHAB CENTER ROSE HILL KS For profit - Corporation N 3175127 LEGACY AT SALINA SALINA KS For profit - Corporation N 3175208 PITTSBURG CARE & REHABILITATION CENTER, LLC PITTSBURG KS For profit - Corporation N 3175337 WELLINGTON CARE & REHAB CTR, LLC, DBA BOTKIN CARE WELLINGTON KS For profit - Corporation N 3175356 GOOD SAMARITAN SOCIETY - DECATUR COUNTY OBERLIN KS Non profit - Corporation N 3175456 VILLA MARIA MULVANE KS Non profit - Corporation N 3175437 MCPHERSON OPERATOR, LLC MCPHERSON KS For profit - Corporation N 317E577 ANDERSON COUNTY HOSPITAL LTCU GARNETT KS Non profit - Corporation Y 3175264 MEDICALODGES COLUMBUS COLUMBUS KS For profit - Corporation N 3175240 PROMISE SKILLED NURSING FACILITY OF OVERLAND PARK, OVERLAND PARK KS For profit - Corporation Y 3175238 LOUISBURG HEALTHCARE & REHAB CENTER LOUISBURG KS For profit - Corporation N 3175213 PINNACLE RIDGE NURSING & REHAB CENTER OLATHE KS For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 98: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

175214 DIVERSICARE OF CHANUTE CHANUTE KS For profit - Corporation N 3175215 TONGANOXIE NURSING CENTER TONGANOXIE KS For profit - Corporation N 3175145 BROOKSIDE RETIREMENT COMMUNITY OVERBROOK KS For profit - Corporation N 2175183 VILLA ST JOSEPH OVERLAND PARK KS Non profit - Corporation N 217E451 DAWSON PLACE HILL CITY KS Non profit - Corporation N 217E531 KEARNY COUNTY HOSPITAL LTCU LAKIN KS For profit - Corporation Y 2175530 LEISURE HOMESTEAD AT STAFFORD STAFFORD KS Non profit - Corporation N 2175412 HIGHLAND HEALTHCARE & REHABILITATION CENTER HIGHLAND KS For profit - Corporation N 2175470 QUAKER HILL MANOR BAXTER SPRINGS KS For profit - Corporation N 2175422 SUNSET HOME INC CONCORDIA KS Non profit - Corporation N 2175374 EASTRIDGE CENTRALIA KS Non profit - Corporation N 2175346 ALMA MANOR ALMA KS For profit - Partnership N 2175354 WOODHAVEN CARE CENTER ELLINWOOD KS For profit - Corporation N 2175304 EMPORIA PRESBYTERIAN MANOR EMPORIA KS Non profit - Corporation N 2175205 WILSON CARE & REHABILITATION CENTER, LLC WILSON KS For profit - Corporation N 2175295 SMITH CENTER OPERATOR, LLC SMITH CENTER KS For profit - Corporation N 2175366 GOOD SAMARITAN SOCIETY - ATWOOD ATWOOD KS Non profit - Corporation N 217E034 PROTECTION VALLEY MANOR PROTECTION KS Non profit - Corporation N 2175551 TWO TRAILS HEALTHCARE, INC, DBA THE HEALTHCARE RES OLATHE KS For profit - Corporation N 217E183 GOVE COUNTY MEDICAL CENTER LTCU QUINTER KS Government - City/county Y 117E026 MEADE DISTRICT HOSP LTCU DBA LONE TREE RETIREMENT MEADE KS Government - Hospital district Y 117E534 ATTICA LONG TERM CARE FACILITY ATTICA KS Government - Hospital district N 1175444 RICHMOND HEALTHCARE & REHAB CENTER RICHMOND KS For profit - Individual N 1175457 PEABODY OPERATOR, LLC PEABODY KS For profit - Corporation N 1175464 MEDICALODGES INDEPENDENCE INDEPENDENCE KS For profit - Corporation N 1175468 PRAIRIE MISSION RETIREMENT VILLAGE SAINT PAUL KS Non profit - Corporation N 1175435 MEDICALODGES JACKSON COUNTY HOLTON KS For profit - Corporation N 1175387 PARKSIDE HOMES HILLSBORO KS Non profit - Corporation N 1175396 CHETOPA MANOR CHETOPA KS For profit - Individual N 1175347 GOOD SAMARITAN SOCIETY - CHEYENNE COUNTY ST FRANCIS KS Non profit - Corporation N 1175300 SALINA PRESBYTERIAN MANOR SALINA KS Non profit - Corporation N 1175235 DIVERSICARE OF LARNED LARNED KS For profit - Corporation N 1175244 MEMORIAL HOSPITAL LTCU (VILLAGE MANOR) ABILENE KS Government - Hospital district Y 1175249 HERITAGE HEALTH CARE CENTER CHANUTE KS For profit - Corporation N 1175256 OSAGE NURSING & REHABILITATION CENTER OSAGE CITY KS For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 99: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

175130 MEADOWBROOK REHABILITATION HOSPITAL LTCU GARDNER KS For profit - Partnership Y 1175141 MEDICALODGES ATCHISON ATCHISON KS For profit - Corporation N 1175165 ROLLING HILLS HEALTH CENTER TOPEKA KS For profit - Corporation N 1175187 OVERLAND PARK NURSING & REHAB CENTER INC OVERLAND PARK KS Non profit - Corporation N 1175124 LAKEPOINT EL DORADO, LLC EL DORADO KS For profit - Partnership N 1175070 MEDICALODGES PITTSBURG PITTSBURG KS For profit - Corporation N 1175334 GOOD SAMARITAN SOCIETY - LIBERAL LIBERAL KS Non profit - Church related N 1175336 GOOD SAMARITAN SOCIETY - LYONS LYONS KS Non profit - Corporation N 1175376 APOSTOLIC CHRISTIAN HOME SABETHA KS Non profit - Church related N 1175397 ROSSVILLE HEALTHCARE & REHAB CENTER ROSSVILLE KS For profit - Corporation N 1175407 LIFE CARE CENTER OF WICHITA WICHITA KS For profit - Corporation N 1175359 GOOD SAMARITAN SOCIETY - VALLEY VISTA WAMEGO KS Non profit - Corporation N 1175373 LIFE CARE CENTER OF BURLINGTON BURLINGTON KS For profit - Corporation N 1175454 CLEARWATER NURSING & REHABILITATION CENTER CLEARWATER KS For profit - Corporation N 1175471 WESTY COMMUNITY CARE HOME WESTMORELAND KS Non profit - Corporation N 1175475 ENTERPRISE ESTATES NURSING CENTER ENTERPRISE KS Non profit - Corporation N 1175465 VIA CHRISTI VILLAGE PITTSBURG INC PITTSBURG KS Non profit - Corporation N 1175414 PINE VILLAGE MOUNDRIDGE KS Non profit - Corporation N 1175532 AVITA HEALTH AND REHAB AT REEDS COVE WICHITA KS For profit - Partnership N 1175543 VIA CHRISTI VILLAGE MCLEAN, INC WICHITA KS Non profit - Corporation N 117A020 TREGO CO-LEMKE MEMORIAL HOSPITAL LTCU WAKEENEY KS Government - County Y 1175498 VIA CHRISTI VILLAGE - HAYS INC HAYS KS Non profit - Corporation N 117E242 COMMUNITY HOSPITAL ONAGA LTCU ST MARYS KS Non profit - Other Y 1175522 CHERRY VILLAGE GREAT BEND KS Non profit - Corporation N 117E627 HODGEMAN COUNTY HEALTH CENTER LTCU JETMORE KS Government - County Y 1175189 THE FORUM AT OVERLAND PARK OVERLAND PARK KS For profit - Corporation N 1175191 STONEYBROOK RETIREMENT COMMUNITY MANHATTAN KS For profit - Corporation N 1175175 GARDEN VALLEY RETIREMENT VILLAGE GARDEN CITY KS For profit - Corporation N 1175180 SERENITY REHABILITATION AND NURSING OVERLAND PARK OVERLAND PARK KS For profit - Corporation N 1175157 LIFE CARE CENTER OF ANDOVER ANDOVER KS For profit - Corporation N 1175228 LANSING CARE & REHABILITATION CENTER, LLC LANSING KS For profit - Corporation N 1175239 DIVERSICARE OF COUNCIL GROVE COUNCIL GROVE KS For profit - Corporation N 1175241 SABETHA MANOR SABETHA KS For profit - Corporation N 1175255 PLAZA WEST REGIONAL HEALTH CENTER TOPEKA KS For profit - Corporation N 1175274 MERIDIAN REHABILITATION AND HEALTH CARE CENTER WICHITA KS For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 100: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

175299 STERLING PRESBYTERIAN MANOR STERLING KS Non profit - Corporation N 1175310 CLAY CENTER PRESBYTERIAN MANOR CLAY CENTER KS Non profit - Corporation N 1175276 NORTH POINT SKILLED NURSING CENTER PAOLA KS For profit - Corporation N 1185334 BEAVER DAM NURSING & REHAB CENTER, INC BEAVER DAM KY For profit - Corporation N 28185360 PROVIDENCE GALLATIN WARSAW KY For profit - Corporation N 22185274 WEST LIBERTY NURSING AND REHABILITATION CENTER WEST LIBERTY KY For profit - Corporation N 22185141 SIGNATURE HEALTHCARE OF GEORGETOWN GEORGETOWN KY For profit - Corporation N 20185342 SIGNATURE HEALTHCARE AT COLONIAL REHAB & WELLNESS BARDSTOWN KY For profit - Corporation N 18185160 LEXINGTON COUNTRY PLACE LEXINGTON KY For profit - Corporation N 16185039 HIGHLANDS HEALTH AND REHABILITATION CENTER LOUISVILLE KY For profit - Corporation N 15185250 OAKMONT MANOR FLATWOODS KY For profit - Corporation N 13185096 GEORGETOWN MANOR LOUISVILLE KY Non profit - Corporation N 12185174 FLORENCE PARK CARE CENTER FLORENCE KY For profit - Corporation N 12185362 PROVIDENCE NEW CASTLE NEW CASTLE KY For profit - Corporation N 12185332 GRAND HAVEN NURSING HOME CYNTHIANA KY For profit - Individual N 11185195 OAKVIEW NURSING & REHABILITATION CENTER CALVERT CITY KY For profit - Corporation N 11185354 FORDSVILLE NURSING AND REHABILITATION CENTER FORDSVILLE KY For profit - Corporation N 11185322 ROSE MANOR HEALTH CARE LEXINGTON KY For profit - Corporation N 11185474 THE WILLOWS AT CITATION LEXINGTON KY For profit - Corporation N 9185028 JOHNSON MATHERS NURSING HOME CARLISLE KY For profit - Corporation N 9185265 GRANT CENTER WILLIAMSTOWN KY For profit - Corporation N 9185470 THE WILLOWS AT HAMBURG LEXINGTON KY For profit - Corporation N 9185177 GRAYSON NURSING AND REHABILITATION LEITCHFIELD KY Non profit - Corporation N 8185268 THE GOOD SAMARITAN SOCIETY-JEFFERSONTOWN JEFFERSONTOWN KY Non profit - Corporation N 8185464 GREEN MEADOWS HEALTH CARE CENTER 1 MOUNT WASHINGTON KY For profit - Corporation N 7185281 FRIENDSHIP HEALTH AND REHABILITATION, LLC PEWEE VALLEY KY For profit - Corporation N 7185256 PARKVIEW NURSING AND REHABILITATION CENTER PIKEVILLE KY For profit - Corporation N 7185331 FRANKLIN-SIMPSON NURSING AND REHABILITATION CENTER FRANKLIN KY For profit - Corporation N 7185366 CORBIN HEALTH AND REHABILITATION CENTER CORBIN KY For profit - Corporation N 7185314 PIONEER TRACE GROUP, LLC FLEMINGSBURG KY For profit - Corporation N 7185358 SIGNATURE HEALTHCARE OF TRIMBLE COUNTY BEDFORD KY For profit - Corporation N 7185305 SPRINGHURST HEALTH AND REHAB LOUISVILLE KY Non profit - Church related N 6185253 CARTER NURSING & REHABILITATION CENTER GRAYSON KY For profit - Corporation N 6185480 KINGS DAUGHTERS MEDICAL CENTER ASHLAND KY Non profit - Corporation Y 6185442 NAZARETH HOME CLIFTON LOUISVILLE KY Non profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 101: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

185309 SPRING VIEW HEALTH & REHAB CENTER, INC LEITCHFIELD KY Non profit - Church related N 6185279 MILLS HEALTH & REHAB CENTER, INC MAYFIELD KY Non profit - Church related N 6185210 THE WILLOWS AT HARRODSBURG HARRODSBURG KY For profit - Corporation Y 6185270 CUMBERLAND VALLEY MANOR BURKESVILLE KY Non profit - Corporation N 5185263 DAWSON SPRINGS HEALTH AND REHABILITATION CENTER DAWSON SPRINGS KY For profit - Corporation N 5185433 TRI-CITIES NURSING AND REHABILITATION CENTER CUMBERLAND KY For profit - Corporation N 5185353 BRANDENBURG NURSING AND REHABILITATION CENTER BRANDENBURG KY For profit - Partnership N 5185227 SUPERIOR CARE HOME PADUCAH KY For profit - Corporation N 4185346 HERMITAGE CARE AND REHABILITATION CENTER OWENSBORO KY For profit - Corporation N 4185145 CEDAR RIDGE HEALTH CAMPUS CYNTHIANA KY For profit - Corporation N 4185042 THE GRANDVIEW NURSING AND REHABILITATION FACILITY CAMPBELLSVILLE KY For profit - Corporation N 4185165 WESTPORT CARE CENTER LOUISVILLE KY For profit - Corporation N 4185262 MADISON HEALTH AND REHABILITATION CENTER RICHMOND KY For profit - Corporation N 4185443 KENSINGTON CENTER ELIZABETHTOWN KY For profit - Corporation N 4185364 OWENTON CENTER OWENTON KY For profit - Corporation N 4185418 BOYD NURSING & REHABILITATION CENTER ASHLAND KY For profit - Corporation N 3185333 KLONDIKE CENTER LOUISVILLE KY For profit - Corporation N 3185259 RIVERS EDGE NURSING AND REHABILITATION CENTER PROSPECT KY For profit - Corporation N 3185207 MAYSVILLE NURSING AND REHABILITATION FACILITY MAYSVILLE KY For profit - Corporation N 3185133 TRADEWATER POINTE DAWSON SPRINGS KY For profit - Corporation N 3185142 CONCORDIA HEALTHCARE CENTER-HERITAGE MANOR MAYFIELD KY For profit - Corporation N 3185150 KNOTT COUNTY HEALTH AND REHABILITATION CENTER HINDMAN KY For profit - Corporation N 3185300 SIGNATURE HEALTHCARE AT SUMMERFIELD REHAB & WELLNE LOUISVILLE KY For profit - Individual N 3185306 RIDGEWOOD TERRACE NURSING HOME MADISONVILLE KY For profit - Corporation N 3185318 CHRISTIAN CARE CENTER OF KUTTAWA, LLC KUTTAWA KY For profit - Corporation N 3185267 CEDARS OF LEBANON NURSING CENTER LEBANON KY For profit - Partnership N 3185468 CHRISTIAN HEALTH CENTER - WEST, INC LOUISVILLE KY Non profit - Corporation N 3185479 THE HOME PLACE AT MIDWAY MIDWAY KY Non profit - Corporation N 3185478 FOREST SPRINGS HEALTH CAMPUS LOUISVILLE KY For profit - Corporation N 2185261 WURTLAND NURSING AND REHABILITATION CENTER WURTLAND KY For profit - Corporation N 2185217 METCALFE HEALTH CARE CENTER EDMONTON KY Non profit - Corporation N 2185252 SHADY LAWN NURSING AND REHABILITATION CENTER CADIZ KY For profit - Corporation N 2185320 LIFE CARE CENTER OF LA CENTER LA CENTER KY For profit - Limited Liability company N 2185302 HARDINSBURG NURSING AND REHABILITATION CENTER HARDINSBURG KY For profit - Corporation N 2185378 MASONIC HOME OF SHELBYVILLE SHELBYVILLE KY For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 102: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

185132 FRANCISCAN HEALTH CARE CENTER LOUISVILLE KY For profit - Corporation N 2185127 DANVILLE CENTRE FOR HEALTH AND REHABILITATION DANVILLE KY For profit - Corporation N 2185005 SPRING CREEK HEALTH CARE MURRAY KY Government - City/county Y 2185241 MADONNA MANOR VILLA HILLS KY Non profit - Corporation N 2185243 MOUNTAIN VIEW NURSING AND REHABILITATION CENTER PINEVILLE KY For profit - Corporation N 2185258 LAKE WAY NURSING AND REHABILITATION CENTER BENTON KY For profit - Corporation N 2185282 SOUTH SHORE NURSING & REHABILITATION CENTER SOUTH SHORE KY For profit - Corporation N 2185285 BRECKINRIDGE MEMORIAL NURSING FACILITY HARDINSBURG KY For profit - Limited Liability company Y 2185291 REDBANKS COLONIAL TERRACE SEBREE KY Non profit - Corporation N 2185275 SIGNATURE HEALTHCARE OF HARTFORD REHAB & WELLNESS HARTFORD KY For profit - Corporation N 2185344 BRACKEN COUNTY NURSING & REHABILITATION CENTER AUGUSTA KY For profit - Corporation N 2185326 CLINTON-HICKMAN COUNTY NURSING FACILITY CLINTON KY Non profit - Corporation N 2185402 HENDERSON NURSING AND REHABILITATION CENTER HENDERSON KY For profit - Partnership N 1185423 EDGEWOOD ESTATES FRENCHBURG KY Non profit - Corporation N 1185434 THE HERITAGE CORBIN KY For profit - Corporation N 1185469 CLINTON PLACE CLINTON KY For profit - Corporation N 1185352 STANTON NURSING AND REHABILITATION CENTER STANTON KY For profit - Partnership N 1185271 GLENVIEW HEALTH CARE FACILITY GLASGOW KY For profit - Corporation N 1185298 HICKS GOLDEN YEARS NURSING HOME MONTICELLO KY For profit - Individual N 1185254 RIDGEWAY NURSING & REHABILITATION FACILITY OWINGSVILLE KY For profit - Corporation N 1185224 BOWLING GREEN NURSING AND REHABILITATION CENTER BOWLING GREEN KY For profit - Corporation N 1185193 HYDEN HEALTH AND REHABILITATION CENTER HYDEN KY For profit - Corporation N 1185194 THE FORUM AT BROOKSIDE LOUISVILLE KY For profit - Corporation N 1185061 KENWOOD HEALTH AND REHABILITATION CENTER RICHMOND KY For profit - Corporation N 1185008 OWENSBORO HEALTH MUHLENBERG COMMUNITY HOSPITAL LTC GREENVILLE KY Non profit - Other Y 1185012 HILLSIDE CENTER MADISONVILLE KY For profit - Corporation N 1185038 THE PAVILION AT KENTON COVINGTON KY For profit - Corporation N 1185046 SALEM SPRINGLAKE HEALTH & REHABILITATION CENTER SALEM KY For profit - Corporation N 1185049 AUBURN HEALTH CARE AUBURN KY For profit - Individual N 1185122 LANDMARK OF LOUISVILLE REHABILITATION AND NURSING, LOUISVILLE KY For profit - Corporation N 1185131 THE JORDAN CENTER LOUISA KY For profit - Corporation N 1185138 NAZARETH HOME LOUISVILLE KY For profit - Corporation N 1185148 WILLIAMSBURG HEALTH AND REHABILITATION CENTER WILLIAMSBURG KY For profit - Corporation N 1185167 HOPKINS CENTER WOODBURN KY For profit - Corporation N 1185399 HEARTLAND VILLA CENTER LEWISPORT KY For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 103: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

185414 MOUNTAIN MANOR OF PAINTSVILLE PAINTSVILLE KY For profit - Corporation N 1185419 CHRISTIAN HEALTH CENTER BOWLING GREEN KY Non profit - Corporation N 1185272 MCCRACKEN NURSING AND REHABILITATION CENTER PADUCAH KY For profit - Corporation N 1185310 THE EPISCOPAL CHURCH HOME LOUISVILLE KY Non profit - Corporation N 1185234 CALVERT CITY CONVALESCENT CENTER CALVERT CITY KY Non profit - Corporation N 1185238 VANCEBURG REHABILITATION AND CARE VANCEBURG KY For profit - Corporation N 1185209 RIVERSIDE CARE & REHABILITATION CENTER CALHOUN KY For profit - Corporation N 1185286 FAIR OAKS HEALTH SYSTEMS, LLC JAMESTOWN KY For profit - Partnership N 1185287 HARRODSBURG HEALTH & REHABILITATION CENTER HARRODSBURG KY For profit - Corporation N 1185290 REGENCY CENTER LOUISVILLE KY For profit - Corporation N 1185465 BRECKINRIDGE PLACE MORGANFIELD KY Non profit - Other N 1185361 KINDRED HOSPITAL - LOUISVILLE LOUISVILLE KY For profit - Corporation Y 1195631 ST LUKE'S LIVING CENTER NEW ORLEANS LA For profit - Corporation N 86195545 CLAIBORNE REHABILITATION HOMER LA For profit - Corporation N 71195516 CAMELOT LEISURE LIVING FERRIDAY LA For profit - Corporation N 68195358 LULING LIVING CENTER LULING LA For profit - Limited Liability company N 42195309 BAYSIDE HEALTHCARE CENTER GRETNA LA For profit - Limited Liability company N 29195522 GOLDEN AGE OF WELSH, LLC WELSH LA For profit - Individual N 29195394 COLONIAL MANOR NURSING & REHABILITATION HOME RAYVILLE LA For profit - Corporation N 24195596 MARY GOSS NURSING HOME MONROE LA For profit - Corporation N 23195557 VALLEY VIEW HEALTH CARE MARKSVILLE LA For profit - Corporation N 23195591 WEST JEFFERSON HEALTH CARE CENTER HARVEY LA For profit - Individual N 19195562 GREEN MEADOW HAVEN COUSHATTA LA For profit - Corporation N 18195349 TANGI PINES NURSING CENTER AMITE LA For profit - Partnership N 17195398 WEST CARROLL CARE CENTER, INC OAK GROVE LA For profit - Corporation N 17195437 ST MARGARET'S DAUGHTERS HOME NEW ORLEANS LA Non profit - Corporation N 16195214 FERNCREST MANOR LIVING CENTER NEW ORLEANS LA For profit - Corporation N 15195554 LEGRAND HEALTHCARE AND REHABILITATION CENTER BASTROP LA For profit - Corporation N 15195606 COURTYARD MANOR NURSE CARE CENTER & ASSISTED LIV LAFAYETTE LA For profit - Corporation N 15195615 S C C OF BOOKER T WASHINGTON REHABILITATION CENTER SHREVEPORT LA For profit - Corporation N 15195314 JEFF DAVIS LIVING CENTER, LLC JENNINGS LA For profit - Partnership N 14195346 WILLOW RIDGE NURSING AND REHABILITATION CENTER,LLC ARCADIA LA For profit - Partnership N 14195536 COLONIAL OAKS LIVING CENTER METAIRIE LA For profit - Corporation N 14195423 CARROLL NURSING HOME OAK GROVE LA For profit - Corporation N 13195618 CONSOLATA HOME NEW IBERIA LA Non profit - Church related N 13

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 104: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

195578 EVANGELINE OAKS GUEST HOUSE CARENCRO LA For profit - Corporation N 13195293 NATCHITOCHES NURSING AND REHABILITATION CENTER,LLC NATCHITOCHES LA For profit - Corporation N 13195439 FARMERVILLE NURSING AND REHABILITATION CENTER, LLC FARMERVILLE LA For profit - Partnership N 12195469 AMELIA MANOR NURSING HOME LAFAYETTE LA For profit - Corporation N 12195396 BERNICE NURSING AND REHABILITATION CENTER, LLC BERNICE LA For profit - Partnership N 11195307 MAISON DE'VILLE NURSING HOME HOUMA LA For profit - Corporation N 11195329 PLAQUEMINE MANOR NURSING HOME PLAQUEMINE LA For profit - Corporation N 11195410 ST JAMES PLACE NURSING CARE CENTER BATON ROUGE LA For profit - Corporation N 11195509 OUR LADY OF WISDOM HEALTH CARE CENTER NEW ORLEANS LA Non profit - Church related N 11195619 SAVOY CARE CENTER MAMOU LA For profit - Partnership N 11195628 NORTHEAST LA WAR VETERANS HOME MONROE LA Government - State N 10195316 CLAIBORNE HEALTHCARE CENTER SHREVEPORT LA For profit - Corporation N 9195291 HERITAGE MANOR HEALTH & REHAB FERRIDAY LA For profit - Corporation N 9195442 VERMILION HEALTH CARE CENTER KAPLAN LA For profit - Corporation N 9195532 TOWN AND COUNTRY HEALTH & REHAB MINDEN LA For profit - Partnership N 9195297 PONTCHARTRAIN HEALTH CARE CENTER MANDEVILLE LA For profit - Individual N 9195510 RUSTON NURSING AND REHABILITATION CENTER,LLC RUSTON LA For profit - Partnership N 8195481 RIVERBEND NURSING AND REHABILITATION CENTER, INC BELLE CHASSE LA For profit - Corporation N 8195403 MAISON DE'VILLE NURSING HOME OF HARVEY HARVEY LA For profit - Corporation N 8195452 CYPRESS POINT NURSING & REHABILITATION CENTER BOSSIER CITY LA For profit - Corporation N 8195399 JENA NURSING AND REHABILITATION CENTER, LLC JENA LA For profit - Partnership N 8195502 RIVER OAKS RETIREMENT MANOR LAFAYETTE LA For profit - Corporation N 8195564 ACADIA ST. LANDRY GUEST HOUSE CHURCH POINT LA For profit - Corporation N 8195589 CHATEAU DE NOTRE DAME NEW ORLEANS LA Non profit - Church related N 7195430 COLFAX REUNION NURSING AND REHABILITATION CENTER COLFAX LA For profit - Corporation N 7195136 PROGRESSIVE CARE CENTER SHREVEPORT LA Non profit - Corporation N 7195149 JOHN J HAINKEL JR HOME AND REHABILITATION CENTER NEW ORLEANS LA Non profit - Corporation N 6195504 PLANTATION OAKS NURSING & REHABILITATION CENTER WISNER LA For profit - Individual N 6195505 AFFINITY NURSING & REHAB CENTER BATON ROUGE LA For profit - Partnership N 6195535 DERIDDER RETIREMENT & REHABILITATION CENTER DERIDDER LA For profit - Corporation N 6195579 PRESBYTERIAN VILLAGE OF HOMER HOMER LA Non profit - Corporation N 6195604 S C C OF COLONIAL OAKS REHABILITATION CENTER BOSSIER CITY LA For profit - Corporation N 6195386 MORGAN CITY HEALTH CARE CENTER MORGAN CITY LA For profit - Corporation N 6195324 HERITAGE MANOR OF FRANKLINTON FRANKLINTON LA For profit - Partnership N 6195328 NEW IBERIA MANOR NORTH NEW IBERIA LA For profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 105: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

195310 MANY HEALTHCARE NORTH MANY LA For profit - Corporation N 5195635 OLD JEFFERSON HOLDINGS, L L C BATON ROUGE LA Non profit - Corporation N 5195598 OAK WOODS HOME FOR THE ELDERLY MER ROUGE LA Non profit - Corporation N 5195614 COVENANT HOME NEW ORLEANS LA Non profit - Church related N 5195543 KENTWOOD MANOR NURSING HOME KENTWOOD LA For profit - Corporation N 5195325 VIVIAN HEALTHCARE CENTER VIVIAN LA For profit - Corporation N 5195326 NEW IBERIA MANOR SOUTH NEW IBERIA LA For profit - Corporation N 5195350 HIGHLAND PLACE REHAB AND NURSING CENTER SHREVEPORT LA For profit - Partnership N 5195315 KAPLAN HEALTHCARE CENTER KAPLAN LA For profit - Corporation N 4195392 CHARLYN REHAB & NURSING CENTER WINNSBORO LA For profit - Individual N 4195301 GREENBRIAR COMMUNITY CARE CENTER SLIDELL LA Non profit - Corporation N 4195247 GARDEN COURT HEALTH AND REHABILITATION CENTER BOSSIER CITY LA For profit - Partnership N 4195568 WYATT MANOR NURSING AND REHAB CTR, INC JONESBORO LA For profit - Corporation N 4195553 EASTRIDGE NURSING CENTER ABBEVILLE LA Non profit - Corporation N 4195541 CHERRY RIDGE BASTROP LA For profit - Corporation N 4195480 HERITAGE MANOR OF BATON ROUGE BATON ROUGE LA For profit - Corporation N 4195438 LANDMARK NURSING & REHAB CTR WEST MONROE LA For profit - Corporation N 4195476 CAPITOL HOUSE NURSING AND REHAB CENTER BATON ROUGE LA For profit - Corporation N 4195538 S C C OF ALPINE REHABILITATION CENTER RUSTON LA For profit - Corporation N 4195637 REGENCY HOUSE OF ALEXANDRIA ALEXANDRIA LA For profit - Corporation N 4195176 BELLE VIE LIVING CENTER GRETNA LA For profit - Partnership N 4195203 WALDON HEALTH CARE CENTER KENNER LA For profit - Corporation N 4195446 LAKEVIEW MANOR NURSING HOME NEW ROADS LA For profit - Corporation N 4195488 NOTTINGHAM REGIONAL REHAB CENTER BATON ROUGE LA For profit - Corporation N 4195517 UNITY NURSING & REHAB CENTER NEW ORLEANS LA For profit - Partnership N 3195518 HERITAGE NURSING CENTER HAYNESVILLE LA For profit - Corporation N 3195486 HERITAGE MANOR OF STRATMORE NURSING & REHAB CTR SHREVEPORT LA For profit - Corporation N 3195515 S C C OF SHREVEPORT MANOR REHABILITATION CENTER SHREVEPORT LA For profit - Corporation N 3195388 FRANKLIN HEALTH CARE CENTER FRANKLIN LA For profit - Partnership N 3195454 WINNFIELD NURSING AND REHABILITATION CENTER, LLC WINNFIELD LA For profit - Corporation N 3195174 MAISON ORLEANS HEALTHCARE OF NEW ORLEANS NEW ORLEANS LA For profit - Corporation N 3195323 HERITAGE MANOR OF BOSSIER BOSSIER CITY LA For profit - Individual N 3195258 GRACE NURSING HOME SLAUGHTER LA For profit - Corporation N 3195603 BAYOU VISTA COMMUNITY CARE CENTER BUNKIE LA Non profit - Corporation N 3195575 OAK HAVEN COMMUNITY CARE CENTER CENTER POINT LA For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 106: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

195458 GUEYDAN MEMORIAL GUEST HOME GUEYDAN LA Government - Hospital district N 3195513 BRADFORD REHABILITATION CENTER (THE) SHREVEPORT LA For profit - Corporation N 3195526 HERITAGE HEALTHCARE - HAMMOND HAMMOND LA For profit - Corporation N 3195608 SOUTHWEST LOUISIANA WAR VETERANS HOME JENNINGS LA Government - State N 3195593 LAGNIAPPE HEALTHCARE BASTROP LA For profit - Individual N 3195303 TWIN OAKS NURSING HOME LAPLACE LA For profit - Corporation N 3195342 PELICAN POINTE HEALTHCARE AND REHABILITATION MAURICE LA Non profit - Corporation N 2195393 DEERFIELD NURSING & REHABILITATION CENTER DELHI LA For profit - Partnership N 2195184 CHATEAU LIVING CENTER KENNER LA For profit - Corporation N 2195610 ST HELENA PARISH NURSING HOME GREENSBURG LA Government - Hospital district Y 2195612 GOOD SAMARITAN LIVING CENTER FRANKLINTON LA Non profit - Corporation N 2195613 ST CHRISTINA NURSING AND REHABILITATION CENTER PINEVILLE LA For profit - Corporation N 2195634 CORNERSTONE VILLAGE SOUTH, INC LAFAYETTE LA For profit - Corporation N 2195601 HIGH HOPE CARE CENTER SULPHUR LA For profit - Limited Liability company N 2195530 DELTA GRANDE SKILLED NURSING AND REHABILITATION MONROE LA For profit - Partnership N 2195556 DESOTO RETIREMENT & REHAB CTR, INC MANSFIELD LA For profit - Corporation N 2195561 NORTHRIDGE CARE CENTER BAKER LA For profit - Corporation N 2195570 ST ANTHONY'S NURSING HOME METAIRIE LA For profit - Corporation N 2195550 CAMELOT BROOKSIDE JENNINGS LA For profit - Corporation N 2195506 TOLEDO RETIREMENT AND REHABILITATION CENTER ZWOLLE LA For profit - Corporation N 2195487 LANDMARK OF ACADIANA SAINT MARTINVILLE LA For profit - Corporation N 2195412 AUTUMN LEAVES NURSING AND REHAB CTR, LLC WINNFIELD LA For profit - Corporation N 2195539 MANSFIELD NURSING CENTER MANSFIELD LA For profit - Corporation N 2195544 CAMELOT PLACE RAYNE LA For profit - Corporation N 2195533 VILLAGE HEALTH CARE AT THE GLEN SHREVEPORT LA Non profit - Corporation N 2195559 HESSMER NURSING HOME HESSMER LA For profit - Corporation N 2195312 PIERREMONT HEALTHCARE CENTER SHREVEPORT LA For profit - Corporation N 2195353 CARRINGTON PLACE OF SPRINGHILL SPRINGHILL LA For profit - Corporation N 2195356 GOOD SAMARITAN REHABILITATION AND NURSING CTR NEW ORLEANS LA For profit - Corporation N 2195362 ZACHARY MANOR NURSING AND REHABILITATION CENTER ZACHARY LA For profit - Corporation N 2195528 RIDGECREST COMMUNITY CARE CENTER WEST MONROE LA Non profit - Corporation N 2195493 KINDER RETIREMENT AND REHABILITATION CENTER KINDER LA For profit - Corporation N 2195500 TIOGA COMMUNITY CARE CENTER PINEVILLE LA Non profit - Corporation N 2195512 COLONIAL CARE RETIREMENT CENTER BATON ROUGE LA For profit - Corporation N 1195483 CARRINGTON PLACE OF BATON ROUGE BATON ROUGE LA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 107: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

195484 LANDMARK NURSING CENTER HAMMOND HAMMOND LA For profit - Corporation N 1195531 OUACHITA HEALTHCARE AND REHABILITATION CENTER MONROE LA For profit - Corporation N 1195525 WESTWOOD MANOR NURSING HOME, INC DERIDDER LA For profit - Corporation N 1195363 WHISPERING PINES COMMUNITY CARE CENTER PLAIN DEALING LA Non profit - Corporation N 1195401 ASCENSION OAKS NURSING & REHABILITATION CENTER GONZALES LA For profit - Limited Liability company N 1195459 ARBOR LAKE SKILLED NURSING & REHABILITATION FARMERVILLE LA For profit - Corporation N 1195460 BELLE TECHE NURSING & REHABILITATION CENTER NEW IBERIA LA For profit - Corporation N 1195466 LASALLE NURSING HOME JENA LA Government - Hospital district N 1195420 NAOMI HEIGHTS NURSING & REHABILITATION CENTER ALEXANDRIA LA For profit - Corporation N 1195424 LEXINGTON HOUSE ALEXANDRIA LA For profit - Corporation N 1195443 OLIVE BRANCH SENIOR CARE CENTER (THE) TALLULAH LA For profit - Corporation N 1195359 CHRISTUS ST JOSEPH HOME MONROE LA Non profit - Corporation N 1195344 SCC OF SPRING LAKE REHABILITATION CENTER SHREVEPORT LA For profit - Corporation N 1195265 HAVEN NURSING CENTER COLUMBIA LA For profit - Corporation N 1195281 MEADOWVIEW HEALTH & REHAB CENTER MINDEN LA For profit - Corporation N 1195220 HERITAGE MANOR OF SLIDELL SLIDELL LA For profit - Corporation N 1195248 GARDEN PARK NURSING & REHAB CTR, LLC SHREVEPORT LA For profit - Corporation N 1195558 SOUTHERN OAKS NURSING & REHABILITATION CENTER SHREVEPORT LA For profit - Corporation N 1195563 SOUTHWIND NURSING & REHABILITATION CENTER CROWLEY LA Non profit - Corporation N 1195605 MARY ANNA NURSING HOME WISNER LA For profit - Corporation N 1195600 MATTHEWS MEMORIAL HEALTH CARE CENTER ALEXANDRIA LA For profit - Corporation N 1195467 ST MARTIN DE PORRES MULTI-CARE CENTER LAKE CHARLES LA For profit - Corporation N 1195478 COLUMNS COMMUNITY CARE CENTER ( THE ) JONESVILLE LA Non profit - Corporation N 1195496 ROSEVIEW NURSING AND REHABILITATION CENTER SHREVEPORT LA For profit - Corporation N 1195565 BETHANY MHS HEALTH CARE CENTER LAFAYETTE LA Non profit - Church related N 1195524 GOLDEN AGE HEALTHCARE AND REHABILITATION CENTER DENHAM SPRINGS LA For profit - Corporation N 1195594 S C C OF PILGRIM MANOR REHABILITATION CENTER BOSSIER CITY LA For profit - Corporation N 1195592 CAMELOT OF BROUSSARD BROUSSARD LA For profit - Corporation N 1195257 PLANTATION MANOR NURSING AND REHAB CENTER, LLC WINNSBORO LA For profit - Corporation N 1195272 JEFFERSON HEALTHCARE CENTER JEFFERSON LA For profit - Corporation N 1195275 AUDUBON HEALTH AND REHAB THIBODAUX LA For profit - Corporation N 1195406 MAGNOLIA MANOR NURSING AND REHAB CTR, LLC SHREVEPORT LA For profit - Corporation N 1195407 RINGGOLD NURSING AND REHABILITATION CENTER, LLC RINGGOLD LA For profit - Partnership N 1195380 GUEST HOUSE REHABILITATION CENTER (THE) SHREVEPORT LA For profit - Corporation N 1195382 STERLING PLACE BATON ROUGE LA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 108: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

195348 LACOMBE NURSING CENTER LACOMBE LA For profit - Corporation N 1225640 BERKELEY RETIREMENT HOME,THE LAWRENCE MA Non profit - Corporation N 90225541 CARLYLE HOUSE FRAMINGHAM MA For profit - Corporation N 45225455 CRANEVILLE PLACE REHABILITATION & SKILLED CARE CT DALTON MA For profit - Corporation N 27225779 ADAMS HOUSE FALL RIVER MA Non profit - Corporation N 25225615 RIVERBEND OF SOUTH NATICK S NATICK MA For profit - Corporation N 25225619 MARIE ESTHER HEALTH CENTER INC MARLBOROUGH MA Non profit - Corporation N 23225471 JESMOND NURSING HOME NAHANT MA For profit - Corporation N 21225725 BLACKSTONE NURSING HOME BLACKSTONE MA For profit - Corporation N 17225776 DANIELS HOUSE NURSING HOME READING MA For profit - Corporation N 15225772 OUR ISLAND HOME NANTUCKET MA Government - City/county N 15225743 BAKER-KATZ SKILLED NURSING AND REHABILITATION CTR HAVERHILL MA For profit - Partnership N 14225227 FITCHBURG GARDENS FOR NURSING AND REHABILITATION FITCHBURG MA For profit - Corporation N 13225780 HIGHLAND MANOR CARE AND REHABILITATION CENTER LLC FALL RIVER MA For profit - Corporation N 13225613 POPE NURSING HOME WEYMOUTH MA For profit - Corporation N 13225360 POET'S SEAT HEALTH CARE CENTER GREENFIELD MA For profit - Partnership N 12225709 TIMOTHY DANIELS HOUSE HOLLISTON MA For profit - Corporation N 11225352 RENAISSANCE MANOR ON CABOT HOLYOKE MA For profit - Corporation N 11225483 BROOKSIDE REHABILITATION AND HEALTHCARE CENTER WEBSTER MA For profit - Corporation N 1022E522 COUNTRYSIDE NURSING HOME INC FRAMINGHAM MA For profit - Corporation N 9225694 ROYAL TABER STREET NURS & REHAB CTR NEW BEDFORD MA For profit - Corporation N 8225291 CHAPIN CENTER SPRINGFIELD MA Non profit - Corporation N 8225317 FALL RIVER JEWISH HOME, INC FALL RIVER MA Non profit - Corporation N 8225386 SPRINGSIDE REHABILITATION AND SKILLED CARE CENTER PITTSFIELD MA For profit - Corporation N 8225439 ODD FELLOWS HOME OF MASSACHUSETTS WORCESTER MA Non profit - Corporation N 7225286 HERITAGE HALL EAST AGAWAM MA For profit - Corporation N 6225401 LAKEVIEW HOUSE SKLD NRSG AND RESIDENTIAL CARE FAC HAVERHILL MA For profit - Corporation N 6225616 BRIDGEWATER NURSING HOME BRIDGEWATER MA For profit - Corporation N 6225783 WHITTIER BRADFORD TRANSITIONAL CARE UNIT BRADFORD MA For profit - Corporation N 6225645 THOMAS UPHAM HOUSE MEDFIELD MA For profit - Corporation N 6225333 CEDAR VIEW REHABILITATION AND HEALTHCARE CENTER METHUEN MA For profit - Corporation N 6225189 SWEET BROOK OF WILLIAMSTOWN REHABILITATION & N CTR WILLIAMSTOWN MA For profit - Corporation N 6225303 WINGATE AT EAST LONGMEADOW EAST LONGMEADOW MA For profit - Corporation N 4225395 LANESSA EXTENDED CARE WEBSTER MA For profit - Corporation N 4225609 COREY HILL NURSING HOME, INC BRIGHTON MA For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 109: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

225612 DIGHTON CARE AND REHABILITATION CENTER LLC NORTH DIGHTON MA For profit - Corporation N 4225230 GREAT BARRINGTON NURSING AND REHABILITATION GREAT BARRINGTON MA For profit - Partnership N 4225265 WINGATE AT HAMPDEN HAMPDEN MA For profit - Corporation N 4225145 OAKHILL HEALTHCARE MIDDLEBORO MA For profit - Corporation N 4225194 KIMWELL NURSING AND REHABILITATION FALL RIVER MA For profit - Corporation N 3225009 HERMITAGE HEALTHCARE (THE) WORCESTER MA For profit - Corporation N 3225366 HATHAWAY MANOR EXTENDED CARE NEW BEDFORD MA Non profit - Corporation N 3225539 CHICOPEE GARDENS FOR NURSING REHABILITATION CHICOPEE MA For profit - Partnership N 3225492 ROYAL SPRING VALLEY CENTER WORCESTER MA For profit - Partnership N 3225500 WEST SIDE HOUSE LTC FACILITY WORCESTER MA For profit - Corporation N 3225739 DWYER HOME WEYMOUTH MA Non profit - Corporation N 3225505 ROYAL WOOD MILL CENTER LAWRENCE MA For profit - Corporation N 2225512 WAREHAM HEALTHCARE WAREHAM MA For profit - Individual N 2225513 BEAUMONT REHAB & SKILLED NURSING CTR - NORTHBORO NORTHBOROUGH MA For profit - Corporation N 2225591 ROYAL AT WAYLAND REHABILITATION & NURSING CENTER WAYLAND MA For profit - Corporation N 2225224 CARE ONE AT LOWELL LOWELL MA For profit - Corporation N 2225229 MAPLEWOOD REHAB AND NURSING AMESBURY MA For profit - Corporation N 2225343 NORWOOD HEALTHCARE NORWOOD MA For profit - Corporation N 2225403 COLEMAN HOUSE NORTHBOROUGH MA For profit - Corporation N 2225453 CRAWFORD SKILLED NURSING AND REHABILITATION CENTER FALL RIVER MA For profit - Corporation N 2225458 FAIRHAVEN HEALTHCARE CENTER LOWELL MA Non profit - Corporation N 2225511 WILLOW MANOR LOWELL MA For profit - Corporation N 2225598 WATERVIEW LODGE LLC, REHABILITATION & HEALTHCARE ASHLAND MA For profit - Corporation N 2225752 SERENITY HILL NURSING CENTER WRENTHAM MA For profit - Corporation N 2225199 WORCESTER REHABILITATION & HEALTH CARE CENTER WORCESTER MA For profit - Corporation N 2225049 PINE KNOLL NURSING CENTER LEXINGTON MA For profit - Corporation N 2225067 WEDGEMERE HEALTHCARE TAUNTON MA For profit - Corporation N 1225117 ROYAL OF FAIRHAVEN NURSING CENTER FAIRHAVEN MA For profit - Partnership N 1225133 BLUEBERRY HILL REHABILITATION AND HEALTHCARE CTR BEVERLY MA For profit - Corporation N 1225036 BRAEMOOR HEALTH CENTER BROCKTON MA For profit - Corporation N 1225274 BRUSH HILL CARE CENTER MILTON MA For profit - Corporation N 1225275 BEAUMONT REHAB & SKILLED NURSING CTR - WESTBORO WESTBOROUGH MA For profit - Partnership N 1225283 WEBSTER MANOR REHABILITATION & HEALTH CARE CENTER WEBSTER MA For profit - Corporation N 1225768 NEW ENGLAND HOMES FOR THE DEAF, INC DANVERS MA Non profit - Corporation N 1225727 BEAUMONT REHAB & SKILLED NURSING CTR - NATICK NATICK MA For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 110: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

225562 MILFORD CENTER MILFORD MA For profit - Corporation N 1225467 WORCESTER HEALTH CENTER WORCESTER MA For profit - Partnership N 1225490 ROYAL SANDALWOOD CENTER OXFORD MA For profit - Corporation N 1225443 BLAIRE HOUSE OF WORCESTER WORCESTER MA For profit - Corporation N 1225411 LAFAYETTE REHABILITATION & SKILLED NURSING FACILIT MARBLEHEAD MA Non profit - Corporation N 1225367 BROOKHAVEN AT LEXINGTON LEXINGTON MA Non profit - Corporation N 1225293 SOUTHBRIDGE REHABILITATION & HEALTH CARE CENTER SOUTHBRIDGE MA For profit - Corporation N 1225328 OAKS, THE NEW BEDFORD MA For profit - Corporation N 1225329 MELROSE HEALTHCARE MELROSE MA For profit - Corporation N 1225341 WILLIAMSTOWN COMMONS NURSING & REHAB WILLIAMSTOWN MA Non profit - Corporation N 1225349 WINDSOR NURSING & RETIREMENT HOME SOUTH YARMOUTH MA Non profit - Corporation N 1225383 WESTFIELD GARDENS NURSING AND REHAB WESTFIELD MA For profit - Partnership N 1225385 CHRISTOPHER HOUSE OF WORCESTER WORCESTER MA Non profit - Other N 1225210 RIVER TERRACE REHABILITATION AND HEALTHCARE CTR LANCASTER MA For profit - Corporation N 1225594 BEAUMONT AT UNIVERSITY CAMPUS WORCESTER MA For profit - Partnership N 1225603 SOUTHPOINTE REHAB CENTER FALL RIVER MA For profit - Corporation N 1225431 WINGATE AT READING READING MA For profit - Corporation N 1225547 HANNAH B G SHAW HOME FOR THE AGED MIDDLEBORO MA Non profit - Corporation N 1225581 MOUNT CARMEL CARE CENTER LENOX MA Non profit - Church related N 1225527 FARREN CARE CENTER TURNERS FALLS MA Non profit - Corporation N 1225533 WACHUSETT MANOR GARDNER MA For profit - Corporation N 1225537 TOWN AND COUNTRY HEALTH CARE CENTER LOWELL MA For profit - Partnership N 1225506 NORTH END REHABILITATION AND HEALTHCARE CENTER BOSTON MA Non profit - Corporation N 1225683 STONE REHABILITATION AND SENIOR LIVING NEWTON UPPER FALLS MA Non profit - Corporation N 1225637 SEASHORE POINT AND WELLNESS REHABILITATION PROVINCETOWN MA Non profit - Other N 1225714 NEW ENGLAND HEALTH CENTER SUNDERLAND MA For profit - Partnership N 1225736 GREENWOOD NURSING & REHABILITATION CENTER WAKEFIELD MA For profit - Corporation N 1225782 BENCHMARK SNR LIVING AT THE COMMONS IN LINCOLN SNF LINCOLN MA For profit - Corporation N 1215345 BAYWOODS OF ANNAPOLIS ANNAPOLIS MD For profit - Corporation N 25215229 NORTH OAKS BALTIMORE MD For profit - Corporation N 17215356 THE NURSING AND REHAB CENTER AT STADIUM PLACE BALTIMORE MD For profit - Corporation N 13215268 PLEASANT VIEW NSG HOME MOUNT AIRY MD For profit - Corporation N 8215240 MORAN NURSING AND REHABILITATION CENTER WESTERNPORT MD For profit - Corporation N 8215287 MAPLEWOOD PARK PLACE BETHESDA MD For profit - Corporation N 7215228 ALTHEA WOODLAND NURSING HOME SILVER SPRING MD For profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 111: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

215348 LORIEN TANEYTOWN, INC TANEYTOWN MD For profit - Corporation N 6215336 HAGERSTOWN HEALTHCARE CENTER HAGERSTOWN MD For profit - Corporation N 5215344 VANTAGE HOUSE COLUMBIA MD Non profit - Corporation N 5215262 RESORTS AT CHESTER RIVER MANOR CORP CHESTERTOWN MD Non profit - Corporation N 4215300 MARIA HEALTH CARE CENTER, INC. BALTIMORE MD Non profit - Church related N 3215154 ROLAND PARK PLACE BALTIMORE MD Non profit - Corporation N 3215329 BUCKINGHAM'S CHOICE ADAMSTOWN MD Non profit - Corporation N 3215107 ROCKVILLE NURSING HOME ROCKVILLE MD Non profit - Corporation N 2215204 HOLLY HILL NURSING AND REHABILITATION CENTER TOWSON MD For profit - Corporation N 2215227 RIDGEWAY MANOR NURSING & REHABILITATION CENTER CATONSVILLE MD For profit - Corporation N 2215241 GSNH OPERATOR, LLC BALTIMORE MD For profit - Corporation N 2215259 PICKERSGILL RETIREMENT COMMUNITY TOWSON MD Non profit - Corporation N 2215267 ST JOSEPH'S MINISTRIES EMMITSBURG MD Non profit - Corporation N 1215327 SLIGO CREEK CENTER TAKOMA PARK MD For profit - Corporation N 1215235 HERON POINT OF CHESTERTOWN CHESTERTOWN MD Non profit - Corporation N 1215211 FRIENDS NURSING HOME SANDY SPRING MD Non profit - Church related N 1215174 GINGER COVE ANNAPOLIS MD Non profit - Corporation N 1215352 COFFMAN NURSING HOME HAGERSTOWN MD Non profit - Corporation N 1215357 LORIEN NURSING & REHAB CTR - ELKRIDGE ELKRIDGE MD For profit - Corporation N 1215359 LORIEN BULLE ROCK HAVRE DE GRACE MD For profit - Corporation N 1215136 TRANSITIONS HEALTHCARE AT SYKESVILLE SYKESVILLE MD For profit - Partnership N 1215220 CHAPEL HILL NURSING CENTER RANDALLSTOWN MD For profit - Corporation N 1215052 CADIA HEALTHCARE - SPRINGBROOK SILVER SPRING MD For profit - Individual N 1215082 BRINTON WOODS HEALTH & REHAB CTR OF PIKESVILLE PIKESVILLE MD For profit - Corporation N 1215360 MARYLAND BAPTIST AGED HOME BALTIMORE MD Non profit - Corporation N 121E009 SACRED HEART HOME INC HYATTSVILLE MD Non profit - Church related N 1215299 WESTGATE HILLS REHAB & HEALTHCARE CTR BALTIMORE MD For profit - Partnership N 1215304 ASBURY SOLOMONS SOLOMONS MD Non profit - Corporation N 1205140 THE COMMONS AT TALL PINES BELFAST ME For profit - Corporation N 26205073 BRIDGTON HEALTH CARE CENTER BRIDGTON ME For profit - Corporation N 23205111 COUNTRY MANOR NURSING HOME COOPERS MILLS ME For profit - Corporation N 19205118 NARRAGUAGUS BAY HEALTH CARE FACILITY MILBRIDGE ME For profit - Corporation N 18205170 ODD FELLOWS & REBEKAHS' HOME OF MAINE AUBURN ME Non profit - Corporation N 17205066 FRYEBURG HEALTH CARE CENTER FRYEBURG ME For profit - Corporation N 16205174 SANFIELD REHAB & LIVING CENTER HARTLAND ME For profit - Corporation N 15

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 112: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

205006 MONTELLO MANOR LEWISTON ME For profit - Corporation N 9205135 SONOGEE REHABILITATION & LIVING CENTER BAR HARBOR ME For profit - Corporation N 7205165 SOMERSET REHABILITATION & LIVING CENTER BINGHAM ME For profit - Corporation N 6205133 HERITAGE REHAB & LIVING CTR WINTHROP ME For profit - Corporation N 4205151 MAINE VETERANS HOME - CARIBOU CARIBOU ME Non profit - Other N 3205181 MOUNTAIN HEIGHTS HEALTH CARE PATTEN ME For profit - Corporation N 3205113 COLONIAL HEALTH CARE LINCOLN ME For profit - Corporation N 3205146 EASTPORT MEMORIAL NURSING HOME EASTPORT ME Non profit - Corporation N 2205168 ORCHARD PARK REHAB & LIVING FARMINGTON ME For profit - Corporation N 2205004 HIBBARD SKILLED NURSING & REHABILITATION CENTER DOVER FOXCROFT ME For profit - Corporation N 2205067 COVE'S EDGE DAMARISCOTTA ME Non profit - Corporation N 1205109 MARSHALL HEALTH CARE AND REHAB MACHIAS ME For profit - Corporation N 1205158 GREGORY WING OF ST ANDREWS VILLAGE BOOTHBAY HARBOR ME Non profit - Corporation Y 1205128 MAPLECREST REHAB & LIVING CENTER MADISON ME For profit - Corporation N 1205136 SOUTHRIDGE REHAB & LIVING CTR BIDDEFORD ME For profit - Corporation N 1205143 CUMMINGS HEALTH CARE FACILITY HOWLAND ME For profit - Corporation N 1205149 KATAHDIN NURSING HOME MILLINOCKET ME For profit - Corporation N 1205078 WINSHIP GREEN CENTER FOR HEALTH & REHAB, LLC BATH ME For profit - Corporation N 1205080 GARDINER HEALTH CARE FACILITY HOULTON ME For profit - Corporation N 1235712 CATHERINE'S PLACE FARMINGTON HILLS MI Non profit - Church related N 90235587 WELLSPRING LUTHERAN SERVICES LIVONIA MI Non profit - Corporation N 41235372 THE BAY AT CRANBROOK HEALTH & REHABILITATION CTR DETROIT MI For profit - Individual N 34235705 HELEN NEWBERRY JOY HOSPITAL LTCU NEWBERRY MI Government - County Y 25235628 JAMIESON NURSING HOME HARRISVILLE MI For profit - Corporation N 21235259 WARREN WOODS HEALTH AND REHABILITATION CENTER WARREN MI For profit - Limited Liability company N 20235463 THE VILLA AT THE PARK HIGHLAND PARK MI For profit - Corporation N 15235559 TRANSITIONAL HEALTH SERVICES OF WAYNE WAYNE MI For profit - Corporation N 14235192 SAINT MARY'S STANDISH COMMUNITY HOSPITAL STANDISH MI Non profit - Corporation Y 13235401 CLARK RETIREMENT COMMUNITY GRAND RAPIDS MI Non profit - Corporation N 12235187 CAMBRIDGE EAST HEALTHCARE CENTER MADISON HEIGHTS MI For profit - Corporation N 11235664 CAMBRIDGE SOUTH HEALTHCARE CTR BEVERLY HILLS MI For profit - Corporation N 11235617 REGENCY MANOR NURSING & REHABILITATION CENTER UTICA MI For profit - Individual N 10235232 MAGNUMCARE OF MONROE MONROE MI For profit - Individual N 10235468 THE BAY AT WOODWARD HEALTH & REHABILITATION CENTER DETROIT MI For profit - Corporation N 10235489 THE VILLA AT GREEN LAKE ESTATES ORCHARD LAKE MI For profit - Corporation N 10

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 113: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

235596 SUPERIOR WOODS HEALTHCARE CENTER YPSILANTI MI For profit - Corporation N 9235609 ADVANTAGE LIVING CENTER - ARMADA ARMADA MI For profit - Partnership N 8235013 FAIRVIEW NURSING AND REHABILITATION COMMUNITY CENTREVILLE MI For profit - Corporation N 8235335 GLADWIN NURSING AND REHABILITATION COMMUNITY GLADWIN MI For profit - Corporation N 8235562 BLOOMFIELD ORCHARD VILLA WEST BLOOMFIELD MI For profit - Corporation N 7235422 EASTWOOD CONVALESCENT CENTER DETROIT MI For profit - Corporation N 7235491 ADVANTAGE LIVING CENTER - ROSEVILLE ROSEVILLE MI For profit - Individual N 7235561 ARIA NURSING AND REHAB LANSING MI For profit - Corporation N 7235527 ST JAMES NURSING CENTER DETROIT MI For profit - Corporation N 7235382 HAMILTON NURSING HOME DETROIT MI For profit - Corporation N 6235518 MAPLE WOODS MANOR CLIO MI For profit - Corporation N 6235523 OAKLAND NURSING CENTER SOUTHFIELD MI For profit - Corporation Y 6235591 ROUBAL CARE AND REHAB CENTER STEPHENSON MI For profit - Corporation N 6235182 LYNWOOD MANOR HEALTHCARE CENTER ADRIAN MI For profit - Partnership N 6235447 GRACE OF DOUGLAS DOUGLAS MI For profit - Corporation N 6235492 SHEFFIELD MANOR NURSING & REHAB CENTER DETROIT MI For profit - Corporation N 6235454 THE BAY AT ELMWOOD HEALTH & REHABILITATION CENTER DETROIT MI For profit - Corporation N 6235310 PORTER HILLS HEALTH CENTER GRAND RAPIDS MI Non profit - Corporation N 6235292 MEDILODGE OF SAULT STE MARIE SAULT SAINTE MARIE MI For profit - Corporation N 6235176 TRANSITIONAL HEALTH SERVICES OF FREMONT FREMONT MI For profit - Corporation N 5235544 HALLMARK LIVING BENTON HARBOR BENTON HARBOR MI For profit - Corporation N 5235643 ST ANNS HOME GRAND RAPIDS MI Non profit - Church related N 5235637 PLAINWELL PINES NURSING AND REHABILITATION COMMUNI PLAINWELL MI For profit - Corporation N 5235639 HEATHER HILLS CARE CENTER GRAND RAPIDS MI For profit - Partnership N 5235517 MEDILODGE OF CAMPUS AREA EAST LANSING MI For profit - Corporation N 5235535 RIVERSIDE NURSING CENTRE GRAND HAVEN MI For profit - Corporation N 4235504 MAGNUMCARE OF ADRIAN, LLC ADRIAN MI For profit - Individual N 4235640 MEADOW WOODS NURSING AND REHAB CENTER BLOOMINGDALE MI For profit - Corporation N 4235549 ROOSEVELT PARK NURSING AND REHABILITATION COMMUNIT MUSKEGON MI For profit - Corporation N 4235355 METRON OF LAMONT LAMONT MI For profit - Corporation N 4235109 HEARTLAND HEALTH CARE CENTER - GROSSE POINTE WOODS GROSSE POINTE WOODS MI For profit - Corporation N 4235234 HERITAGE MANOR NURSING AND REHAB CENTER, LLC DETROIT MI For profit - Individual N 4235242 BOULEVARD MANOR, LLC DETROIT MI For profit - Corporation N 4235249 ST FRANCIS HOME SAGINAW MI Non profit - Church related N 4235298 FATHER MURRAY NURSING AND REHABILITATION CENTRE CENTER LINE MI For profit - Individual N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 114: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

235613 MAPLE MANOR REHAB CENTER WAYNE MI For profit - Individual N 4235522 HILLCREST NURSING AND REHABILITATION COMMUNITY NORTH MUSKEGON MI For profit - Corporation N 4235524 THE SPRINGS AT THE FOUNTAINS KALAMAZOO MI For profit - Corporation N 4235634 FOX RUN VILLAGE NOVI MI Non profit - Other N 4235471 LIFE CARE CENTER OF PLAINWELL PLAINWELL MI For profit - Corporation N 4235480 ADVANTAGE LIVING CENTER - HARPER WOODS HARPER WOODS MI For profit - Partnership N 4235302 LAURELS OF COLDWATER,THE COLDWATER MI For profit - Corporation N 4235253 LAURELS OF KENT (THE) LOWELL MI For profit - Corporation N 4235311 ALAMO NURSING HOME INC KALAMAZOO MI For profit - Corporation N 4235351 HEARTLAND HEALTH CARE CENTER-PLYMOUTH PLYMOUTH MI For profit - Corporation N 4235374 WEST OAKS SENIOR CARE & REHAB CENTER DETROIT MI For profit - Partnership N 4235254 VISTA GRANDE VILLA JACKSON MI Non profit - Corporation N 3235214 CAMBRIDGE NORTH HEALTHCARE CENTER CLAWSON MI For profit - Corporation N 3235113 SAGINAW SENIOR CARE AND REHAB CENTER, L L C SAGINAW MI For profit - Corporation N 3235595 ST FRANCIS NURSING CENTER DETROIT MI For profit - Corporation N 3235525 HERITAGE NURSING AND REHABILITATION COMMUNITY ZEELAND MI For profit - Corporation N 3235531 ALPHA MANOR NURSING HOME DETROIT MI For profit - Corporation N 3235520 PROMEDICA MONROE SKILLED NURSING AND REHAB MONROE MI Non profit - Corporation N 3235354 GRACE HEALTHCARE OF THREE RIVERS THREE RIVERS MI For profit - Corporation N 3235402 THE VILLA AT GREAT LAKES CROSSING DETROIT MI For profit - Partnership N 3235038 PILGRIM MANOR GRAND RAPIDS MI Non profit - Church related N 3235607 WARWICK LIVING CENTER ALMA MI Non profit - Corporation N 3235635 CARETEL INNS OF TRI-CITIES BAY CITY MI For profit - Corporation N 3235542 MEDILODGE OF WESTWOOD KALAMAZOO MI For profit - Corporation N 2235649 VALLEY HEALTH CENTER GRAND RAPIDS MI Non profit - Corporation N 2235620 ST JUDE NURSING CENTER LIVONIA MI For profit - Individual N 2235621 REGENCY ON THE LAKE - FORT GRATIOT FORT GRATIOT MI For profit - Corporation N 2235506 SHELBY NURSING CENTER SHELBY TOWNSHIP MI For profit - Partnership N 2235370 MEDILODGE OF ST CLAIR EAST CHINA MI For profit - Corporation N 2235452 REGENCY HEIGHTS-DETROIT DETROIT MI For profit - Corporation N 2235360 ARBOR MANOR CARE CENTER SPRING ARBOR MI For profit - Individual N 2235281 MAGNUMCARE OF HASTINGS, LLC HASTINGS MI For profit - Corporation N 2235288 MARVIN & BETTY DANTO FAMILY HEALTH CARE CENTER WEST BLOOMFIELD MI For profit - Corporation N 2235348 CRESTMONT NURSING CARE CENTER FENTON MI For profit - Corporation N 2235201 MUNSON HEALTHCARE CRAWFORD CONTINUING CARE CENTER GRAYLING MI Non profit - Corporation Y 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 115: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

235521 ADVANTAGE LIVING CENTER - WAYNE WAYNE MI For profit - Corporation N 2235608 STRATFORD PINES NURSING AND REHABILITATION CENTER MIDLAND MI For profit - Corporation N 2235589 LAKELAND CENTER (THE) SOUTHFIELD MI For profit - Partnership N 2235483 LAURELS OF GALESBURG (THE) GALESBURG MI For profit - Individual N 2235479 AUTUMNWOOD OF LIVONIA LIVONIA MI For profit - Corporation N 2235495 MEDILODGE OF MARSHALL MARSHALL MI For profit - Corporation N 2235500 OMNI CONTINUING CARE DETROIT MI For profit - Corporation N 2235515 LAKEVIEW MANOR HEALTHCARE CENTER TAWAS CITY MI For profit - Corporation N 2235519 KING NURSING & REHABILITATION COMMUNITY HOUGHTON LAKE MI For profit - Corporation N 2235433 GREENFIELD REHAB AND NURSING CENTER ROYAL OAK MI For profit - Corporation N 2235385 LAURELS OF MT. PLEASANT (THE) MOUNT PLEASANT MI For profit - Corporation N 2235655 CAMELOT HALL CONVALESCENT CTR LIVONIA MI For profit - Corporation N 2235659 RIVERVIEW HEALTH & REHAB CENTER DETROIT MI For profit - Partnership N 2235120 MARYCREST MANOR LIVONIA MI Non profit - Corporation N 2235279 HOLT SENIOR CARE AND REHAB CENTER, L L C HOLT MI For profit - Corporation N 2235319 ST MARY'S NURSING & REHAB CENTER SAINT CLAIR SHORES MI For profit - Corporation N 2235379 MEDILODGE OF TAWAS CITY TAWAS CITY MI For profit - Corporation N 1235383 ST JOSEPH'S HEALTHCARE CENTER HAMTRAMCK MI For profit - Corporation N 1235373 NORTH OTTAWA CARE CENTER SPRING LAKE MI Non profit - Corporation N 1235284 MEDILODGE OF MIDLAND MIDLAND MI For profit - Partnership N 1235174 MARSHALL NURSING AND REHABILITATION COMMUNITY MARSHALL MI For profit - Corporation N 1235177 HARTFORD NURSING & REHABILITATION CENTER DETROIT MI For profit - Corporation N 1235016 ALLEGRA NURSING AND REHAB JACKSON MI For profit - Corporation N 1235077 HALLMARK LIVING HOLLAND HOLLAND MI For profit - Partnership N 1235660 THE OAKS AT WOODFIELD GR BLANC MI For profit - Corporation N 1235703 OAKLAND MANOR NURSING & REHAB CENTER LLC PONTIAC MI For profit - Individual N 1235714 WINDEMERE PARK HEALTH AND REHAB CENTER WARREN MI For profit - Corporation N 1235430 THE NEIGHBORHOODS OF WHITE LAKE WHITE LAKE MI Non profit - Corporation N 1235451 THE OAKS AT NORTHPOINTE WOODS BATTLE CREEK MI For profit - Corporation N 1235456 COURTNEY MANOR BAD AXE MI For profit - Corporation N 1235593 HENRY FORD VILLAGE, INC DEARBORN MI Non profit - Corporation N 1235625 WEST WOODS OF BRIDGMAN BRIDGMAN MI For profit - Individual N 1235550 WILLOWBROOK MANOR FLINT MI For profit - Corporation N 1235552 THE LIGHTHOUSE AT HANCOCK HEALTH AND REHAB HANCOCK MI For profit - Corporation N 1235274 WELLSPRING LUTHERAN NURSING AND REHAB SERVICES MONROE MI Non profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 116: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

235320 LAHSER HILLS CARE CENTRE SOUTHFIELD MI For profit - Corporation N 1235322 OAKRIDGE MANOR NURSING & REHAB CENTER LLC FERNDALE MI For profit - Corporation N 1235327 LAURELS OF HUDSONVILLE (THE) HUDSONVILLE MI For profit - Corporation N 1235250 SAMARITAS SENIOR LIVING SAGINAW SAGINAW MI Non profit - Other N 1235252 LOURDES REHABILITATION AND HEALTHCARE CENTER WATERFORD MI Non profit - Corporation N 1235157 SANILAC MEDICAL CARE FACILITY SANDUSKY MI Government - County N 1235161 ASPIRUS ONTONAGON HOSPITAL, INC ONTONAGON MI Non profit - Corporation Y 1235287 PROVINCIAL HOUSE OF ADRIAN ADRIAN MI Non profit - Corporation N 1235365 HEARTLAND HEALTH CARE CENTER - LIVONIA NE LIVONIA MI For profit - Corporation N 1235356 SANCTUARY AT THE SHORE GRAND HAVEN MI Non profit - Corporation N 1235416 MEDILODGE OF STERLING STERLING MI For profit - Corporation N 1235440 HOLLAND HOME - RAYBROOK MANOR GRAND RAPIDS MI Non profit - Corporation N 1235441 HEARTLAND HEALTH CARE CENTER-CRESTVIEW WYOMING MI For profit - Corporation N 1235442 GREAT LAKES REHAB CENTER SAGINAW MI For profit - Partnership N 1235445 FAIRLANE SENIOR CARE AND REHAB CENTER DETROIT MI For profit - Corporation N 1235052 ABERDEEN REHABILITATION AND SKILLED NURSING CENTER TRENTON MI For profit - Individual N 1235014 ADVANTAGE LIVING CENTER - REDFORD REDFORD MI For profit - Corporation N 1235021 CHELSEA RETIREMENT COMMUNITY CHELSEA MI Non profit - Corporation N 1235008 MAPLE LAWN MEDICAL CARE FACILI COLDWATER MI Government - County N 1235498 BOULEVARD TEMPLE CARE CENTER, LLC DETROIT MI For profit - Corporation N 1235476 RIVERVIEW HEALTH AND REHAB CENTER NORTH DETROIT MI For profit - Individual N 1235481 LAKE ORION NURSING CENTER LAKE ORION MI Non profit - Corporation N 1235541 THE LODGE AT TAYLOR TAYLOR MI For profit - Individual N 1235530 MARYWOOD NURSING CARE CENTER LIVONIA MI Non profit - Church related N 1235532 ASHLEY CARE CENTER ASHLEY MI For profit - Individual N 1235622 QUALICARE NURSING HOME DETROIT MI For profit - Corporation N 1235623 ROYALTON MANOR, L L C ST JOSEPH MI For profit - Corporation N 1235630 MEDILODGE OF WYOMING WYOMING MI For profit - Corporation N 1235633 MICHIGAN CHRISTIAN HOME GRAND RAPIDS MI Non profit - Corporation N 1235554 EASTWOOD NURSING CENTER NEGAUNEE MI For profit - Corporation N 1235718 NOVI LAKES HEALTH CAMPUS NOVI MI For profit - Corporation N 1235719 LAKESIDE MANOR NURSING AND REHABILITATION CENTER STERLING HEIGHTS MI Government - County N 123E362 SCHEURER HOSPITAL LTCU PIGEON MI Non profit - Corporation Y 1245290 OLIVIA REHABILITATION & HEALTHCARE CENTER OLIVIA MN For profit - Corporation N 47245349 STEWARTVILLE CARE CENTER STEWARTVILLE MN Non profit - Corporation N 32

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 117: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

24E507 SOUTHSIDE CARE CENTER MINNEAPOLIS MN For profit - Individual N 29245464 OSTRANDER CARE AND REHAB OSTRANDER MN For profit - Corporation N 25245332 THE ESTATES AT EXCELSIOR LLC EXCELSIOR MN For profit - Corporation N 19245578 BETHANY RESIDENCE AND REHABILITATION CENTER MINNEAPOLIS MN For profit - Corporation N 18245552 COLONIAL MANOR OF BALATON BALATON MN For profit - Corporation N 18245313 MEADOW LANE REHABILITATION & HEALTHCARE CTR BENSON MN For profit - Corporation N 17245570 MAPLE LAWN SENIOR CARE FULDA MN Non profit - Corporation N 15245521 CENTRAL TODD COUNTY CARE CENTER CLARISSA MN Non profit - Corporation N 13245315 SEASONS HEALTHCARE TRIMONT MN For profit - Corporation N 12245367 MEADOW MANOR GRAND MEADOW MN For profit - Corporation N 11245416 RIDGEVIEW LESUEUR LONG TERM CARE AND REHAB CENTER LE SUEUR MN Non profit - Corporation Y 11245125 FITZGERALD NH AND REHAB EVELETH MN For profit - Corporation N 10245231 APPLETON MUNICIPAL HOSPITAL APPLETON MN Government - City Y 9245553 PARKVIEW MANOR NURSING HOME ELLSWORTH MN Government - City N 924E508 HAYES RESIDENCE SAINT PAUL MN For profit - Corporation N 8245052 MOORHEAD REHABILITATION & HEALTHCARE CENTER MOORHEAD MN For profit - Corporation N 8245346 TRUMAN SENIOR LIVING TRUMAN MN For profit - Corporation N 8245261 WOOD DALE HOME INC REDWOOD FALLS MN For profit - Corporation N 8245575 BARRETT CARE CENTER INC BARRETT MN For profit - Corporation N 724E185 BYWOOD EAST HEALTH CARE MINNEAPOLIS MN For profit - Corporation N 7245277 ST RAPHAELS HEALTH & REHAB CENTER EVELETH MN Non profit - Corporation N 7245536 GREEN LEA SENIOR LIVING MABEL MN For profit - Corporation N 7245559 VIKING MANOR NURSING HOME ULEN MN Government - City N 6245323 WALKER REHABILITATION & HEALTHCARE CENTER WALKER MN For profit - Corporation N 6245606 LAKE MINNETONKA CARE CENTER DEEPHAVEN MN For profit - Corporation N 6245542 LITTLEFORK MEDICAL CENTER LITTLEFORK MN Non profit - Corporation N 5245298 THE ESTATES AT TWIN RIVERS LLC ANOKA MN For profit - Corporation N 5245314 GOOD SAMARITAN SOCIETY - WINTHROP WINTHROP MN Non profit - Corporation N 5245375 STERLING PARK HEALTH CARE CENTER WAITE PARK MN For profit - Corporation N 5245186 BROOKVIEW A VILLA CENTER GOLDEN VALLEY MN For profit - Corporation N 5245237 GOOD SAMARITAN SOCIETY - REDWOOD FALLS REDWOOD FALLS MN Non profit - Church related N 5245549 GOOD SAMARITAN SOCIETY - MOUNTAIN LAKE MOUNTAIN LAKE MN Non profit - Corporation N 5245585 TRAVERSE CARE CENTER WHEATON MN Non profit - Corporation N 5245459 BENEDICTINE LIVING COMMUNITY WINSTED WINSTED MN Non profit - Corporation N 5245471 ECUMEN SCENIC SHORES TWO HARBORS MN Non profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 118: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

245551 CLARKFIELD CARE CENTER CLARKFIELD MN Non profit - Other N 4245595 GOOD SAMARITAN SOCIETY - WESTBROOK WESTBROOK MN Non profit - Church related N 4245545 FAIR MEADOW NURSING HOME FERTILE MN Government - City N 4245573 CLARA CITY CARE CENTER CLARA CITY MN Government - City N 4245580 LAKEWOOD CARE CENTER BAUDETTE MN Non profit - Corporation Y 4245440 JANESVILLE NURSING HOME JANESVILLE MN Government - City N 4245449 ST CRISPIN LIVING COMMUNITY RED WING MN Non profit - Corporation N 4245467 HENDRICKS COMMUNITY HOSPITAL HENDRICKS MN Non profit - Corporation Y 4245399 LITTLE FALLS CARE CENTER LITTLE FALLS MN Non profit - Corporation N 3245401 CENTRAL HEALTH CARE LE CENTER MN For profit - Corporation N 3245412 COKATO MANOR COKATO MN Non profit - Corporation N 3245328 PARMLY ON THE LAKE LLC CHISAGO CITY MN Non profit - Church related N 3245251 RIVERVIEW HOSPITAL & NURSING HOME CROOKSTON MN Government - Hospital district Y 3245289 CENTENNIAL GARDENS FOR NURSING & REHABILITATION CRYSTAL MN For profit - Corporation N 3245304 THE GARDENS AT CANNON FALLS CANNON FALLS MN For profit - Partnership N 3245569 HALSTAD LIVING CENTER HALSTAD MN Non profit - Church related N 3245544 VICTORY HEALTH & REHABILITATION CENTER MINNEAPOLIS MN For profit - Corporation N 3245510 EVANSVILLE CARE CENTER EVANSVILLE MN For profit - Corporation N 3245455 GOOD SAMARITAN SOCIETY - JACKSON JACKSON MN Non profit - Corporation N 3245405 HERITAGE LIVING CENTER PARK RAPIDS MN Government - County N 3245372 ST LUKES LUTHERAN CARE CENTER BLUE EARTH MN Non profit - Church related N 3245318 GOOD SAMARITAN SOCIETY - INTERNATIONAL FALLS INTERNATIONAL FALLS MN Non profit - Corporation N 3245325 FOLEY NURSING CENTER FOLEY MN For profit - Corporation N 2245333 FAIRFAX COMMUNITY HOME FAIRFAX MN For profit - Corporation N 2245336 THE ESTATES AT DELANO LLC DELANO MN For profit - Corporation N 2245396 CENTRACARE HEALTH SYSTEM - MELROSE PINE VILLA C C MELROSE MN Non profit - Corporation Y 2245364 ANNANDALE CARE CENTER ANNANDALE MN Non profit - Corporation N 2245281 VALLEY CARE AND REHAB LLC BARNESVILLE MN For profit - Corporation N 2245418 BELGRADE NURSING HOME BELGRADE MN Non profit - Corporation N 2245428 ESSENTIA HEALTH - HOMESTEAD DEER RIVER MN Non profit - Corporation Y 2245442 SPRING VALLEY CARE CENTER SPRING VALLEY MN Non profit - Corporation N 2245496 MINNEOTA MANOR HEALTH CARE CENTER MINNEOTA MN For profit - Corporation N 2245529 BIGFORK VALLEY COMMUNITIES BIGFORK MN Government - Hospital district Y 224E355 AFTENRO HOME DULUTH MN Non profit - Corporation N 2245562 HERITAGE LIVING & REHAB OF NYM NEW YORK MILLS MN Non profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 119: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

245528 GUNDERSEN HARMONY CARE CENTER HARMONY MN Non profit - Corporation N 2245258 FRANCISCAN HEALTH CENTER DULUTH MN Non profit - Corporation N 2245265 ST FRANCIS HOME BRECKENRIDGE MN Non profit - Church related N 2245067 ST LUCAS CARE CENTER FARIBAULT MN For profit - Corporation N 2245369 ST MARKS LUTHERAN HOME AUSTIN MN Non profit - Church related N 2245393 GOOD SHEPHERD LUTHERAN HOME RUSHFORD MN Non profit - Other N 2245423 CHOSEN VALLEY CARE CENTER CHATFIELD MN Non profit - Other N 2245429 TWEETEN LUTHERAN HEALTH CARE CENTER SPRING GROVE MN Non profit - Other N 2245468 KARLSTAD HEALTHCARE CENTER INC KARLSTAD MN For profit - Corporation N 1245497 HAVEN HOMES OF MAPLE PLAIN MAPLE PLAIN MN Non profit - Corporation N 1245499 CALEDONIA CARE AND REHABILITATION CENTER CALEDONIA MN For profit - Corporation N 1245337 THE ESTATES AT LINDEN LLC STILLWATER MN For profit - Corporation N 1245071 MOUNT OLIVET CAREVIEW HOME MINNEAPOLIS MN Non profit - Church related N 1245090 PLEASANT MANOR INC FARIBAULT MN For profit - Corporation N 1245238 MAHNOMEN HEALTH CENTER MAHNOMEN MN Government - City/county N 1245273 FRANKLIN REHABILITATION & HEALTHCARE CENTER FRANKLIN MN For profit - Corporation N 1245286 PIERZ VILLA INC PIERZ MN For profit - Corporation N 1245307 CORNERSTONE NSG & REHAB CENTER BAGLEY MN For profit - Corporation N 1245533 LAKESIDE HEALTH CARE CENTER DASSEL MN Non profit - Corporation N 1245535 JOURDAIN PERPICH EXT CARE FAC REDLAKE MN Non profit - Other N 1245540 HENNING REHABILITATION & HEALTHCARE CENTER HENNING MN For profit - Corporation N 1245592 OAKLAND PARK COMMUNITIES THIEF RIVER FALLS MN For profit - Corporation N 1245593 GOOD SAMARITAN SOCIETY - ST JAMES ST JAMES MN Non profit - Corporation N 1245594 GIL-MOR MANOR MORGAN MN Non profit - Other N 1245572 COLONIAL MANOR NURSING HOME LAKEFIELD MN For profit - Corporation N 1245589 BUFFALO LAKE HEALTH CARE CTR BUFFALO LAKE MN Non profit - Corporation N 1245596 SOUTH SHORE CARE CENTER WORTHINGTON MN For profit - Corporation N 1245616 LIFECARE GREENBUSH MANOR GREENBUSH MN Non profit - Corporation Y 1245625 EPISCOPAL CHURCH HOME GARDENS SAINT PAUL MN Non profit - Corporation N 1245627 THE BIRCHES AT TRILLIUM WOODS PLYMOUTH MN For profit - Partnership N 124E102 MOUNT OLIVET HOME MINNEAPOLIS MN Non profit - Church related N 1245501 BENEDICTINE LIVING COMMUNITY ST PETER MN Non profit - Church related N 1245522 LUTHER MEMORIAL HOME MADELIA MN Non profit - Corporation N 1245475 PARKVIEW HOME BELVIEW MN Government - City N 1245469 ESSENTIA HEALTH NORTHERN PINES MEDICAL CENTER AURORA MN Non profit - Corporation Y 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 120: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

245451 FAIRWAY VIEW NEIGHBORHOODS ORTONVILLE MN Government - City Y 1245433 SYLVAN COURT CANBY MN Non profit - Corporation Y 1245434 BETHANY ON THE LAKE LLC ALEXANDRIA MN For profit - Corporation N 1245436 PARKVIEW CARE CENTER - WELLS WELLS MN For profit - Corporation N 1245441 GOOD SAMARITAN SOCIETY - ALBERT LEA ALBERT LEA MN Non profit - Corporation N 1245371 PRAIRIE VIEW SENIOR LIVING TRACY MN For profit - Individual N 1245373 PELICAN VALLEY HEALTH CENTER PELICAN RAPIDS MN Government - Hospital district N 1245340 GALTIER A VILLA CENTER SAINT PAUL MN For profit - Corporation N 1245348 THE ESTATES AT RUSH CITY LLC RUSH CITY MN For profit - Corporation N 1245243 GRANITE MANOR GRANITE FALLS MN Government - City Y 1245252 THIEF RIVER CARE CENTER THIEF RIVER FALLS MN Non profit - Corporation N 1245222 THE ESTATES AT CHATEAU LLC MINNEAPOLIS MN For profit - Corporation N 1245225 SLEEPY EYE CARE CENTER SLEEPY EYE MN Non profit - Corporation N 1245280 LAKEVIEW METHODIST HEALTH CARE CENTER FAIRMONT MN Non profit - Church related N 1245083 PARK HEALTH A VILLA CENTER SAINT LOUIS PARK MN For profit - Corporation N 1245102 SAUER HEALTH CARE WINONA MN Non profit - Corporation N 1245127 MILLE LACS HEALTH SYSTEM ONAMIA MN Non profit - Corporation Y 1265534 HERITAGE CARE CENTER SAINT LOUIS MO For profit - Individual N 90265469 LEVERING REGIONAL HEALTH CARE CENTER HANNIBAL MO For profit - Corporation N 90265500 BERNARD CARE CENTER SAINT LOUIS MO For profit - Corporation N 9026E084 MYERS NURSING & CONVALESCENT CENTER KANSAS CITY MO For profit - Corporation N 90265425 EDGEWOOD MANOR CENTER FOR REHAB AND HEALTHCARE RAYTOWN MO For profit - Partnership N 80265730 EASTVIEW MANOR CARE CENTER TRENTON MO For profit - Corporation N 76265676 ST ELIZABETH CARE CENTER SAINT ELIZABETH MO For profit - Corporation N 74265794 HEISINGER LUTHERAN HOME JEFFERSON CITY MO Non profit - Church related N 69265532 PARKWAY HEALTH CARE CENTER KANSAS CITY MO For profit - Corporation N 65265353 QUAIL RUN HEALTH CARE CENTER CAMERON MO For profit - Individual N 5926A293 CLARA MANOR NURSING HOME KANSAS CITY MO For profit - Corporation N 57265549 PORTAGEVILLE HEALTH CARE CENTER PORTAGEVILLE MO For profit - Partnership N 56265537 TARKIO REHABILITATION & HEALTH CARE TARKIO MO For profit - Corporation N 50265526 CHARITON PARK HEALTH CARE CENTER SALISBURY MO For profit - Corporation N 46265131 SUNSET VILLAGE OF THE OZARKS INC SAINT ROBERT MO For profit - Corporation N 43265721 GREGORY RIDGE HEALTH CARE CENTER KANSAS CITY MO For profit - Individual N 42265736 U-CITY FOREST MANOR SAINT LOUIS MO For profit - Corporation N 33265698 NICK'S HEALTH CARE CENTER, LLC PLATTSBURG MO For profit - Corporation N 32

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 121: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265856 FAIR VIEW NURSING HOME SEDALIA MO For profit - Individual N 31265720 CREVE COEUR MANOR SAINT LOUIS MO For profit - Individual N 3026A484 ST LOUIS ALTENHEIM SAINT LOUIS MO Non profit - Other N 26265709 BELLEFONTAINE GARDENS NURSING & REHAB SAINT LOUIS MO For profit - Corporation N 26265585 HILLSIDE MANOR HEALTHCARE AND REHAB CENTER SAINT LOUIS MO For profit - Corporation N 26265712 ESTATES OF ST LOUIS, LLC, THE SAINT LOUIS MO For profit - Corporation N 25265606 SWEET SPRINGS VILLA SWEET SPRINGS MO For profit - Corporation N 25265668 CARRIE ELLIGSON GIETNER HOME SAINT LOUIS MO For profit - Corporation N 25265665 HILL CREST MANOR HAMILTON MO For profit - Corporation N 23265776 ESTATES OF SPANISH LAKE, THE SAINT LOUIS MO For profit - Partnership N 23265427 OAK PARK CARE CENTER SAINT LOUIS MO For profit - Partnership N 23265582 STONECREST HEALTHCARE VIBURNUM MO For profit - Corporation N 23265845 TRUMAN MEDICAL CENTER LAKEWOOD CARE CENTER KANSAS CITY MO Non profit - Corporation Y 22265719 OAKWOOD ESTATE NURSING AND REHABILITATION CENTER NORMANDY MO For profit - Individual N 2126E256 JOHNSON COUNTY CARE CENTER WARRENSBURG MO For profit - Corporation N 20265523 PARKWOOD SKILLED NURSING AND REHABILITATION CENTER MARYLAND HEIGHTS MO For profit - Corporation N 20265457 ROSEWOOD CARE CENTER OF ST LOUIS SAINT LOUIS MO For profit - Corporation N 18265120 ST SOPHIA HEALTH & REHABILITATION CENTER FLORISSANT MO Non profit - Corporation N 18265743 RIVERVIEW AT THE PARK CARE AND REHABILITATION CTR SAINTE GENEVIEVE MO For profit - Corporation N 18265669 WARRENSBURG MANOR CARE CENTER WARRENSBURG MO For profit - Individual N 1826A494 EXCELSIOR SPRINGS HOSPITAL EXCELSIOR SPRINGS MO Government - City/county Y 17265554 MERAMEC NURSING CENTER SULLIVAN MO For profit - Corporation N 17265708 SHIRKEY NURSING AND REHABILITATION CENTER RICHMOND MO Government - County N 1726A469 PEMISCOT COUNTY MEMORIAL HOSPITAL HAYTI MO Government - County Y 16265410 BENTONVIEW PARK HEALTH & REHABILITATION MONETT MO For profit - Corporation N 16265471 BUFFALO PRAIRIE CENTER FOR REHAB AND HEALTHCARE BUFFALO MO For profit - Corporation N 16265762 LAVERNA VILLAGE OF ST JOSEPH SAINT JOSEPH MO For profit - Corporation N 16265775 COMMUNITY CARE CENTER OF LEMAY INC SAINT LOUIS MO For profit - Corporation N 16265757 BENTWOOD NURSING & REHAB FLORISSANT MO For profit - Corporation N 15265798 COMMUNITY MANOR FARMINGTON MO For profit - Individual N 15265846 SHADY LAWN LIVING CENTER SAVANNAH MO Government - County N 15265358 RIVERBEND HEIGHTS HEALTH & REHABILITATION LEXINGTON MO For profit - Corporation N 15265773 WORTH COUNTY CONVALESCENT CENTER GRANT CITY MO Government - County N 15265822 BRIDGEWOOD HEALTH CARE CENTER KANSAS CITY MO For profit - Individual N 14265578 NORMANDY NURSING CENTER SAINT LOUIS MO For profit - Corporation N 14

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 122: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265362 MEADOWVIEW OF HARRISONVILLE HEALTH & REHABILITATIO HARRISONVILLE MO For profit - Corporation N 14265480 GRAND RIVER HEALTH CARE CHILLICOTHE MO For profit - Corporation N 14265577 MARSHFIELD CARE CENTER FOR REHAB AND HEALTHCARE MARSHFIELD MO For profit - Corporation N 14265666 LAWSON MANOR & REHAB LAWSON MO For profit - Corporation N 14265778 COLUMBIA MANOR CARE CENTER COLUMBIA MO For profit - Corporation N 13265510 HIDDEN LAKE CARE CENTER RAYTOWN MO For profit - Corporation N 13265230 OZARK MOUNTAIN REGIONAL HEALTHCARE CENTER CRANE MO For profit - Corporation N 13265238 MILAN HEALTH CARE CENTER MILAN MO For profit - Corporation N 13265552 CROWLEY RIDGE CARE CENTER DEXTER MO For profit - Individual N 13265509 SOUTH COUNTY NURSING HOME INC ARNOLD MO For profit - Corporation N 13265373 LIFE CARE CENTER OF WAYNESVILLE WAYNESVILLE MO For profit - Corporation N 12265824 VILLAGES OF ST PETERS, THE SAINT PETERS MO For profit - Corporation N 12265118 FRONTIER HEALTH & REHABILITATION SAINT CHARLES MO For profit - Corporation N 12265522 LAKEVIEW HEALTH CARE & REHABILITATION CENTER BOONVILLE MO For profit - Individual N 12265827 RIVERSIDE PLACE SAINT JOSEPH MO For profit - Corporation N 12265832 SENATH SOUTH HEALTH CARE CENTER SENATH MO For profit - Corporation N 12265646 LA BELLE MANOR CARE CENTER LA BELLE MO For profit - Corporation N 12265639 LENOIR HEALTH CARE CENTER COLUMBIA MO Non profit - Corporation N 11265843 APPLETON CITY MANOR APPLETON CITY MO For profit - Partnership N 11265566 WARSAW HEALTH AND REHABILITATION CENTER WARSAW MO For profit - Corporation N 10265625 NEW FLORENCE NURSING AND CARE CENTER NEW FLORENCE MO Non profit - Corporation N 10265349 GOLDEN YEARS CENTER FOR REHAB AND HEALTHCARE HARRISONVILLE MO For profit - Corporation N 10265514 CLARU DEVILLE NURSING CENTER FREDERICKTOWN MO For profit - Corporation N 10265649 SARCOXIE NURSING CENTER SARCOXIE MO For profit - Corporation N 10265594 OZARKS METHODIST MANOR, THE MARIONVILLE MO Non profit - Corporation N 10265820 VILLAGES OF JACKSON CREEK, THE INDEPENDENCE MO For profit - Corporation N 10265294 LIFE CARE CENTER OF CARROLLTON CARROLLTON MO For profit - Corporation N 10265145 SWOPE RIDGE GERIATRIC CENTER KANSAS CITY MO Non profit - Corporation N 9265365 VALLEY-A STONEBRIDGE COMMUNITY, THE FLORISSANT MO For profit - Corporation N 9265547 GREENVILLE HEALTH CARE CENTER GREENVILLE MO For profit - Corporation N 9265451 BLOOMFIELD LIVING CENTER BLOOMFIELD MO For profit - Corporation N 9265443 BETHANY CARE CENTER BETHANY MO For profit - Corporation N 9265802 ARMOUR OAKS SENIOR LIVING COMMUNITY KANSAS CITY MO Non profit - Corporation N 9265835 BROOKHAVEN NURSING & REHAB SPRINGFIELD MO For profit - Individual N 9265409 GIDEON CARE CENTER GIDEON MO For profit - Corporation N 9

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 123: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265428 LEBANON SOUTH NURSING & REHAB LEBANON MO For profit - Corporation N 9265701 ST JOE MANOR BONNE TERRE MO For profit - Individual N 9265711 DELMAR GARDENS OF MERAMEC VALLEY FENTON MO For profit - Corporation N 8265831 ACKERT PARK SKILLED NURSING & REHABILITATION CENTE UNIVERSITY CITY MO For profit - Corporation N 8265796 PEARL'S II EDEN FOR ELDERS PRINCETON MO For profit - Corporation N 8265779 LAKESIDE MEADOWS-A STONEBRIDGE COMMUNITY OSAGE BEACH MO For profit - Corporation N 8265508 MAR-SALINE MANOR CARE CENTER MARSHALL MO For profit - Corporation N 8265440 GERALD NURSING AND REHAB GERALD MO For profit - Corporation N 8265416 CLARK'S MOUNTAIN NURSING CENTER PIEDMONT MO For profit - Corporation N 8265407 MOBERLY NURSING & REHAB MOBERLY MO For profit - Corporation N 8265489 ST GENEVIEVE CARE CENTER INC SAINTE GENEVIEVE MO For profit - Corporation N 826A206 SALEM CARE CENTER SALEM MO For profit - Corporation N 8265777 WESTPHALIA HILLS-A STONEBRIDGE COMMUNITY WESTPHALIA MO For profit - Corporation N 8265680 OAK KNOLL SKILLED NURSING & REHABILITATION CENTER FERGUSON MO For profit - Corporation N 8265565 PLEASANT HILL HEALTH AND REHABILITATION CENTER PLEASANT HILL MO For profit - Corporation N 8265336 CARRIAGE SQUARE LIVING & REHAB CENTER SAINT JOSEPH MO For profit - Corporation N 8265420 APPLE RIDGE CARE CENTER WAVERLY MO For profit - Individual N 7265647 CROWN CARE CENTER HARRISONVILLE MO For profit - Corporation N 7265512 LEE'S SUMMIT POINTE HEALTH & REHABILITATION LEES SUMMIT MO For profit - Corporation N 7265377 JEFFERSON HEALTH CARE LEES SUMMIT MO For profit - Corporation N 7265389 SOUTHBROOK-SKILLED NURSING BY AMERICARE FARMINGTON MO For profit - Corporation N 7265285 JEFFERSON CITY MANOR CARE CENTER JEFFERSON CITY MO For profit - Corporation N 7265697 GARDEN VALLEY HEALTHCARE CENTER KANSAS CITY MO For profit - Corporation N 7265771 SOUTHGATE LIVING CENTER CARUTHERSVILLE MO For profit - Individual N 7265866 STEELVILLE SENIOR LIVING STEELVILLE MO For profit - Corporation N 7265780 ADRIAN MANOR HEALTH & REHABILITATION CENTER ADRIAN MO Government - City N 6265679 PLEASANT VALLEY MANOR CARE CENTER LIBERTY MO For profit - Corporation N 6265312 GAINESVILLE HEALTH CARE CENTER GAINESVILLE MO For profit - Corporation N 6265320 CARTHAGE HEALTH AND REHABILITATION CENTER CARTHAGE MO For profit - Corporation N 6265378 ROYAL OAK NURSING AND REHAB, LLC SAINT LOUIS MO For profit - Corporation N 6265361 RIVERDELL CARE CENTER BOONVILLE MO For profit - Corporation N 6265237 MAPLE LAWN NURSING HOME PALMYRA MO Government - County N 6265611 SILEX COMMUNITY CARE SILEX MO For profit - Corporation N 6265800 GOWER CONVALESCENT CENTER, INC GOWER MO Non profit - Corporation N 6265536 VALLEY VIEW HEALTH & REHABILITATION MOBERLY MO For profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 124: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265402 RANCHO MANOR HEALTHCARE AND REHABILITATION CENTER FLORISSANT MO For profit - Corporation N 6265352 WEST COUNTY CARE CENTER BALLWIN MO For profit - Corporation N 5265355 LIFE CARE CENTER OF GRANDVIEW GRANDVIEW MO For profit - Corporation N 5265209 NEW MADRID LIVING CENTER NEW MADRID MO For profit - Corporation N 5265520 WEBCO MANOR MARSHFIELD MO Government - County N 5265434 RIVERVIEW NURSING CENTER MOKANE MO For profit - Corporation N 5265589 ST PETERS MANOR CARE CENTER SAINT PETERS MO For profit - Corporation N 5265165 CHARLESTON MANOR CHARLESTON MO For profit - Individual N 5265501 NEW HAVEN LIVING CENTER ODESSA MO For profit - Corporation N 5265438 JACKSON MANOR NURSING HOME JACKSON MO For profit - Corporation N 5265464 OZARK RIVERVIEW MANOR OZARK MO Non profit - Corporation N 5265419 COUNTRY VIEW NURSING FACILITY, INC BOWLING GREEN MO For profit - Corporation N 5265442 MANOR, THE POPLAR BLUFF MO For profit - Individual N 5265648 MONITEAU CARE CENTER CALIFORNIA MO For profit - Corporation N 5265760 FULTON MANOR CARE CENTER FULTON MO For profit - Corporation N 5265744 PLEASANT VIEW ROCK PORT MO For profit - Corporation N 5265758 REDWOOD OF KANSAS CITY SOUTH KANSAS CITY MO For profit - Corporation N 5265847 SONSHINE MANOR REPUBLIC MO For profit - Partnership N 5265838 LIFE CARE CENTER OF FLORISSANT FLORISSANT MO For profit - Corporation N 4265683 WINDSOR HEALTHCARE & REHAB CENTER WINDSOR MO For profit - Corporation N 4265781 MOORE-PIKE NURSING HOME BOWLING GREEN MO For profit - Corporation N 4265819 OAK TREE VILLAS-A STONEBRIDGE COMMUNITY JEFFERSON CITY MO For profit - Corporation N 4265825 ELSBERRY MISSOURI HEALTH CARE CENTER ELSBERRY MO Non profit - Corporation N 4265655 GOLDEN AGE LIVING CENTER STOVER MO Government - County N 4265633 REDWOOD OF CAMERON CAMERON MO For profit - Individual N 4265664 JAMES RIVER NURSING AND REHABILITATION SPRINGFIELD MO For profit - Corporation N 4265557 WESTFIELD NURSING CENTER, INC SIKESTON MO For profit - Partnership N 4265431 TRUMAN LAKE MANOR INC LOWRY CITY MO For profit - Corporation N 4265411 POINT LOOKOUT NURSING & REHAB HOLLISTER MO For profit - Corporation N 4265460 CASSVILLE HEALTH CENTER FOR REHAB AND HEALTHCARE CASSVILLE MO For profit - Corporation N 4265364 LINN OAK REHABILITATION CENTER LINN MO Non profit - Corporation N 4265645 COUNTRY CLUB CARE CENTER OF WARRENSBURG WARRENSBURG MO For profit - Corporation N 4265614 CLEARVIEW NURSING CENTER SIKESTON MO For profit - Corporation N 4265621 LIVINGSTON MANOR CARE CENTER CHILLICOTHE MO For profit - Corporation N 4265834 QUARTERS AT DES PERES, THE DES PERES MO For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 125: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265788 SCOTLAND COUNTY CARE CENTER MEMPHIS MO Government - County N 4265765 LUTHERAN NURSING HOME CONCORDIA MO Non profit - Corporation N 4265739 HOLDEN MANOR CARE CENTER HOLDEN MO For profit - Corporation N 4265175 NHC HEALTHCARE, JOPLIN JOPLIN MO For profit - Corporation N 4265486 STONEBRIDGE MARYLAND HEIGHTS MARYLAND HEIGHTS MO For profit - Corporation N 3265492 CHAFFEE NURSING CENTER CHAFFEE MO For profit - Corporation N 3265474 COUNTRY AIRE RETIREMENT CENTER LEWISTOWN MO For profit - Corporation N 3265475 MARANATHA VILLAGE, INC SPRINGFIELD MO Non profit - Corporation N 3265550 ADVANCE NURSING CENTER ADVANCE MO For profit - Corporation N 3265586 ST LOUIS PLACE HEALTH & REHABILITATION SAINT LOUIS MO For profit - Corporation N 3265740 MAPLE GROVE LODGE LOUISIANA MO For profit - Individual N 3265735 APERION CARE HIDDEN LAKE SAINT LOUIS MO For profit - Corporation N 3265754 DIVERSICARE OF ST JOSEPH SAINT JOSEPH MO For profit - Corporation N 3265795 KINGSWOOD KANSAS CITY MO Non profit - Corporation N 3265682 INDEPENDENCE MANOR CARE CENTER INDEPENDENCE MO For profit - Corporation N 3265677 GENERAL BAPTIST NURSING HOME CAMPBELL MO Non profit - Corporation N 3265727 REDWOOD OF CARMEL HILLS INDEPENDENCE MO For profit - Corporation N 3265705 GOOD SHEPHERD COMMUNITY CARE AND REHABILITATION LOCKWOOD MO Non profit - Other N 3265839 MOUNT CARMEL SENIOR LIVING - O'FALLON, LLC O FALLON MO For profit - Corporation N 3265331 SUNSET HILLS HEALTH AND REHABILITATION CENTER SAINT LOUIS MO For profit - Corporation N 3265347 WESTWOOD LIVING CENTER CLINTON MO For profit - Corporation N 3265140 MARYMOUNT MANOR EUREKA MO For profit - Corporation N 3265195 ST ANDREW'S AT FRANCIS PLACE EUREKA MO Non profit - Church related N 3265470 HOUSTON HOUSE HOUSTON MO For profit - Corporation N 3265516 GEORGIAN GARDENS CENTER FOR REHAB AND HEALTHCARE POTOSI MO For profit - Corporation N 3265398 GAMMA ROAD LODGE WELLSVILLE MO For profit - Corporation N 3265433 LINCOLN COUNTY NURSING & REHAB TROY MO For profit - Corporation N 3265430 BIG RIVER NURSING & REHABILITATION CENTER CEDAR HILL MO For profit - Individual N 3265450 MARK TWAIN CARING CENTER POPLAR BLUFF MO For profit - Corporation N 3265456 TRUMAN GARDENS INDEPENDENCE MO For profit - Corporation N 3265609 MALDEN NURSING & REHAB MALDEN MO For profit - Individual N 3265643 VILLAGE CARE CENTER INC MARYVILLE MO For profit - Corporation N 3265657 ABBEY WOODS CENTER FOR REHABILITATION AND HEALING SAINT JOSEPH MO For profit - Corporation N 3265828 AVALON GARDEN SAINT LOUIS MO For profit - Corporation N 3265759 ST MARYS MANOR BLUE SPRINGS MO Non profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 126: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265737 LAURIE CARE CENTER LAURIE MO Non profit - Other N 3265763 KNOX COUNTY NURSING HOME DISTRICT EDINA MO Government - County N 3265772 VILLAS-A STONEBRIDGE COMMUNITY, THE DE SOTO MO For profit - Corporation N 3265850 SEASONS CARE CENTER KANSAS CITY MO For profit - Corporation N 3265864 SUNTERRA SPRINGS INDEPENDENCE INDEPENDENCE MO For profit - Corporation N 2265844 ROLLA HEALTH & REHABILITATION SUITES ROLLA MO For profit - Corporation N 2265706 CARROLL HOUSE CARROLLTON MO For profit - Corporation N 2265836 NODAWAY NURSING HOME MARYVILLE MO For profit - Corporation N 2265823 CRESTWOOD HEALTH CARE CENTER, LLC FLORISSANT MO For profit - Individual N 2265663 FULTON NURSING & REHAB FULTON MO For profit - Individual N 2265564 MEDICALODGES BUTLER BUTLER MO For profit - Corporation N 2265667 MEYER CARE CENTER HIGGINSVILLE MO Non profit - Corporation N 2265617 SPRING RIVER CHRISTIAN VILLAGE INC JOPLIN MO Non profit - Corporation N 2265618 SOUTH HAMPTON PLACE COLUMBIA MO For profit - Individual N 2265573 BIG SPRING CARE CENTER FOR REHAB AND HEALTHCARE HUMANSVILLE MO For profit - Individual N 2265579 MONTEREY PARK REHABILITATION & HEALTH CARE CENTER INDEPENDENCE MO For profit - Individual N 2265581 FULTON PRESBYTERIAN MANOR FULTON MO Non profit - Corporation N 2265546 GASCONADE MANOR NURSING HOME OWENSVILLE MO Non profit - Other N 2265531 HERITAGE NURSING CENTER-SKILLED NURS BY AMERICARE KENNETT MO For profit - Corporation N 2265406 AUTUMN OAKS CARING CENTER MOUNTAIN GROVE MO For profit - Individual N 2265517 FAYETTE CARING CENTER FAYETTE MO For profit - Corporation N 2265506 PINE VIEW MANOR INC STANBERRY MO Non profit - Corporation N 2265493 MEDICALODGES NEVADA NEVADA MO For profit - Corporation N 2265468 GRANBY HOUSE GRANBY MO For profit - Individual N 2265159 MARY, QUEEN AND MOTHER CENTER SHREWSBURY MO Non profit - Church related N 2265205 CEDARGATE HEALTHCARE POPLAR BLUFF MO For profit - Corporation N 2265174 VILLAGE NORTH RETIREMENT AND HEALTH CENTER SAINT LOUIS MO Non profit - Corporation N 2265178 OZARK REHABILITATION & HEALTH CARE CENTER OSAGE BEACH MO For profit - Corporation N 2265185 LIFE CARE CENTER OF CAPE GIRARDEAU CAPE GIRARDEAU MO For profit - Corporation N 2265091 CAMDENTON WINDSOR ESTATES CAMDENTON MO For profit - Corporation N 2265266 MEDICALODGES NEOSHO NEOSHO MO For profit - Corporation N 2265303 CARONDELET MANOR KANSAS CITY MO Non profit - Church related N 2265351 ALEXIAN BROS LANSDOWNE VILLAGE SAINT LOUIS MO Non profit - Corporation N 2265865 BIRCH POINTE HEALTH AND REHABILITATION SPRINGFIELD MO For profit - Corporation N 2265851 SILVERSTONE PLACE ROLLA MO For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 127: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265852 ST JOSEPH CHATEAU SAINT JOSEPH MO For profit - Corporation N 2265728 KING CITY MANOR KING CITY MO For profit - Corporation N 2265688 LIVING CENTER, THE MARSHALL MO Non profit - Corporation N 2265693 REDWOOD OF INDEPENDENCE INDEPENDENCE MO For profit - Individual N 2265632 HICKORY MANOR LICKING MO Government - City N 2265597 REDWOOD OF BLUE RIVER KANSAS CITY MO For profit - Corporation N 2265599 CLARENCE CARE CENTER CLARENCE MO Government - County N 2265608 GLENWOOD HEALTHCARE SEYMOUR MO For profit - Corporation N 2265651 FRENE VALLEY OF HERMANN-A STONEBRIDGE COMMUNITY HERMANN MO For profit - Corporation N 2265793 LA PLATA NURSING HOME LA PLATA MO Government - County N 2265810 ADAMS STREET -A STONEBRIDGE COMMUNITY JEFFERSON CITY MO For profit - Corporation N 2265731 MAGNOLIA SQUARE NURSING AND REHAB SPRINGFIELD MO For profit - Corporation N 2265734 COUNTRY MEADOWS PARK HILLS MO For profit - Corporation N 2265745 SUNSET HOME MAYSVILLE MO For profit - Corporation N 2265572 DADE COUNTY NURSING HOME DISTRICT GREENFIELD MO Government - County N 2265538 ROARING RIVER HEALTH AND REHABILITATION CASSVILLE MO For profit - Corporation N 2265182 AURORA NURSING CENTER AURORA MO For profit - Corporation N 2265333 JONESBURG NURSING & REHAB JONESBURG MO For profit - Corporation N 2265356 VALLEY MANOR AND REHABILITATION CENTER EXCELSIOR SPRINGS MO For profit - Individual N 2265393 SHEPHERD OF THE HILLS LIVING CENTER BRANSON MO For profit - Corporation N 2265387 HUNTER ACRES CARING CENTER SIKESTON MO For profit - Corporation N 2265367 CYPRESS POINT-SKILLED NURSING BY AMERICARE DEXTER MO For profit - Corporation N 2265368 BIRCH VIEW NURSING CENTER BIRCH TREE MO For profit - Corporation N 1265390 SUNSET HEALTH CARE CENTER UNION MO For profit - Individual N 1265360 LEWIS COUNTY NURSING HOME DISTRICT CANTON MO Government - County N 1265354 MARYVILLE LIVING CENTER MARYVILLE MO For profit - Corporation N 1265321 GARDEN VIEW CARE CENTER O FALLON MO For profit - Corporation N 1265254 HEART OF THE OZARKS HEALTHCARE CENTER AVA MO For profit - Corporation N 1265288 TABLEROCK HEALTHCARE KIMBERLING CITY MO For profit - Corporation N 1265198 TWIN PINES ADULT CARE CENTER KIRKSVILLE MO Government - City/county N 1265208 VILLA MARIE-A STONEBRIDGE COMMUNITY JEFFERSON CITY MO For profit - Corporation N 1265181 WARRENTON MANOR WRIGHT CITY MO For profit - Corporation N 1265530 JEFFERSON CITY NURSING AND REHABILITATION CTR, LLC JEFFERSON CITY MO For profit - Partnership N 1265535 GLASGOW GARDENS GLASGOW MO For profit - Corporation N 1265479 SIKESTON CONVALESCENT CENTER SIKESTON MO For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 128: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265481 PIN OAKS LIVING CENTER MEXICO MO For profit - Corporation N 1265513 ABC HEALTH CARE HARRISONVILLE MO For profit - Corporation N 1265519 PARKVIEW HEALTH CARE FACILITY BOLIVAR MO Non profit - Corporation N 1265439 BARNES-JEWISH EXTENDED CARE SAINT LOUIS MO Non profit - Corporation N 1265446 COMMUNITY SPRINGS HEALTHCARE FACILITY EL DORADO SPRINGS MO Non profit - Corporation N 1265472 BRENT B TINNIN MANOR ELLINGTON MO For profit - Corporation N 1265738 ASHLEY MANOR CARE CENTER BOONVILLE MO For profit - Corporation N 1265791 BROOKING PARK CHESTERFIELD MO Non profit - Corporation N 1265799 NEIGHBORHOODS AT QUAIL CREEK, THE SPRINGFIELD MO For profit - Corporation N 1265797 RIDGE CREST NURSING CENTER WARRENSBURG MO For profit - Corporation N 1265833 MANOR GROVE, INCORPORATED KIRKWOOD MO Non profit - Corporation N 1265821 EXCELSIOR SPRINGS NURSING & REHAB EXCELSIOR SPRINGS MO For profit - Corporation N 1265829 INDEPENDENCE CARE CENTER OF PERRY COUNTY PERRYVILLE MO Non profit - Corporation N 1265591 PARKDALE MANOR CARE CENTER MARYVILLE MO For profit - Corporation N 1265610 LIFE CARE CENTER OF ST LOUIS SAINT LOUIS MO For profit - Corporation N 1265729 DAVIESS COUNTY NURSING AND REHABILITATION GALLATIN MO For profit - Corporation N 1265707 ASHLAND HEALTHCARE ASHLAND MO For profit - Corporation N 1265713 MILLER COUNTY CARE AND REHABILITATION CENTER TUSCUMBIA MO Government - County N 1265717 GRAND MANOR NURSING & REHABILITATION CENTER SAINT LOUIS MO For profit - Individual N 1265849 MCKNIGHT PLACE EXTENDED CARE SAINT LOUIS MO For profit - Corporation N 1265396 CALIFORNIA CARE CENTER CALIFORNIA MO For profit - Corporation N 1265340 LIFE CARE CENTER OF SULLIVAN SULLIVAN MO For profit - Corporation N 1265341 PILLARS OF NORTH COUNTY HEALTH & REHAB CENTER, THE FLORISSANT MO For profit - Corporation N 1265110 MOORE-FEW CARE CENTER NEVADA MO Government - City/county N 1265121 FRIENDSHIP VILLAGE CHESTERFIELD CHESTERFIELD MO Non profit - Corporation N 1265236 MARK TWAIN MANOR BRIDGETON MO For profit - Corporation N 1265247 KIRKSVILLE MANOR CARE CENTER KIRKSVILLE MO For profit - Corporation N 1265163 MACON HEALTH CARE CENTER MACON MO For profit - Corporation N 1265200 LOCH HAVEN MACON MO Government - County N 1265404 MAYWOOD TERRACE LIVING CENTER INDEPENDENCE MO For profit - Individual N 1265415 NEW HAVEN CARE CENTER NEW HAVEN MO Non profit - Corporation N 1265437 ASHTON COURT CARE AND REHABILITATION CENTRE LIBERTY MO For profit - Corporation N 1265551 EAST PRAIRIE NURSING CENTER EAST PRAIRIE MO For profit - Corporation N 1265558 NEVADA NURSING & REHAB NEVADA MO For profit - Corporation N 1265574 MONROE CITY MANOR CARE CENTER MONROE CITY MO For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 129: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

265607 CRYSTAL CREEK HEALTH AND REHABILITATION CENTER FLORISSANT MO For profit - Corporation N 1265681 POTOSI MANOR, INC POTOSI MO For profit - Corporation N 1265678 BERTRAND NURSING AND REHAB CENTER BERTRAND MO For profit - Corporation N 1265629 OREGON CARE CENTER OREGON MO For profit - Corporation N 1265830 SERENITY REHABILITATION AND NURSING KANSAS CITY KANSAS CITY MO For profit - Partnership N 1265787 LA VERNA VILLAGE NURSING HOME SAVANNAH MO For profit - Corporation N 1265715 SUNNYVIEW NURSING HOME & APARTMENTS TRENTON MO Non profit - Other N 1255210 PINE CREST GUEST HOME INC HAZLEHURST MS For profit - Corporation N 48255220 SHARKEY-ISSAQUENA NURSING HOME ROLLING FORK MS Government - County Y 2225A414 METHODIST SPECIALTY CARE CENTER FLOWOOD MS Non profit - Corporation Y 1725A188 BOLIVAR MEDICAL CENTER LTC CLEVELAND MS For profit - Corporation Y 16255344 QUITMAN COUNTY HEALTH & REHAB LLC MARKS MS For profit - Corporation N 14255308 STONE COUNTY NURSING AND REHABILITATION CENTER,INC WIGGINS MS For profit - Corporation N 12255292 LEGACY MANOR NURSING AND REHABILITATION GREENVILLE MS For profit - Corporation N 11255213 MEADVILLE CONVALESCENT HOME MEADVILLE MS For profit - Individual N 11255113 RULEVILLE NURSING AND REHABILITATION CENTER LLC RULEVILLE MS For profit - Limited Liability company N 10255313 DUGAN MEMORIAL HOME WEST POINT MS Non profit - Corporation N 10255283 VAIDEN COMMUNITY LIVING CENTER VAIDEN MS For profit - Corporation N 8255226 NATCHEZ REHABILITATION AND HEALTHCARE CENTER, LLC NATCHEZ MS For profit - Corporation N 8255125 CHADWICK NURSING AND REHABILITATION CENTER LLC JACKSON MS For profit - Partnership N 8255162 COUNTRYBROOK LIVING CENTER BROOKHAVEN MS For profit - Corporation N 8255285 COMMUNITY PLACE JACKSON MS Non profit - Corporation N 7255221 HAVEN HALL HEALTH CARE CENTER BROOKHAVEN MS Non profit - Corporation N 7255185 INDIANOLA REHABILITATION AND HEALTHCARE CENTER LLC INDIANOLA MS For profit - Corporation N 7255311 GREAT OAKS REHABILITATION AND HEALTHCARE CENTER LL BYHALIA MS For profit - Corporation N 7255332 HOLMES COUNTY LONG TERM CARE CENTER - DURANT DURANT MS For profit - Corporation N 6255164 JEFFERSON COUNTY NURSING HOME FAYETTE MS Government - County N 6255243 BILLDORA SENIOR CARE TYLERTOWN MS For profit - Corporation N 6255249 COMPERE NH INC JACKSON MS For profit - Corporation N 6255329 MADISON CO NH CANTON MS Government - County N 6255116 LAKELAND NURSING AND REHABILITATION CENTER LLC JACKSON MS For profit - Partnership N 6255179 LEAKESVILLE REHABILITATION AND NURSING CENTER, INC LEAKESVILLE MS For profit - Corporation N 6255166 QUEEN CITY NURSING CENTER MERIDIAN MS For profit - Corporation N 5255091 LEXINGTON MANOR SENIOR CARE, LLC LEXINGTON MS For profit - Corporation N 5255334 TUNICA COUNTY HEALTH & REHAB, LLC TUNICA MS For profit - Corporation N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 130: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

255229 HOLLY SPRINGS REHABILITATION AND HEALTHCARE CENTER HOLLY SPRINGS MS For profit - Corporation N 5255273 FOREST HILL NURSING CENTER JACKSON MS For profit - Corporation N 5255325 WISTERIA GARDENS PEARL MS For profit - Partnership N 5255228 DELTA REHABILITATION AND HEALTHCARE CENTER OF CLEV CLEVELAND MS For profit - Limited Liability company N 4255252 MS CARE CENTER OF GREENVILLE GREENVILLE MS For profit - Corporation N 4255139 DIVERSICARE OF BATESVILLE BATESVILLE MS For profit - Corporation N 4255216 RIVERVIEW NURSING & REHABILITATION CENTER GREENWOOD MS Non profit - Corporation N 4255315 POPLAR SPRINGS NURSING CTR, LLC MERIDIAN MS For profit - Corporation N 425A416 BEDFORD ALZHEIMER'S CARE CENTER HATTIESBURG MS For profit - Corporation N 425A380 PONTOTOC NURSING HOME PONTOTOC MS Non profit - Corporation Y 4255101 MCCOMB NURSING AND REHABILITATION CENTER LLC MCCOMB MS For profit - Partnership N 4255118 DIVERSICARE OF MERIDIAN MERIDIAN MS For profit - Corporation N 3255310 SILVER CROSS HEALTH & REHAB BROOKHAVEN MS For profit - Partnership N 3255304 THE NICHOLS CENTER MADISON MS For profit - Corporation N 3255217 RIVER HEIGHTS HEALTHCARE CENTER GREENVILLE MS Non profit - Corporation N 3255262 LAURELWOOD COMM LIVING CENTER LAUREL MS For profit - Corporation N 3255275 MAGNOLIA SENIOR CARE, LLC JACKSON MS For profit - Corporation N 3255145 COURTYARD REHABILITATION AND HEALTHCARE MCCOMB MS For profit - Corporation N 3255126 WILKINSON COUNTY SENIOR CARE CENTREVILLE MS For profit - Corporation N 3255159 PERRY COUNTY NURSING CENTER RICHTON MS For profit - Corporation N 3255163 WOODLAND VILLAGE NURSING CENTER DIAMONDHEAD MS For profit - Corporation N 2255331 ARRINGTON LIVING CENTER COLLINS MS Government - City/county Y 2255300 WILLOW CREEK RETIREMENT CENTER JACKSON MS For profit - Corporation N 2255271 LIBERTY COMMUNITY LIVING CTR LIBERTY MS For profit - Partnership N 2255280 CAMELLIA ESTATES MCCOMB MS For profit - Corporation N 2255263 MERIDIAN COMM LIVING CENTER MERIDIAN MS For profit - Corporation N 225A389 WEBSTER HEALTH SERVICES, INC EUPORA MS Non profit - Corporation N 225A190 TALLAHATCHIE GENERAL HOSP ECF CHARLESTON MS Government - County Y 225A233 BAPTIST NURSING HOME-CALHOUN, INC CALHOUN CITY MS Non profit - Corporation Y 2255130 TIPPAH COUNTY NURSING HOME RIPLEY MS Government - County Y 2255105 DIVERSICARE OF TUPELO TUPELO MS For profit - Corporation N 2255108 TREND HEALTH & REHAB OF CARTHAGE LLC CARTHAGE MS For profit - Individual N 2255096 LOUISVILLE HEALTHCARE LLC LOUISVILLE MS For profit - Corporation N 2255114 CLEVELAND NURSING AND REHABILITATION CENTER LLC CLEVELAND MS For profit - Limited Liability company N 1255111 WEST POINT COMMUNITY LIVING CENTER WEST POINT MS For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 131: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

255192 CLAIBORNE COUNTY SENIOR CARE PORT GIBSON MS For profit - Corporation N 1255214 LAWRENCE CO NURSING CENTER MONTICELLO MS For profit - Individual N 125A178 JASPER CO NH BAY SPRINGS MS Government - County Y 125A401 JNH-MONROE INN WHITFIELD MS Government - State N 1255307 GOLDEN AGE NURSING HOME GREENWOOD MS Non profit - Corporation N 1255326 COTTAGE GROVE NURSING HOME JACKSON MS For profit - Partnership N 1255266 BRANDON COURT BRANDON MS For profit - Corporation N 1255219 ARBOR WALK HEALTHCARE CENTER GREENVILLE MS Non profit - Corporation N 1255278 HILLCREST NURSING CENTER, LLC MAGEE MS For profit - Corporation N 1255274 HIGHLAND HOME RIDGELAND MS For profit - Partnership N 1255297 BEDFORD CARE CTR-MONROE HALL HATTIESBURG MS For profit - Corporation N 1255301 CARRINGTON, LLC D/B/A THE CARRINGTON STARKVILLE MS For profit - Corporation N 1255281 LANDMARK OF DESOTO HORN LAKE MS For profit - Corporation N 1255279 SARDIS COMMUNITY NH SARDIS MS For profit - Corporation N 1255289 RIVER CHASE VILLAGE GAUTIER MS For profit - Corporation N 1255294 GREENBOUGH HEALTH AND REHABILITATION CENTER CLARKSDALE MS For profit - Corporation N 125A156 PEARL RIVER CO NURSING HOME POPLARVILLE MS For profit - Corporation Y 125A174 YALOBUSHA COUNTY NURSING HOME WATER VALLEY MS Government - County Y 1255312 UNION CO HEALTH AND REHAB CENTER, INC NEW ALBANY MS For profit - Corporation N 1255314 WASHINGTON CARE CENTER GREENVILLE MS For profit - Corporation N 1255149 BEDFORD CARE CENTER OF PETAL PETAL MS For profit - Corporation N 1255158 BEDFORD CARE CENTER OF HATTIES HATTIESBURG MS For profit - Corporation N 1255259 HUMPHREYS CO NURSING CENTER BELZONI MS For profit - Corporation N 1255261 THE OAKS REHABILITATION AND HEALTHCARE CENTER MERIDIAN MS For profit - Corporation N 1255267 CLARKSDALE NURSING CENTER CLARKSDALE MS For profit - Corporation N 1255173 GLENBURNEY HEALTH CARE AND REHABILITATION CENTER NATCHEZ MS For profit - Partnership N 1255222 TRINITY HEALTHCARE CENTER COLUMBUS MS Non profit - Corporation N 1255109 DIVERSICARE OF SOUTHAVEN SOUTHAVEN MS For profit - Corporation N 1275096 PONDEROSA PINES HEALTH CARE BILLINGS MT For profit - Corporation N 53275116 BIG SANDY MEDICAL CENTER LTC BIG SANDY MT Non profit - Other Y 27275130 HERITAGE ACRES NURSING HOME HARDIN MT Non profit - Corporation N 18275091 VALLEY VIEW HOME GLASGOW MT Non profit - Church related N 16275040 LIBBY CARE CENTER LIBBY MT For profit - Individual N 13275090 BEARTOOTH HEALTHCARE COMMUNITY COLUMBUS MT For profit - Corporation N 12275080 APPLE REHAB COONEY HELENA MT For profit - Corporation N 12

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 132: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

275131 HI-LINE RETIREMENT CENTER MALTA MT Non profit - Corporation N 9275147 TOBACCO ROOT MOUNTAINS CARE CENTER SHERIDAN MT Government - County N 8275082 GARFIELD COUNTY HEALTH CENTER JORDAN MT Government - City/county N 7275056 ELKHORN HEALTHCARE & REHABILITATION CLANCY MT For profit - Corporation N 7275132 WHITEFISH CENTER WHITEFISH MT For profit - Corporation N 7275134 DEER LODGE DEER LODGE MT For profit - Corporation N 6275021 VALLE VISTA HEALTHCARE COMMUNITY LEWISTOWN MT For profit - Corporation N 6275114 ROCKY MOUNTAIN HEALTHCARE COMMUNITY HELENA MT For profit - Corporation N 6275101 VALLEY VIEW ESTATES HEALTH & REHABILITATION HAMILTON MT Non profit - Other N 5275115 BRIDGER REHAB AND CARE COMMUNITY BOZEMAN MT For profit - Corporation N 5275065 COMMUNITY NURSING HOME OF ANACONDA ANACONDA MT Non profit - Corporation Y 4275081 FRIENDSHIP VILLA HEALTHCARE COMMUNITY MILES CITY MT For profit - Corporation N 4275125 THE LIVING CENTRE STEVENSVILLE MT For profit - Corporation N 3275061 MARIAS CARE CENTER SHELBY MT For profit - Corporation N 3275027 HILLSIDE HEALTH & REHABILITATION MISSOULA MT For profit - Partnership N 3275069 HOT SPRINGS HEALTH & REHABILITATION CENTER HOT SPRINGS MT For profit - Corporation N 2275122 CREST NURSING HOME BUTTE MT For profit - Corporation N 2275133 BLACKFEET CARE CENTER BROWNING MT Government - City/county N 2275140 ASPEN MEADOWS HEALTH AND REHABILITATION CENTER BILLINGS MT Non profit - Corporation N 2275136 MADISON VALLEY MANOR ENNIS MT Government - County N 2275094 LAKE VIEW HEALTHCARE COMMUNITY BIGFORK MT For profit - Individual N 2275119 PONDERA MEDICAL CENTER LTC CONRAD MT Non profit - Corporation Y 1275087 POWDER RIVER MANOR BROADUS MT Government - County N 1275044 BIG SKY HEALTHCARE COMMUNITY HELENA MT For profit - Corporation N 1275020 BELLA TERRA OF BILLINGS BILLINGS MT For profit - Corporation N 1275127 SWEET MEMORIAL NURSING HOME CHINOOK MT Non profit - Corporation N 1275072 ROSEBUD HEALTH CARE CENTER FORSYTH MT Non profit - Corporation Y 1275079 WIBAUX COUNTY NURSING HOME WIBAUX MT Non profit - Corporation N 1345573 ARBOR ACRES UNITED METHODIST RETIREMENT COMMUNITY WINSTON SALEM NC Non profit - Church related N 90345512 CYPRESS GLEN RETIREMENT COMMUN GREENVILLE NC Non profit - Corporation N 84345425 FAIR HAVEN HOME INC BOSTIC NC For profit - Corporation N 31345431 OUR COMMUNITY HOSPITAL SCOTLAND NECK NC Non profit - Other Y 25345227 AVANTE AT REIDSVILLE REIDSVILLE NC For profit - Corporation N 22345358 LOUISBURG HEALTHCARE & REHABILITATION CENTER LOUISBURG NC For profit - Corporation N 22345315 HIGHLAND ACRES NURSING AND REHABILITATION CENTER LUMBERTON NC For profit - Corporation N 22

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 133: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

345148 FRIENDS HOMES AT GUILFORD GREENSBORO NC Non profit - Corporation N 21345367 GOLDEN YEARS NURSING HOME FALCON NC For profit - Corporation N 20345530 PENN NURSING CENTER REIDSVILLE NC For profit - Corporation N 19345297 SCOTIA VILLAGE-SNF LAURINBURG NC Non profit - Corporation N 17345293 RICHMOND PINES HEALTHCARE AND REHABILITATION CENTE HAMLET NC For profit - Corporation N 15345288 MAGNOLIA ESTATES SKILLED CARE SPENCER NC For profit - Corporation N 14345330 THE GRAYBRIER NURS & RETIREMENT CT TRINITY NC For profit - Corporation N 14345049 RALEIGH REHABILITATION CENTER RALEIGH NC For profit - Corporation N 13345132 GREENHAVEN HEALTH AND REHABILITATION CENTER GREENSBORO NC For profit - Corporation N 13345150 KENANSVILLE HEALTH & REHABILITATION CENTER KENANSVILLE NC For profit - Corporation N 13345323 BRIAN CTR HLTH & REHABILITATIO WALLACE NC For profit - Corporation N 13345481 WOODLANDS NURSING & REHABILITATION CENTER FAYETTEVILLE NC For profit - Partnership N 12345504 SOUTHPORT NURSING CENTER SOUTHPORT NC For profit - Corporation N 12345184 CONCORDIA TRANSITIONAL CARE & REHAB-ELIZABETH CITY ELIZABETH CITY NC For profit - Corporation N 12345209 BROOKRIDGE RETIREMENT COMMUNITY WINSTON-SALEM NC Non profit - Corporation N 12345416 BERMUDA VILLAGE RETIREMENT CENTER BERMUDA RUN NC For profit - Corporation N 12345503 LIBERTY COMMONS NSG & REH ROWA SALISBURY NC For profit - Corporation N 12345568 DAVIS HEALTH & WELLNESS CTR AT CAMBRIDGE VILLAG WILMINGTON NC Non profit - Corporation N 11345167 YADKIN NURSING CARE CENTER YADKINVILLE NC For profit - Corporation N 11345142 UNIVERSITY PLACE NURSING AND REHABILITATION CENTER CHARLOTTE NC For profit - Corporation N 11345149 BRIAN CTR HEALTH & RETIREMENT WINSTON-SALEM NC For profit - Corporation N 11345292 GRANTSBROOK NURSING AND REHABILITATION CENTER GRANTSBORO NC For profit - Corporation N 11345262 BRIAN CENTER HEALTH & REHAB/HE HERTFORD NC For profit - Corporation N 11345265 BRIAN CENTER HEALTH & REHAB/YA YANCEYVILLE NC For profit - Corporation N 11345342 BIG ELM RETIREMENT AND NURSING CENTERS KANNAPOLIS NC Non profit - Corporation N 11345319 ELDERBERRY HEALTH CARE MARSHALL NC For profit - Corporation N 10345418 ASHEVILLE HEALTH CARE CENTER SWANNANOA NC For profit - Partnership N 10345405 CHARLOTTE HEALTH & REHABILITATION CENTER CHARLOTTE NC For profit - Corporation N 10345202 CAPITAL NURSING AND REHABILITATION CENTER RALEIGH NC For profit - Corporation N 10345406 ACCORDIUS HEALTH AND REHABILITATION GATESVILLE NC For profit - Corporation N 10345236 ACCORDIUS HEALTH AT WILMINGTON WILMINGTON NC For profit - Corporation N 10345273 KINDRED HOSPITAL EAST GREENSBORO GREENSBORO NC For profit - Corporation Y 10345313 NORTHAMPTON NURSING AND REHABILITATION CENTER JACKSON NC For profit - Corporation N 10345471 MECKLENBURG HEALTH & REHABILITATION CENTER CHARLOTTE NC For profit - Corporation N 10345457 BELAIRE HEALTH CARE CENTER GASTONIA NC For profit - Corporation N 9

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 134: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

345201 COMPLETE CARE AT CHARLOTTE CHARLOTTE NC For profit - Partnership N 9345164 CHOWAN RIVER NURSING AND REHABILITATION CENTER EDENTON NC For profit - Corporation N 9345169 BRIAN CTR HEALTH & REHAB/GASTO GASTONIA NC For profit - Corporation N 8345376 CUMBERLAND NURSING AND REHABILITATION CENTER FAYETTEVILLE NC For profit - Corporation N 8345316 SENIOR CITIZENS HOME HENDERSON NC For profit - Corporation N 8345009 THE OAKS AT WHITAKER GLEN-MAYVIEW RALEIGH NC For profit - Corporation N 8345510 PRODIGY TRANSITIONAL REHAB TARBORO NC For profit - Corporation N 8345474 FRIENDS HOMES WEST GREENSBORO NC Non profit - Corporation N 7345373 LIBERTY COMMONS NURSING & REHAB CTR OF SOUTHPORT, SOUTHPORT NC For profit - Corporation N 7345566 PRUITTHEALTH-UNION POINTE MONROE NC For profit - Corporation N 7345228 RIDGEWOOD LIVING & REHAB CENTER WASHINGTON NC For profit - Individual N 7345072 CAROLINA RIVERS NURSING AND REHABILITATION CENTER JACKSONVILLE NC For profit - Individual N 7345089 WALNUT COVE HEALTH AND REHABILITATION CENTER WALNUT COVE NC For profit - Corporation N 6345010 COMPLETE CARE AT ASHEVILLE ASHEVILLE NC For profit - Corporation N 6345244 HARBORVIEW HEALTH CARE CENTER MOREHEAD CITY NC For profit - Corporation N 6345396 SMOKY MOUNTAIN HEALTH AND REHABILITATION CENTER WAYNESVILLE NC For profit - Individual N 6345550 WHITE OAK OF WAXHAW WAXHAW NC For profit - Corporation N 6345562 CLEAR CREEK NURSING & REHABILITATION CENTER MINT HILL NC For profit - Corporation N 6345519 LIBERTY COMMONS NSG & REH JOHN BENSON NC For profit - Corporation N 6345325 CORNERSTONE NURSING AND REHABILITATION CENTER DUNN NC For profit - Corporation N 6345385 CARDINAL HEALTHCARE AND REHAB LINCOLNTON NC For profit - Corporation N 6345442 FORREST OAKES HEALTHCARE CENTER ALBEMARLE NC For profit - Corporation N 6345448 MAPLE GROVE HEALTH AND REHABILITATION CENTER GREENSBORO NC For profit - Corporation N 6345390 COUNTRYSIDE MANOR STOKESDALE NC For profit - Corporation N 6345392 AMBASSADOR REHAB & HEALTHCARE CENTER WADESBORO NC For profit - Corporation N 6345363 THE PRESBYTERIAN HOME OF HAWFIELDS MEBANE NC Non profit - Corporation N 6345412 BRANTWOOD NH & RETIREMENT CENT OXFORD NC Government - County Y 5345496 LIBERTY COMMONS N&R ALAMANCE BURLINGTON NC For profit - Corporation N 5345450 WESTWOOD HEALTH AND REHABILITA ARCHDALE NC For profit - Corporation N 5345543 BERMUDA COMMONS NURSING AND REHABILITATION CENTER ADVANCE NC For profit - Corporation N 5345423 WILSON REHABILITATION AND NURSING CENTER WILSON NC For profit - Corporation N 5345459 WILLOWBROOKE COURT SC CTR AT TRYON ESTATES COLUMBUS NC Non profit - Corporation N 5345340 MAPLE LEAF HEALTH CARE STATESVILLE NC For profit - Corporation N 5345304 BRIAN CENTER NURSING CARE/SHAM CHARLOTTE NC For profit - Corporation N 5345378 PRUITTHEALTH-ROCKINGHAM ROCKINGHAM NC For profit - Corporation N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 135: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

345384 PRUITTHEATH-FARMVILLE FARMVILLE NC For profit - Corporation N 5345279 HUNTER HILLS NURSING AND REHABILITATION CENTER ROCKY MOUNT NC For profit - Corporation N 5345284 THE OAKS WINSTON SALEM NC For profit - Corporation N 5345104 ZEBULON REHABILITATION CENTER ZEBULON NC For profit - Corporation N 5345197 WILLOW RIDGE OF NC RUTHERFORDTON NC For profit - Corporation N 4345166 STOKES COUNTY NURSING HOME DANBURY NC For profit - Corporation Y 4345354 PINEY GROVE NURSING AND REHABILITATION CENTER KERNERSVILLE NC For profit - Corporation N 4345460 GUILFORD HEALTH CARE CENTER GREENSBORO NC For profit - Corporation N 4345437 ECKERD LIVING CENTER HIGHLANDS NC Non profit - Corporation Y 4345261 ALLEGHANY CENTER SPARTA NC For profit - Corporation N 4345359 ACCORDIUS HEALTH AT CREEKSIDE CARE AHOSKIE NC For profit - Corporation N 4345219 MAGNOLIA LANE NURSING AND REHABILITATION CENTER MORGANTON NC For profit - Corporation N 4345131 ACCORDIUS HEALTH AT CLEMMONS CLEMMONS NC For profit - Corporation N 4345162 GASTONIA CARE AND REHABILITATION GASTONIA NC For profit - Corporation N 4345180 WESLEY PINES RETIREMENT COMM LUMBERTON NC Non profit - Church related N 3345258 TRANSITIONAL HEALTH SERVICES OF KANNAPOLIS KANNAPOLIS NC For profit - Corporation N 3345298 THE LAURELS OF PENDER BURGAW NC For profit - Corporation N 3345321 KERR LAKE NURSING AND REHABILITATION CENTER HENDERSON NC For profit - Corporation N 3345362 BRIAN CENTER HEALTH & RETIREMENT/CABARRUS CONCORD NC For profit - Corporation N 3345355 GRAHAM HEALTHCARE AND REHABILITATION CENTER ROBBINSVILLE NC For profit - Corporation N 3345546 THE ROSEWOOD HEALTH CENTER RALEIGH NC Non profit - Corporation N 3345537 SILVER STREAM HEALTH AND REHABILITATION CENTER WILMINGTON NC For profit - Corporation N 3345309 LIBERTY COMMONS NSG AND REHAB CTR OF HALIFAX CTY WELDON NC For profit - Corporation N 3345343 BRIAN CENTER HEALTH AND REHABILITATION/GOLDSBORO GOLDSBORO NC For profit - Corporation N 3345484 TRANSYLVANIA REGIONAL HOSPITAL INC BREVARD NC Non profit - Corporation Y 3345532 LIBERTY COMMONS NSG AND REHAB CTR OF LEE COUNTY SANFORD NC For profit - Corporation N 3345545 TWIN LAKES COMMUNITY MEMORY CARE BURLINGTON NC Non profit - Church related N 3345171 WHITE OAK MANOR - SHELBY SHELBY NC For profit - Corporation N 3345285 MOUNTAIN HOME HEALTH AND REHAB HENDERSONVILLE NC For profit - Corporation N 3345302 BLUE RIDGE ON THE MOUNTAIN SYLVA NC For profit - Corporation N 3345237 BARBOUR COURT NURSING AND REHABILITATION CENTER SMITHFIELD NC For profit - Corporation N 2345179 BRIAN CENTER HEALTH AND RETIREMENT MOORESVILLE NC For profit - Corporation N 2345081 CONCORDIA TRANSITIONAL CARE & REHAB-ROSE MANOR DURHAM NC For profit - Corporation N 2345088 TRINITY GLEN WINSTON-SALEM NC Non profit - Church related N 2345207 LIBERTY COMMONS N&R CTR OF COLUMBUS CTY WHITEVILLE NC For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 136: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

345229 PEAK RESOURCES - SHELBY SHELBY NC For profit - Corporation N 2345106 TRINITY RIDGE HICKORY NC Non profit - Church related N 2345130 AVANTE AT CONCORD CONCORD NC For profit - Corporation N 2345011 BRIAN CENTER NURSING CARE/LEXI LEXINGTON NC For profit - Corporation N 2345014 FISHER PARK HEALTH AND REHABILITATION CENTER GREENSBORO NC For profit - Corporation N 2345535 ADAMS FARM LIVING & REHABILITATION JAMESTOWN NC For profit - Corporation N 2345494 PEAK RESOURCES - GASTONIA GASTONIA NC For profit - Corporation N 2345473 WILORA LAKE HEALTHCARE CENTER CHARLOTTE NC For profit - Partnership N 2345479 SALEMTOWNE WINSTON SALEM NC Non profit - Church related N 2345441 ALEXANDRIA PLACE GASTONIA NC For profit - Corporation N 2345366 GREENDALE FOREST NURSING AND REHABILITATION CENTER SNOW HILL NC For profit - Corporation N 2345350 COURTLAND TERRACE GASTONIA NC Non profit - Corporation Y 2345534 SANFORD HEALTH & REHABILITATION CO SANFORD NC For profit - Corporation N 2345563 PAVILION HEALTH CENTER AT BRIGHTMORE CHARLOTTE NC For profit - Corporation N 2345417 HILLSIDE NURSING CENTER OF WAK WAKE FOREST NC For profit - Corporation N 2345518 INN AT QUAIL HAVEN VILLAGE PINEHURST NC For profit - Corporation N 2345339 BRIAN CENTER HLTH & REHAB WINDSOR NC For profit - Corporation N 2345404 THREE RIVERS HEALTH AND REHAB WINDSOR NC For profit - Corporation N 2345410 CENTRAL CONTINUING CARE MOUNT AIRY NC For profit - Corporation N 2345326 WILLOWBROOKE COURT SC CTR AT PLANTATION ESTATES MATTHEWS NC Non profit - Corporation N 2345329 GATEWAY REHABILITATION AND HEALTHCARE LENOIR NC For profit - Corporation N 2345311 ROXBORO HEALTHCARE & REHAB CENTER ROXBORO NC For profit - Corporation N 2345216 WESTFIELD REHABILITATION AND HEALTH CENTER SANFORD NC For profit - Corporation N 2345242 THE FOUNTAINS AT THE ALBEMARLE TARBORO NC For profit - Corporation N 2345243 BRIAN CENTER HEALTH & REHAB/CH CHARLOTTE NC For profit - Corporation N 2345134 AVANTE AT CHARLOTTE CHARLOTTE NC For profit - Partnership N 2345095 CHATHAM NURSING & REHABILITATION ELKIN NC For profit - Partnership N 2345101 ENFIELD OAKS NURSING AND REHABILITATION CENTER ENFIELD NC For profit - Corporation N 1345103 CARRINGTON PLACE MATTHEWS NC For profit - Corporation N 1345051 ANSON HEALTH AND REHABILITATION WADESBORO NC For profit - Corporation N 1345003 SILAS CREEK REHABILITATION CENTER WINSTON-SALEM NC For profit - Individual N 1345008 COMPLETE CARE AT MYERS PARK CHARLOTTE NC For profit - Corporation N 1345195 EDGECOMBE HEALTH AND REHAB CENTER TARBORO NC For profit - Corporation N 1345234 LUMBERTON HEALTH AND REHAB CENTER LUMBERTON NC For profit - Corporation N 1345210 ELIZABETHTOWN HEALTHCARE & REHAB CENTER ELIZABETHTOWN NC For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 137: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

345212 BETHESDA HEALTH CARE FACILITY EASTOVER NC For profit - Corporation N 1345407 CROSS CREEK HEALTH CARE SWANQUARTER NC For profit - Partnership N 1345403 CARY HEALTH AND REHABILITATION CARY NC For profit - Individual N 1345357 PRUITTHEALTH-NEUSE NEW BERN NC For profit - Corporation N 1345370 PINEHURST HEALTHCARE & REHAB PINEHURST NC For profit - Corporation N 1345526 CAROLINA REHAB CENTER OF BURKE CONNELLY SPG NC For profit - Corporation N 1345506 WHITESTONE A MASONIC AND EASTERN STAR COMMUNITY GREENSBORO NC Non profit - Corporation N 1345421 THE LAURELS OF CHATHAM PITTSBORO NC For profit - Corporation N 1345429 PEAK RESOURCES - PINELAKE CARTHAGE NC For profit - Corporation N 1345449 UNIVERSAL HEALTH CARE/KING KING NC For profit - Corporation N 1345564 SHARON TOWERS CHARLOTTE NC Non profit - Corporation N 1345571 CAROLINA BAY HEALTHCARE CTR OF WILMINGTON LLC WILMINGTON NC For profit - Corporation N 1345380 VILLAGE GREEN HEALTH AND REHABILITATION FAYETTEVILLE NC For profit - Corporation N 1345349 WOODBURY WELLNESS CENTER INC HAMPSTEAD NC For profit - Corporation N 1345391 HEARTLAND LIVING & REHAB AT THE MOSES H CONE MEM H GREENSBORO NC For profit - Corporation N 1345414 HAYMOUNT REHABILITATION & NURSING CENTER, INC FAYETTEVILLE NC For profit - Corporation N 1345415 PINEVILLE REHABILITATION AND LIVING CTR PINEVILLE NC For profit - Corporation N 1345464 OAK GROVE HEALTH CARE CENTER RUTHERFORDTON NC For profit - Corporation N 1345465 BAYVIEW NURSING & REHAB CENTER NEW BERN NC For profit - Corporation N 1345500 WINDSOR POINT CONTINUING CARE FUQUAY VARINA NC For profit - Corporation N 1345502 LAKE PARK NURSING AND REHABILITATION CENTER INDIAN TRAIL NC For profit - Corporation N 1345538 PRUITTHEALTH-RALEIGH RALEIGH NC For profit - Corporation N 1345565 TRINITY ELMS CLEMMONS NC Non profit - Corporation N 1345053 PETTIGREW REHABILITATION CENTER DURHAM NC For profit - Corporation N 1345143 SILER CITY CENTER SILER CITY NC For profit - Corporation N 1345077 SUNNYBROOK REHABILITATION CENTER RALEIGH NC For profit - Corporation N 1345232 BRIAN CTR HEALTH & REHABI HICK HICKORY NC For profit - Corporation N 1345223 BLUE RIDGE HEALTH AND REHABILITATION CENTER HENDERSONVILLE NC For profit - Corporation N 1345225 SIGNATURE HEALTHCARE OF CHAPEL HILL CHAPEL HILL NC For profit - Corporation N 1345182 PRUITTHEALTH-SEALEVEL SEALEVEL NC For profit - Corporation N 1345240 WARREN HILLS NURSING CENTER WARRENTON NC For profit - Corporation N 1345241 BRIAN CENTER HEALTH & REHAB/EDEN EDEN NC For profit - Corporation N 1345245 PENDER MEMORIAL HOSP SNF BURGAW NC Non profit - Other Y 1345252 WARSAW HEALTH & REHABILITATION CENTER WARSAW NC For profit - Corporation N 1345254 MONROE REHABILITATION CENTER MONROE NC For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 138: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

345260 ROCKY MOUNT REHABILITATION CENTER ROCKY MOUNT NC For profit - Individual N 1355080 DUNSEITH COM NURSING HOME DUNSEITH ND Government - City N 10355042 WESTERN HORIZONS CARE CENTER HETTINGER ND Non profit - Corporation N 8355087 WEDGEWOOD MANOR CAVALIER ND Non profit - Corporation Y 8355061 SANFORD HILLSBORO CARE CENTER HILLSBORO ND Non profit - Corporation Y 7355100 GOOD SAMARITAN SOCIETY - DEVILS LAKE DEVILS LAKE ND Non profit - Corporation N 7355107 ST ROSE CARE CENTER LAMOURE ND Non profit - Corporation N 5355108 MARYHILL MANOR ENDERLIN ND Non profit - Corporation N 5355050 MAPLE MANOR CARE CENTER LANGDON ND Non profit - Other N 4355099 GOOD SAMARITAN SOCIETY - MOTT MOTT ND Non profit - Church related N 4355091 ASHLEY MEDICAL CENTER NURSING HOME ASHLEY ND Non profit - Corporation Y 3355093 GOOD SAMARITAN SOCIETY - BOTTINEAU BOTTINEAU ND Non profit - Corporation N 3355041 LUTHERAN HOME OF THE GOOD SHEPHERD NEW ROCKFORD ND Non profit - Corporation N 2355051 HATTON PRAIRIE VILLAGE HATTON ND Non profit - Corporation N 1355024 MANOR CARE HEALTH SERVICES FARGO ND For profit - Corporation N 1355034 TIOGA MEDICAL CENTER LTC TIOGA ND Non profit - Corporation Y 1355095 GOOD SAMARITAN SOCIETY - OAKES OAKES ND Non profit - Corporation N 1355096 ANETA PARKVIEW HEALTH CTR ANETA ND Non profit - Corporation N 1355115 GARRISON MEM HOSP NSG FAC GARRISON ND Non profit - Church related Y 1355097 GOOD SAMARITAN SOCIETY - LARIMORE LARIMORE ND Non profit - Other N 1355081 ROLETTE COMMUNITY CARE CENTER ROLETTE ND Non profit - Corporation N 1355084 LUTHERAN SUNSET HOME GRAFTON ND Non profit - Church related N 1355049 STRASBURG NURSING HOME STRASBURG ND Non profit - Corporation N 1355078 EVENTIDE JAMESTOWN JAMESTOWN ND Non profit - Corporation N 1285144 BLUE HILL CARE CENTER BLUE HILL NE For profit - Corporation N 4728A065 CARL T CURTIS HEALTH EDUCATION CENTER NURSING HOME MACY NE Non profit - Other N 34285141 SUTHERLAND CARE CENTER SUTHERLAND NE For profit - Corporation N 31285259 BLUE VALLEY LUTHERAN NURSING HOME HEBRON NE Non profit - Corporation N 31285161 UTICA COMMUNITY CARE CENTER UTICA NE For profit - Corporation N 31285261 PARKVIEW HAVEN NURSING HOME DESHLER NE Government - City N 30285132 CRESTVIEW CARE CENTER MILFORD NE For profit - Corporation N 25285286 GREELEY CARE HOME GREELEY NE Government - City N 23285265 HEMINGFORD COMMUNITY CARE CENTER HEMINGFORD NE Government - City N 21285294 VALLEY VIEW SENIOR VILLAGE ORD NE For profit - Corporation N 20285148 GOOD SHEPHERD LUTHERAN HOME BLAIR NE Non profit - Corporation N 19

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 139: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

285269 BEAVER CITY MANOR BEAVER CITY NE Government - City N 18285252 IMPERIAL MANOR NURSING HOME IMPERIAL NE Government - City N 17285147 CENTRAL CITY CARE CENTER CENTRAL CITY NE For profit - Corporation N 12285220 WAUNETA CARE AND THERAPY CENTER WAUNETA NE Government - City/county N 1228E191 MEMORIAL COMMUNITY CARE AURORA NE Non profit - Corporation N 12285273 PLAINVIEW MANOR PLAINVIEW NE Government - City N 11285253 EL DORADO MANOR NURSING HOME TRENTON NE Government - City/county N 11285055 FALLS CITY NURSING AND REHABILITATION CENTER FALLS CITY NE For profit - Corporation N 10285065 GOLD CREST RETIREMENT CENTER ADAMS NE Non profit - Corporation N 10285091 INDIAN HILLS HEALTHCARE COMMUNITY OGALLALA NE For profit - Corporation N 10285178 HILLCREST CARE CENTER LAUREL NE Government - City N 828E195 CAMBRIDGE MANOR CAMBRIDGE NE Non profit - Corporation Y 828E257 GORDON COUNTRYSIDE CARE GORDON NE Government - Hospital district Y 7285232 SUNRISE COUNTRY MANOR MILFORD NE For profit - Corporation N 7285151 WISNER CARE CENTER WISNER NE Government - City/county N 7285271 NORTHFIELD RETIREMENT COMMUNITIES CARE CENTER SCOTTSBLUFF NE Non profit - Corporation N 7285238 KEYSTONE RIDGE POST ACUTE NURSING AND REHAB OMAHA NE For profit - Corporation N 7285225 HERITAGE OF RED CLOUD RED CLOUD NE Non profit - Corporation N 6285216 MT CARMEL HOME- KEENS MEMORIAL KEARNEY NE Non profit - Corporation N 6285282 GARDENSIDE LTC-JCHC FAIRBURY NE Non profit - Corporation Y 6285082 MATNEY'S COLONIAL MANOR SOUTH SIOUX CITY NE For profit - Corporation N 6285159 PLUM CREEK HEALTHCARE COMMUNITY LEXINGTON NE For profit - Corporation N 628E173 HENDERSON CARE CENTER HENDERSON NE Non profit - Corporation N 6285103 PREMIER ESTATES OF FREMONT, LLC FREMONT NE For profit - Individual N 5285185 GOOD SAMARITAN SOCIETY - COLONIAL VILLA ALMA NE Non profit - Corporation N 5285258 BERTRAND NURSING HOME BERTRAND NE Government - City N 5285203 GOOD SAMARITAN SOCIETY - BEATRICE BEATRICE NE Non profit - Corporation N 5285183 COLONIAL MANOR OF RANDOLPH RANDOLPH NE For profit - Corporation N 4285186 LEGACY GARDEN REHABILITATION & LIVING CENTER PENDER NE Government - Hospital district N 4285150 CREST VIEW HEALTHCARE COMMUNITY CHADRON NE For profit - Corporation N 4285137 LIFE CARE CENTER OF OMAHA OMAHA NE For profit - Corporation N 4285172 WILBER CARE CENTER WILBER NE Government - City N 4285114 FALLS CITY HEALTHCARE COMMUNITY FALLS CITY NE For profit - Corporation N 4285298 SANDHILLS CARE CENTER AINSWORTH NE Government - City/county N 4285165 NORTH PLATTE CARE CENTER, LLC NORTH PLATTE NE For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 140: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

285201 CLOVERLODGE CARE CENTER ST EDWARD NE Non profit - Corporation N 4285275 LANCASTER REHABILITATION CENTER, LLC LINCOLN NE For profit - Corporation N 4285260 CHIMNEY ROCK VILLA BAYARD NE Government - City N 4285139 PREMIER ESTATES OF PIERCE, LLC PIERCE NE For profit - Corporation N 4285240 OMAHA NURSING AND REHABILITATION CENTER OMAHA NE For profit - Corporation N 3285241 SARAH ANN HESTER MEMORIAL HOME BENKELMAN NE Non profit - Corporation N 3285267 LOUISVILLE CARE CENTER LOUISVILLE NE Government - City N 3285274 BRIGHTON GARDENS OF OMAHA OMAHA NE For profit - Corporation N 3285204 COLONIAL HAVEN BEEMER NE Government - City N 3285078 ST. JOSEPH VILLA NURSING CENTER OMAHA NE For profit - Corporation N 3285300 HILLCREST FIRETHORN LINCOLN NE For profit - Corporation N 3285247 BIRCHWOOD MANOR NORTH BEND NE For profit - Individual N 3285277 SUTTON COMMUNITY HOME, INC. SUTTON NE Non profit - Other N 3285158 PREMIER ESTATES OF WEST POINT, LLC WEST POINT NE For profit - Individual N 3285208 COMMUNITY PRIDE CARE CENTER BATTLE CREEK NE Government - City/county N 2285212 PIONEER MANOR NURSING HOME HAY SPRINGS NE Government - City N 2285279 RIDGEWOOD REHABILITATION & CARE CENTER SEWARD NE For profit - Corporation N 2285256 KIMBALL COUNTY MANOR KIMBALL NE Government - County N 2285230 HERITAGE CROSSINGS GENEVA NE For profit - Corporation N 2285222 HERITAGE OF EMERSON EMERSON NE Non profit - Corporation N 2285229 HOOPER CARE CENTER HOOPER NE Non profit - Corporation N 2285163 HILLTOP ESTATES GOTHENBURG NE For profit - Corporation N 2285152 MORYS HAVEN COLUMBUS NE For profit - Corporation N 2285200 CALLAWAY GOOD LIFE CENTER, INC CALLAWAY NE Non profit - Corporation N 2285239 RIDGECREST REHABILITATION CENTER OMAHA NE For profit - Corporation N 1285245 PARKSIDE MANOR STUART NE Government - City N 1285281 OAKLAND HEIGHTS OAKLAND NE Government - City N 1285299 OLD CHENEY REHABILITATION LINCOLN NE For profit - Corporation N 1285157 PREMIER ESTATES OF PAWNEE, LLC PAWNEE CITY NE For profit - Individual N 1285138 GOOD SAMARITAN SOCIETY - SYRACUSE SYRACUSE NE Non profit - Corporation N 1285209 WAKEFIELD HEALTH CARE CENTER WAKEFIELD NE Government - City N 1285215 ELWOOD CARE CENTER ELWOOD NE Government - City N 1285170 PREMIER ESTATES OF CRETE, LLC CRETE NE For profit - Individual N 1285175 GOOD SAMARITAN SOCIETY - ARAPAHOE ARAPAHOE NE Non profit - Corporation N 1285193 GOOD SAMARITAN SOCIETY - OSCEOLA OSCEOLA NE Non profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 141: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

285198 GOOD SAMARITAN SOCIETY - WOOD RIVER WOOD RIVER NE Non profit - Corporation N 1285080 HILLCREST NURSING HOME MCCOOK NE Government - City/county N 1285036 EASTMONT TOWERS LINCOLN NE Non profit - Other N 1285262 HERITAGE CARE CENTER FAIRBURY NE Non profit - Other N 1285213 MID-NEBRASKA LUTHERAN HOME NEWMAN GROVE NE Non profit - Corporation N 1285191 ELMS HEALTH CARE CENTER PONCA NE For profit - Corporation N 1285135 CAREAGE CAMPUS OF CARE WAYNE NE For profit - Corporation N 1285073 PARK VIEW HAVEN NURSING HOME COLERIDGE NE Government - City N 1285058 NEBRASKA SKILLED NURSING & REHAB OMAHA NE For profit - Corporation N 128E180 REGIONAL WEST GARDEN COUNTY NURSING HOME OSHKOSH NE Non profit - Corporation N 1305088 ST JOSEPH RESIDENCE MANCHESTER NH Non profit - Church related N 22305074 HOLY CROSS HEALTH CENTER MANCHESTER NH Non profit - Corporation N 8305053 GRAFTON COUNTY NURSING HOME NORTH HAVERHILL NH Government - County N 8305043 WARDE HEALTH CENTER WINDHAM NH Non profit - Church related N 6305068 THE ELMS CENTER MILFORD NH For profit - Corporation N 5305079 VILLA CREST MANCHESTER NH For profit - Corporation N 5305070 SAINT FRANCIS REHABILITATION AND NURSING CENTER LACONIA NH Non profit - Church related N 4305096 BEL-AIR NURSING AND REHAB CENTER INC GOFFSTOWN NH For profit - Corporation N 3305095 AURORA SENIOR LIVING OF DERRY, LLC DERRY NH For profit - Corporation N 3305066 SAINT VINCENT DE PAUL REHABILITATION & NURSING CTR BERLIN NH Non profit - Corporation N 2305075 MOUNTAIN RIDGE CENTER, GENESIS HEALTHCARE FRANKLIN NH For profit - Corporation N 2305057 COURVILLE AT MANCHESTER MANCHESTER NH For profit - Corporation N 2305064 EXETER CENTER EXETER NH For profit - Corporation N 2305072 GOOD SHEPHERD REHABILITATION AND NURSING CENTER JAFFREY NH Non profit - Church related N 2305041 ELM WOOD CENTER AT CLAREMONT CLAREMONT NH For profit - Corporation N 2305020 HANOVER TERRACE HEALTH & REHABILITATION CENTER HANOVER NH For profit - Corporation N 1305089 LANGDON PLACE OF DOVER DOVER NH For profit - Corporation N 1305100 FAIRVIEW NURSING HOME HUDSON NH For profit - Corporation N 1315297 FOUNTAINS AT CEDAR PARKE, THE ATCO NJ For profit - Individual N 43315256 LEISURE PARK HEALTH CENTER LAKEWOOD NJ For profit - Corporation N 15315223 HAMILTON CONTINUING CARE HAMILTON NJ Non profit - Corporation N 13315341 CLARK NURSING AND REHAB CNTR CLARK NJ For profit - Corporation N 13315061 SOUTH JERSEY EXTENDED CARE BRIDGETON NJ For profit - Individual N 12315108 PRINCETON CARE CENTER PRINCETON NJ For profit - Corporation N 6315206 MANAHAWKIN CONV CTR MANAHAWKIN NJ For profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 142: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

315467 LITTLE BROOK NURSING AND CONVALESCENT HOME CALIFON NJ For profit - Corporation N 6315471 ST CATHERINE OF SIENA CALDWELL NJ Non profit - Corporation N 5315347 HAMILTON PLACE AT THE PINES AT WHITING WHITING NJ Non profit - Corporation N 5315483 PLAZA HEALTHCARE & REHABILITATION CENTER ELIZABETH NJ For profit - Corporation N 5315479 CARE ONE AT LIVINGSTON LIVINGSTON NJ For profit - Corporation N 4315299 KING MANOR CARE AND REHABILITATION CENTER NEPTUNE NJ For profit - Partnership N 3315383 CHESHIRE HOME FLORHAM PARK NJ Non profit - Corporation N 3315205 MAJESTIC CENTER FOR REHAB & SUB-ACUTE CARE CAMDEN NJ For profit - Corporation N 3315014 EAGLEVIEW HEALTH AND REHABILITATION PITTSGROVE NJ For profit - Corporation N 3315128 VIRTUA HEALTH & REHAB MT HOLLY LUMBERTON NJ Non profit - Corporation N 2315239 CHILDRENS SPECIALIZED HOSPITAL MOUNTAINSIDE MOUNTAINSIDE NJ Non profit - Other Y 2315120 CHATHAM HILLS SUBACUTE CARE CENTER CHATHAM NJ For profit - Partnership N 2315443 CHILDRENS SPECIALIZED HOSPITAL TOMS RIVER TOMS RIVER NJ Non profit - Other Y 2315141 ABINGDON CARE & REHABILITATION CENTER GREEN BROOK NJ For profit - Individual N 1315210 HEALTH CENTER AT GALLOWAY, THE GALLOWAY TOWNSHIP NJ For profit - Partnership N 1315235 RIVERSIDE NURSING AND REHABILITATION CENTER TRENTON NJ For profit - Corporation N 1315111 ARCADIA NURSING AND REHAB HAMILTON SQUARE NJ Non profit - Corporation N 1315064 ASHBROOK CARE & REHABILITATION CENTER SCOTCH PLAINS NJ For profit - Individual N 1315286 MAJESTIC REHAB AND NURSING CENTER AT RED BANK RED BANK NJ For profit - Corporation N 1315327 FOUNTAIN VIEW CARE CENTER LAKEWOOD NJ For profit - Corporation N 1315514 EGG HARBOR CARE CENTER EGG HARBOR TOWNSHIP NJ For profit - Partnership N 1315523 CONTINUING CARE AT LANTERN HILL NEW PROVIDENCE NJ Non profit - Corporation N 1315021 DAUGHTERS OF MIRIAM CENTER CLIFTON NJ Non profit - Corporation N 1315037 TEANECK NURSING CENTER TEANECK NJ For profit - Corporation N 1315019 DWELLING PLACE AT ST CLARE'S DOVER NJ For profit - Corporation N 1315053 PINE ACRES CONVALESCENT CENTER MADISON NJ For profit - Partnership N 1315056 NEPTUNE GARDENS NURSING AND REHAB LLC NEPTUNE NJ For profit - Corporation N 1315069 TOWER LODGE CARE CENTER WALL NJ For profit - Partnership N 1315013 BARCLAYS REHABILITATION AND HEALTHCARE CENTER CHERRY HILL NJ For profit - Partnership N 1315448 BAPTIST HOME OF SOUTH JERSEY RIVERTON NJ Non profit - Church related N 1315461 VIRTUA H & R C AT BERLIN BERLIN NJ Non profit - Corporation N 1315465 MANHATTANVIEW NURSING HOME UNION CITY NJ For profit - Corporation N 1315282 PINE BROOK CARE CENTER ENGLISHTOWN NJ For profit - Corporation N 1315284 MONMOUTH CARE CENTER LONG BRANCH NJ For profit - Corporation N 1315330 MARCELLA CENTER BURLINGTON NJ For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 143: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

315374 DE LA SALLE HALL LINCROFT NJ Non profit - Corporation N 1315492 BOONTON CARE CENTER BOONTON NJ For profit - Partnership N 1325056 SOMBRILLO NURSING FACILITY LOS ALAMOS NM Non profit - Corporation N 13325083 SOUTH VALLEY CARE CENTER, LLC ALBUQUERQUE NM For profit - Individual N 13325057 GOOD SAMARITAN - LOVINGTON LOVINGTON NM Non profit - Corporation N 10325084 RATON NURSING AND REHAB CENTER RATON NM For profit - Partnership N 1032E032 COLFAX GENERAL LTC SPRINGER NM Government - Hospital district N 8325113 CEDAR RIDGE INN FARMINGTON NM For profit - Corporation N 7325058 GOOD SAMARITAN SOCIETY - GRANTS GRANTS NM Non profit - Corporation N 6325067 GOOD SAMARITAN SOCIETY LAS CRUCES VILLAGE LAS CRUCES NM Non profit - Corporation N 5325060 ALBUQUERQUE POST ACUTE ALBUQUERQUE NM For profit - Corporation N 5325044 MISSION ARCH CENTER ROSWELL NM For profit - Corporation N 5325105 TAOS LIVING CENTER TAOS NM For profit - Corporation N 4325128 SAN PEDRO NURSING AND REHABILITATION CENTER ARTESIA NM For profit - Partnership N 4325108 CASA DEL SOL CENTER LAS CRUCES NM For profit - Corporation N 4325130 NEIGHBORHOOD IN RIO RANCHO (THE) RIO RANCHO NM Non profit - Other N 3325127 THE RIO AT CABEZON RIO RANCHO NM For profit - Corporation N 2325054 CANYON TRANSITIONAL REHABILITATION CENTER, LLC ALBUQUERQUE NM For profit - Corporation N 2325117 SUNSET VILLA CARE CENTER ROSWELL NM For profit - Corporation N 2325118 MCKINLEY CENTER GALLUP NM For profit - Corporation N 2325125 BEAR CANYON REHABILITATION CENTER ALBUQUERQUE NM For profit - Corporation N 2325065 VIDA ENCANTADA NURSING & REHAB LAS VEGAS NM For profit - Corporation N 2325076 ST ANTHONY HEALTHCARE AND REHAB CENTER, L CLOVIS NM For profit - Corporation N 1325033 RIO RANCHO CENTER RIO RANCHO NM For profit - Individual N 1325116 MESCALERO CARE CENTER MESCALERO NM For profit - Individual N 1325102 LEA REGIONAL MEDICAL CENTER - TRANSITIONAL CARE UN HOBBS NM For profit - Corporation Y 1325123 THE MEDICAL RESORT AT FIESTA PARK ALBUQUERQUE NM For profit - Corporation N 1325100 CLAYTON NURSING AND REHAB CLAYTON NM For profit - Corporation N 1325101 CARLSBAD MEDICAL CENTER - TCU CARLSBAD NM For profit - Corporation Y 1325047 CASA DE ORO CENTER LAS CRUCES NM For profit - Corporation N 1295087 KINDRED HOSPITAL - LAS VEGAS (FLAMINGO) - SNF/DP LAS VEGAS NV For profit - Corporation N 10295036 NORTH LAS VEGAS CARE CENTER NORTH LAS VEGAS NV For profit - Corporation N 10295011 SOUTH LYON MEDICAL CENTER YERINGTON NV Non profit - Corporation Y 8295000 PERSHING GENERAL HOSPITAL SNF LOVELOCK NV Government - Hospital district Y 8295029 WHITE PINE CARE CENTER ELY NV For profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 144: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

29E037 MISSION PINES NURSING & REHABILITATION CENTER NORTH LAS VEGAS NV For profit - Corporation N 4295001 LEFA SERAN SNF HAWTHORNE NV Government - Hospital district Y 3295099 HORIZON RIDGE SKILLED NURSING & REHABILITATION CTR HENDERSON NV For profit - Corporation N 3295098 SAGE CREEK POST-ACUTE LAS VEGAS NV For profit - Corporation N 2295023 CARSON NURSING AND REHABILITATION CENTER CARSON CITY NV For profit - Corporation N 1295078 HIGHLAND MANOR OF ELKO ELKO NV Non profit - Corporation N 1295082 GARDNERVILLE HEALTH & REHAB CENTER GARDNERVILLE NV For profit - Corporation N 1295008 EL JEN CONVALESCENT HOSPITAL AND RETIREMENT CENTER LAS VEGAS NV For profit - Corporation N 1335313 MEDINA MEMORIAL HOSPITAL S N F MEDINA NY Non profit - Corporation Y 51335554 THE BRIGHTONIAN ROCHESTER NY For profit - Corporation N 26335407 PENFIELD PLACE PENFIELD NY For profit - Corporation N 25335864 FLUSHING HOSPITAL MEDICAL CENTER T C U FLUSHING NY Non profit - Corporation Y 24335208 VALLEY VIEW MANOR NURSING HOME NORWICH NY For profit - Corporation N 23335077 NORTHWOODS REHAB AND E C F AT MORAVIA MORAVIA NY For profit - Partnership N 22335202 BATAVIA HEALTH CARE CENTER, LLC BATAVIA NY For profit - Corporation N 21335409 SUNNYSIDE CARE CENTER EAST SYRACUSE NY For profit - Corporation N 20335408 WEDGEWOOD NURSING HOME SPENCERPORT NY For profit - Individual N 18335595 DUNKIRK REHABILITATION & NURSING CENTER DUNKIRK NY For profit - Individual N 17335663 SAFIRE REHABILITATION OF SOUTHTOWN, L L C BUFFALO NY For profit - Corporation N 11335585 WATERVILLE RESIDENTIAL CARE CENTER WATERVILLE NY For profit - Partnership N 10335863 ST JOHNS PENFIELD HOMES CORPORATION FAIRPORT NY Non profit - Corporation N 10335799 UNION PLAZA CARE CENTER FLUSHING NY For profit - Partnership N 9335825 BAIRD NURSING HOME ROCHESTER NY For profit - Individual N 8335859 GOOD SHEPHERD VILLAGE AT ENDWELL ENDWELL NY Non profit - Corporation N 7335219 NEWARK MANOR NURSING HOME NEWARK NY For profit - Corporation N 7335364 CUBA MEMORIAL HOSPITAL INC S N F CUBA NY Non profit - Corporation Y 7335587 SUNSET NURSING AND REHABILITATION CENTER, INC BOONVILLE NY For profit - Corporation N 7335593 EMERALD SOUTH NURSING AND REHABILITATION CENTER BUFFALO NY For profit - Partnership N 6335759 NORWICH REHABILITATION & NURSING CENTER NORWICH NY For profit - Corporation N 6335070 BROOKLYN GARDENS NURSING & REHABILITATION CENTER BROOKLYN NY Non profit - Corporation N 6335478 ESSEX CENTER FOR REHABILITATION AND HEALTHCARE ELIZABETHTOWN NY For profit - Corporation N 6335548 ONONDAGA CENTER FOR REHABILITATION AND NURSING MINOA NY For profit - Corporation N 6335454 RIVER LEDGE HEALTH CARE AND REHABILITATION CENTER OGDENSBURG NY Non profit - Corporation N 5335489 MORNINGSTAR RESIDENTIAL CARE CENTER OSWEGO NY For profit - Corporation N 4335494 PENN YAN MANOR NURSING HOME IN PENN YAN NY Non profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 145: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

335322 HORNELL GARDENS HORNELL NY For profit - Corporation N 4335338 BISHOP REHABILITATION AND NURSING CENTER SYRACUSE NY For profit - Partnership N 4335175 BROOKSIDE MULTICARE NURSING CENTER SMITHTOWN NY For profit - Corporation N 4335676 HAVEN MANOR HEALTH CARE CENTER L L C FAR ROCKAWAY NY For profit - Partnership N 4335732 BETHANY GARDENS SKILLED LIVING CENTER ROME NY For profit - Corporation N 4335753 BRONX LEBANON SPECIAL CARE CENTER BRONX NY Non profit - Corporation N 4335093 PARK NURSING HOME ROCKAWAY PARK NY For profit - Individual N 4335659 FORDHAM NURSING AND REHABILITATION CENTER BRONX NY For profit - Corporation N 4335279 MAYFAIR CARE CENTER INC HEMPSTEAD NY For profit - Corporation N 4335465 DAUGHTERS OF SARAH NURSING CENTER ALBANY NY Non profit - Corporation N 3335216 AVON NURSING HOME AVON NY For profit - Corporation N 3335255 ELM MANOR NURSING HOME CANANDAIGUA NY For profit - Corporation N 3335816 CANTERBURY WOODS WILLIAMSVILLE NY Non profit - Corporation N 3335473 BRIGHTON MANOR ROCHESTER NY For profit - Corporation N 3335387 PENINSULA NURSING AND REHABILITATION CENTER FAR ROCKAWAY NY For profit - Corporation N 3335527 GOOD SHEPHERD FAIRVIEW HOME BINGHAMTON NY Non profit - Corporation N 3335423 PREMIER GENESEE CENTER FOR NURSING AND REHAB BATAVIA NY For profit - Corporation N 3335435 JENNIE B RICHMOND CHAFFEE NURSING HOME CO., INC. SPRINGVILLE NY Non profit - Corporation Y 3335532 AARON MANOR REHABILITATION & NURSING CENTER FAIRPORT NY For profit - Individual N 2335331 GRANVILLE CENTER FOR REHABILITATION AND NURSING GRANVILLE NY For profit - Corporation N 2335225 OAK HILL MANOR NURSING HOME ITHACA NY For profit - Partnership N 2335110 EVERGREEN COMMONS REHAB & NURSING CENTER EAST GREENBUSH NY For profit - Corporation N 2335615 HAMILTON MANOR NURSING HOME ROCHESTER NY For profit - Individual N 2335617 LATTA ROAD NURSING HOME WEST ROCHESTER NY For profit - Corporation N 2335556 CREEKVIEW NURSING AND REHAB CENTER ROCHESTER NY For profit - Corporation N 2335563 ROME MEMORIAL HOSPITAL R H C F ROME NY Non profit - Corporation Y 2335564 ONTARIO CENTER FOR REHABILITATION AND HEALTHCARE CANANDAIGUA NY Non profit - Corporation N 2335566 MAPLEWOOD HEALTH CARE AND REHABILITATION CENTER CANTON NY Non profit - Corporation N 2335762 ST MARYS CENTER INC NEW YORK NY Non profit - Corporation N 2335190 JEWISH HOME OF CENTRAL NEW YORK SYRACUSE NY Non profit - Corporation N 2335229 PUTNAM NURSING AND REHABILITATION CENTER HOLMES NY For profit - Corporation N 2335087 ST JOSEPHS HOME OGDENSBURG NY Non profit - Corporation N 2335096 RIVERDALE NURSING HOME BRONX NY For profit - Corporation N 1335103 RIVERVIEW MANOR HEALTH CARE CENTER OWEGO NY For profit - Corporation N 1335127 ALICE HYDE MEDICAL CENTER S N F MALONE NY Non profit - Corporation Y 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 146: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

335528 PLATTSBURGH REHABILITATION AND NURSING CENTER PLATTSBURGH NY For profit - Corporation N 1335297 THE GRAND PAVILION FOR R & N AT ROCKVILLE CENTRE ROCKVILLE CENTRE NY For profit - Partnership N 1335344 CHASEHEALTH REHAB & RESIDENTIAL CARE NEW BERLIN NY Non profit - Corporation N 1335725 HOPE CENTER FOR H I V AND NURSING CARE BRONX NY For profit - Partnership N 1335618 LATTA ROAD NURSING HOME EAST ROCHESTER NY For profit - Individual N 1335628 SULLIVAN COUNTY ADULT CARE CENTER LIBERTY NY Government - County N 1335639 CATSKILL REGIONAL MEDICAL CENTER S N F HARRIS NY Non profit - Corporation Y 1335787 NASSAU REHABILITATION & NURSING CENTER HEMPSTEAD NY For profit - Corporation N 1335822 INCARNATION CHILDRENS CENTER NEW YORK NY Non profit - Corporation N 1335835 ISLAND NURSING AND REHABILITATION CENTER INC HOLTSVILLE NY Non profit - Corporation N 1335848 KENDAL ON HUDSON SLEEPY HOLLOW NY Non profit - Corporation N 1335854 FOX RUN AT ORCHARD PARK ORCHARD PARK NY Non profit - Church related N 1335860 EDDY VILLAGE GREEN AT BEVERWYCK SLINGERLANDS NY Non profit - Corporation N 1335768 CORTLAND REGIONAL MEDICAL CENTER INC CORTLAND NY Non profit - Corporation Y 1335824 PUTNAM RIDGE BREWSTER NY For profit - Corporation N 1335837 MARIA REGINA RESIDENCE INC BRENTWOOD NY Non profit - Corporation N 1335590 PONTIAC NURSING HOME OSWEGO NY For profit - Partnership N 1335657 CAMPBELL HALL REHAB CENTER CAMPBELL HALL NY For profit - Corporation N 1335048 WILLIAMSBRIDGE MANOR N H BRONX NY For profit - Individual N 1335210 HIGHLAND PARK REHABILITATION AND NURSING CENTER WELLSVILLE NY For profit - Individual N 1335212 THE VILLAGES OF ORLEANS HEALTH AND REHAB CTR ALBION NY For profit - Partnership N 1335397 ORCHARD MANOR REHABILITATION AND NURSING CENTER MEDINA NY For profit - Corporation N 1335543 CAPSTONE CENTER FOR REHABILITATION AND NURSING AMSTERDAM NY For profit - Corporation N 1335457 FIDDLERS GREEN MANOR REHABILITATION & NURSING CTR SPRINGVILLE NY For profit - Corporation N 1366234 COLONIAL NURSING CENTER OF ROCKFORD ROCKFORD OH For profit - Corporation N 90365520 SUNRISE POINTE CARE & REHABILITATION CENTER MAPLE HEIGHTS OH For profit - Corporation N 84365867 CRYSTAL CARE CENTER OF PORTSMOUTH PORTSMOUTH OH For profit - Corporation N 80365748 WHITE OAK MANOR WARREN OH For profit - Corporation N 80365364 GARDEN COURT NURSING AND REHABILITATION CENTER DAYTON OH For profit - Corporation N 76366231 ROSELAWN GARDENS NURSING & REHABILITATION ALLIANCE OH For profit - Corporation N 66365831 DANRIDGES BURGUNDI MANOR YOUNGSTOWN OH For profit - Corporation N 55366207 ISABELLE RIDGWAY POST ACUTE CARE CAMPUS LLC COLUMBUS OH For profit - Corporation N 48366038 HEARTH & CARE OF GREENFIELD GREENFIELD OH For profit - Corporation N 42365343 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF WILLAR WILLARD OH For profit - Corporation N 41365218 BLUE ASH CARE CENTER CINCINNATI OH For profit - Corporation N 39

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 147: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365606 SPRING MEADOWS CARE CENTER WOODSTOCK OH For profit - Corporation N 38366003 CRYSTAL CARE CENTER OF FRANKLIN FURNACE FRANKLIN FURNACE OH For profit - Corporation N 38365531 LANCIA VILLA ROYALE STEUBENVILLE OH For profit - Corporation N 36365605 MILCREST NURSING CENTER MARYSVILLE OH For profit - Corporation N 35366037 BOWERSTON HILLS NURSING & REHABILITATION BOWERSTON OH For profit - Corporation N 34366202 CRYSTAL CARE OF COAL GROVE COAL GROVE OH For profit - Corporation N 33366181 GRAND RAPIDS CARE CENTER GRAND RAPIDS OH For profit - Corporation N 31365296 FAIRLAWN REHAB AND NURSING CENTER AKRON OH For profit - Corporation N 28365705 WALTON MANOR HEALTH CARE CENTER WALTON HILLS OH For profit - Corporation N 27365490 PREMIER ESTATES OF HIGHLANDS NORWOOD OH For profit - Corporation N 27365767 OAK GROVE CENTER DESHLER OH For profit - Corporation N 26365670 WILLOWS HEALTH AND REHAB CTR EUCLID OH For profit - Corporation N 26366192 LUTHERAN VILLAGE AT WOLFCREEK HOLLAND OH Non profit - Corporation N 26366336 EDEN SPRINGS NURSING AND REHABILITATION EAST LLC GREEN SPRINGS OH For profit - Corporation N 26366217 AUTUMN COURT OTTAWA OH For profit - Corporation N 26366002 CRESTLINE NURSING CENTER CRESTLINE OH For profit - Corporation N 25365601 HARMONY CENTER FOR REHABILITATION AND HEALING XENIA OH Non profit - Corporation N 24366183 SEASONS NURSING AND REHAB STOW OH For profit - Partnership N 23366402 WILLOW RIDGE OF MENNONITE HOME COMMUNITIES OF OHIO BLUFFTON OH Non profit - Corporation N 23365401 HERITAGE HEALTH CARE CENTER OAKWOOD VILLAGE OH For profit - Corporation N 23365331 SHELBY POINTE, INC SHELBY OH For profit - Corporation N 22366452 LAKES OF SYLVANIA, THE SYLVANIA OH For profit - Corporation N 22365835 MORROW MANOR NURSING CENTER CHESTERVILLE OH For profit - Corporation N 22366013 LEXINGTON COURT CARE CENTER LEXINGTON OH For profit - Corporation N 21366286 CEDAR HILL CARE CENTER ZANESVILLE OH For profit - Corporation N 21365565 MEADOWVIEW CARE CENTER SEVILLE OH For profit - Corporation N 21365257 PREMIER ESTATES OF OXFORD OXFORD OH For profit - Corporation N 21366014 WHISPERING HILLS CARE CENTER MOUNT VERNON OH For profit - Corporation N 21366323 WAYSIDE FARM INC PENINSULA OH For profit - Corporation N 20366422 ELMWOOD ASSISTED LIVING & SKILLED NURSING OF FREMO FREMONT OH For profit - Corporation N 20365638 JEFFERSON HEALTHCARE CENTER JEFFERSON OH For profit - Corporation N 20365088 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF ENGLEW ENGLEWOOD OH For profit - Corporation N 20365129 EASTBROOK HEALTHCARE CENTER CLEVELAND OH For profit - Corporation N 20366288 SUNRISE MANOR AND CONVALESCENT CENTER, INC AMELIA OH For profit - Corporation N 20366443 BELPRE LANDING NURSING AND REHABILITATION BELPRE OH For profit - Corporation N 19

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 148: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365187 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF XENIA XENIA OH For profit - Corporation N 19366369 ALTERCARE THORNVILLE INC. THORNVILLE OH For profit - Corporation N 19366066 VANCREST OF CONVOY CONVOY OH For profit - Corporation N 19366081 PARKVIEW CARE CTR FREMONT OH For profit - Corporation N 18365907 FRANCISCAN CARE CTR SYLVANIA TOLEDO OH Non profit - Corporation N 18366406 LAKES OF MONCLOVA HEALTH CAMPUS THE MAUMEE OH For profit - Corporation N 17365729 BRAEVIEW MANOR EUCLID OH For profit - Individual N 17365794 PATASKALA OAKS CARE CENTER PATASKALA OH For profit - Corporation N 17365428 SANCTUARY WADSWORTH WADSWORTH OH For profit - Corporation N 17365483 COVINGTON CARE CENTER COVINGTON OH For profit - Corporation N 17365488 FAIRVIEW SKILLED NURSING AND R TOLEDO OH For profit - Corporation N 16365734 WEXFORD PLACE INC. CINCINNATI OH For profit - Corporation N 16366190 BELMONT MANOR ST CLAIRSVILLE OH For profit - Corporation N 16365405 THE MEADOWS OF DELPHOS BLUFFTON OH For profit - Corporation N 16365587 ABBYSHIRE PLACE SKILLED NSG & REHAB CTR BIDWELL OH For profit - Corporation N 15366191 MAPLECREST NURSING AND HTA STRUTHERS OH For profit - Corporation N 15366118 ELMS RETIREMENT VILLAGE INC WELLINGTON OH For profit - Corporation N 15366456 WINDSOR MEDICAL CENTER INC NORTH CANTON OH For profit - Corporation N 15366224 GARDENS AT CELINA CELINA OH For profit - Corporation N 15366239 CRYSTAL CARE CENTER OF ASHLAND ASHLAND OH For profit - Corporation N 15366299 CENTERBURG POINTE CENTERBURG OH For profit - Corporation N 14365461 MUSKINGUM SKILLED NURSING & REHABILITATION BEVERLY OH For profit - Corporation N 14365441 LAKE POINTE REHABILITATION AND NURSING CENTER CONNEAUT OH For profit - Corporation N 14365448 REST HAVEN NURSING HOME INC GREENVILLE OH For profit - Individual N 14365390 HAMDEN HEALTH CARE VENTURES HAMDEN OH For profit - Individual N 14366050 OTTERBEIN-CRIDERSVILLE CRIDERSVILLE OH Non profit - Corporation N 14366110 CRAWFORD MANOR HEALTHCARE CENTER CLEVELAND OH For profit - Corporation N 13365902 MEADOWBROOK MANOR FOWLER OH For profit - Corporation N 13365979 PATRIOT RIDGE COMMUNITY FAIRBORN OH Non profit - Church related N 13365426 ARBORS WEST WEST JEFFERSON OH For profit - Corporation N 13365539 SIGNATURE HEALTHCARE OF WARREN WARREN OH For profit - Corporation N 13365744 ROSELAWN MANOR SPENCERVILLE OH For profit - Corporation N 13365755 COLONIAL MANOR HEALTH CARE CEN LOUDONVILLE OH For profit - Corporation N 13365570 PARK VIEW NURSING CENTER EDGERTON OH For profit - Corporation N 13365624 PERRYSBURG CARE AND REHABILITATION CENTER PERRYSBURG OH For profit - Corporation N 13

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 149: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365817 SAMARITAN CARE CENTER AND VILLA MEDINA OH Non profit - Corporation N 13365707 WINDSONG CARE CENTER AKRON OH For profit - Corporation N 13366237 WADSWORTH POINTE WADSWORTH OH For profit - Corporation N 13366122 MARY SCOTT NURSING CENTER DAYTON OH Non profit - Other N 13365962 GENEVA SHORES NURSING AND REHAB GENEVA OH For profit - Corporation N 13365626 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF BELLBR BELLBROOK OH For profit - Corporation N 12365756 WHITEHOUSE COUNTRY MANOR WHITEHOUSE OH For profit - Corporation N 12365652 COTTINGHAM RETIREMENT COMMUNITY CINCINNATI OH Non profit - Corporation N 12365466 HEATH NURSING CARE CENTER HEATH OH For profit - Corporation N 12365874 HUDSON ELMS NURSING HOME HUDSON OH For profit - Partnership N 12365791 SANCTUARY AT OHIO VALLEY IRONTON OH Non profit - Corporation N 12365833 JUDSON CARE CENTER, INC CINCINNATI OH Non profit - Church related N 12366171 CRIDERSVILLE HEALTHCARE CENTER CRIDERSVILLE OH For profit - Corporation N 12366256 WEXFORD CARE CENTER CINCINNATI OH For profit - Corporation N 11366026 COUNTRY CLUB CENTER V, INC DELAWARE OH For profit - Individual N 11365673 WOODVIEW CARE AND REHABILITATION COLUMBUS OH For profit - Corporation N 11365155 AVON PLACE AVON OH For profit - Corporation N 11365071 BEACHWOOD POINTE CARE CENTER BEACHWOOD OH For profit - Corporation N 11365893 BEREA CENTER BEREA OH For profit - Corporation N 11366156 LINCOLN CRAWFORD CARE CENTER CINCINNATI OH For profit - Corporation N 11366272 O'NEILL HEALTHCARE NORTH OLMSTED NORTH OLMSTED OH For profit - Corporation N 11366386 DEUPREE COTTAGES CINCINNATI OH Non profit - Corporation N 11365970 UNION CITY CARE CENTER UNION CITY OH For profit - Corporation N 10365418 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF FREMON FREMONT OH For profit - Corporation N 10365297 PAVILION THE SIDNEY OH For profit - Corporation N 10365368 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF JAMEST JAMESTOWN OH For profit - Corporation N 10366125 LAURELS OF SHANE HILL ROCKFORD OH For profit - Individual N 10366025 MT HEALTHY CHRISTIAN HOME CINCINNATI OH Non profit - Church related N 9366041 ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER MAUMEE OH For profit - Corporation N 9365684 EAGLEWOOD CARE CENTER SPRINGFIELD OH For profit - Corporation N 9365598 LAURELS OF WEST CARROLLTON THE WEST CARROLLTON OH For profit - Corporation N 9365619 HEARTLAND OF BUCYRUS BUCYRUS OH For profit - Corporation N 9365766 PARKSIDE HEALTH CARE CENTER COLUMBIANA OH For profit - Corporation N 9365730 GATEWAY HEALTH CARE CENTER EUCLID OH For profit - Corporation N 9365679 SIGNATURE HEALTHCARE OF FAYETTE COUNTY WASHINGTON COURT HOU OH For profit - Corporation N 9

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 150: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365353 CANDLEWOOD PARK HEALTHCARE CEN EAST CLEVELAND OH For profit - Corporation N 9365981 FOREST VIEW CARE & REHABILITATION CENTER DAYTON OH For profit - Corporation N 9366197 GARDENS AT ST HENRY SAINT HENRY OH For profit - Corporation N 9366198 GOLDEN YEARS NURSING CENTER HAMILTON OH For profit - Corporation N 9366149 WILLIAMS CO HILLSIDE COUNTRY L BRYAN OH Government - County N 9366148 SUNSET HOUSE TOLEDO OH Non profit - Corporation N 8366173 BECKETT HOUSE AT NEW CONCORD NEW CONCORD OH For profit - Corporation N 8366354 OTTERBEIN PERRYSBURG PERRYSBURG OH Non profit - Church related N 8365814 CORTLAND CENTER CORTLAND OH For profit - Corporation N 8365623 LAKE POINTE HEALTH CARE LORAIN OH For profit - Corporation N 8366031 MILL MANOR CARE CENTER VERMILION OH For profit - Individual N 8366269 WYANDOT COUNTY SKILLED NURSING AND REHABILITATION UPPER SANDUSKY OH Government - County N 8366313 SCIOTO POINTE COLUMBUS OH For profit - Corporation N 8366430 OTTERBEIN GAHANNA GAHANNA OH Non profit - Corporation N 8366445 OTTERBEIN LOVELAND LOVELAND OH Non profit - Other N 7366035 CROSSROADS REHABILITATION & NURSING VANDALIA OH For profit - Corporation N 7366150 GLENCARE CENTER CINCINNATI OH For profit - Corporation N 7366170 THE SANCTUARY AT TUTTLE CROSSING DUBLIN OH Non profit - Corporation N 7365826 CONTINUING HEALTHCARE OF CUYAHOGA FALLS CUYAHOGA FALLS OH Non profit - Corporation N 7365429 RIVERSIDE MANOR NRSG & REHAB CTR NEWCOMERSTOWN OH For profit - Corporation N 7365591 SHADY LAWN NURSING HOME DALTON OH For profit - Corporation N 7365306 MADISON HEALTH CARE MADISON OH For profit - Corporation N 7365202 LIMA REHAB AND NURSING CENTER LIMA OH For profit - Corporation N 7365809 ST MARYS LIVING CENTER ST MARYS OH For profit - Corporation N 7365680 HICKORY CREEK AT HICKSVILLE HICKSVILLE OH Non profit - Corporation N 7365688 SABER SKILLED NURSING UNIT AT BARBERTON BARBERTON OH For profit - Corporation N 7365654 AUSTINWOODS REHAB HEALTH CARE AUSTINTOWN OH For profit - Corporation N 7365489 EDGEWOOD MANOR NURSING CENTER PORT CLINTON OH For profit - Corporation N 7365292 HANOVER HOUSE MASSILLON OH For profit - Corporation N 7365236 HOMESTEAD II PAINESVILLE OH For profit - Corporation N 7366457 CREEKSIDE CARE CENTER COLUMBUS OH For profit - Corporation N 7366088 AUSTINBURG NSG AND REHAB CTR AUSTINBURG OH For profit - Corporation N 7365940 AUTUMN AEGIS NURSING HOME LORAIN OH For profit - Corporation N 7366042 SPRING MEADOWS NURSING & REHABILITATION CENTRE HOLLAND OH For profit - Corporation N 7365886 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF TOLEDO TOLEDO OH For profit - Corporation N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 151: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365825 HERITAGE NURSING AND REHAB CTR OAKWOOD VILLAGE OH For profit - Corporation N 7365854 GREENBRIAR NURSING CENTER THE EATON OH For profit - Corporation N 7366199 COUNTRY LANE GARDENS REHAB & NURSING CTR PLEASANTVILLE OH For profit - Corporation N 6366383 MCGREGOR AT OVERLOOK CLEVELAND OH Non profit - Corporation N 6366414 COTTAGES OF CLAYTON INC THE DAYTON OH For profit - Partnership N 6366254 OAK POINTE NURSING & REHAB CENTER BALTIC OH For profit - Corporation N 6365339 DARLINGTON NURSING & REHAB CEN TOLEDO OH For profit - Corporation N 6365387 BRIAR HILL HEALTH CAMPUS NORTH BALTIMORE OH For profit - Corporation N 6365588 ARCADIA VALLEY SKILLED NURSING AND REHABILITATION COOLVILLE OH For profit - Corporation N 6365715 ST MARY'S ALZHEIMER'S CENTER COLUMBIANA OH For profit - Corporation N 6365769 WILLOWS AT WILLARD THE WILLARD OH For profit - Corporation N 6365996 OHIO LIVING SWAN CREEK TOLEDO OH Non profit - Corporation N 6366095 GLENWOOD CARE AND REHABILITATION CANTON OH For profit - Corporation N 6366270 EAGLE POINTE SKILLED NURSING & REHAB ORWELL OH For profit - Corporation N 6366255 VANCREST HEALTH CARE CTR OF HO HOLGATE OH For profit - Corporation N 5366108 DAYVIEW CARE CENTER INC NEW CARLISLE OH For profit - Corporation N 5366051 OAKS AT NORTHPOINTE ZANESVILLE OH For profit - Corporation N 5366077 CANTON HEALTH CARE CENTER CANTON OH For profit - Corporation N 5365731 EAST PARK CARE CENTER BROOK PARK OH For profit - Corporation N 5365675 ARBORS AT MILFORD MILFORD OH For profit - Individual N 5365633 ESSEX HEALTHCARE OF TALLMADGE TALLMADGE OH For profit - Corporation N 5365572 EASTLAND HEALTH CARE AND REHABILITATION CENTER COLUMBUS OH For profit - Individual N 5365577 PRESTIGE GARDENS REHABILITATION AND NURSING CENTER MARYSVILLE OH For profit - Corporation N 5365363 PARKSIDE NURSING AND REHABILITATION CENTER FAIRFIELD OH For profit - Corporation N 5365460 WINDSOR HEALTH CARE CENTER YOUNGSTOWN OH For profit - Corporation N 5365746 BRENTWOOD HEALTH CARE CENTER SAGAMORE HILLS OH For profit - Individual N 5365760 VISTA CENTER OF BOARDMAN BOARDMAN OH For profit - Corporation N 5366284 AMHERST MEADOWS MASSILLON OH For profit - Corporation N 5366169 BLOSSOM NURSING AND REHAB CENTER SALEM OH For profit - Corporation N 5365828 WILLOW PARK CONVALESCENT HOME CLEVELAND OH For profit - Corporation N 5365897 NEW LEBANON CARE AND REHABILITATION CENTER NEW LEBANON OH For profit - Corporation N 5365928 COURT HOUSE MANOR WASHINGTON CH OH For profit - Corporation N 5365949 CONCORD CARE CENTER OF CORTLAND CORTLAND OH For profit - Corporation N 5366028 WOODSIDE VILLAGE CARE CENTER MOUNT GILEAD OH For profit - Corporation N 4366034 ESSEX OF SALEM III SALEM OH For profit - Corporation N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 152: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365808 WESTLAKE REHAB AND NURSING CENTER WESTLAKE OH For profit - Corporation N 4365911 WINCHESTER TERRACE MANSFIELD OH For profit - Partnership N 4365887 ARLINGTON GOOD SAMARITAN CENTE ARLINGTON OH Non profit - Corporation N 4366203 ORRVILLE POINTE ORRVILLE OH For profit - Corporation N 4366113 LIBERTY HEALTH CARE CENTER INC YOUNGSTOWN OH For profit - Corporation N 4366084 VANCREST HEALTH CARE CENTER OF EATON EATON OH For profit - Corporation N 4366275 NORTHFIELD VILLAGE RETIREMENT COMMUNITY NORTHFIELD OH For profit - Individual N 4366368 OTTERBEIN SPRINGBORO CENTERVILLE OH Non profit - Corporation N 4366329 HAMPTON WOODS NURSING CENTER, INC POLAND OH For profit - Corporation N 4366442 CENTER FOR REHABILITATION AT HAMPTON WOODS THE POLAND OH For profit - Corporation N 4366410 ST CLARE COMMONS PERRYSBURG OH Non profit - Other N 4366412 MOUNT VERNON HEALTH AND REHABILITATION CENTER MOUNT VERNON OH For profit - Corporation N 4366413 OAKS AT BETHESDA THE ZANESVILLE OH For profit - Corporation N 4366460 CANFIELD ACRES LLC DBA WINDSOR HOUSE AT CANFIELD CANFIELD OH For profit - Corporation N 4365672 AUTUMN HILLS CARE CENTER NILES OH For profit - Corporation N 4365420 ESSEX OF SPRINGFIELD SPRINGFIELD OH For profit - Corporation N 4365629 DIXON HEALTH CARE CENTER WINTERSVILLE OH For profit - Corporation N 4365295 LOGAN ELM HEALTH CARE CENTER CIRCLEVILLE OH For profit - Corporation N 4365268 ALTERCARE OF WADSWORTH WADSWORTH OH For profit - Corporation N 4365181 MARION MANOR NURSING HOME INC MARION OH For profit - Corporation N 4365627 LAURELS OF HUBER HEIGHTS THE HUBER HEIGHTS OH For profit - Corporation N 4365559 ROLLING HILLS REHAB AND CARE CTR BRIDGEPORT OH For profit - Corporation N 4365708 IVY WOODS MANOR NORTH LIMA OH For profit - Corporation N 4365318 ST CATHERINES MANOR OF WASHINGTON COURT HOUSE WASHINGTON COURT HOU OH For profit - Corporation N 4366033 SIDNEY CARE CENTER SIDNEY OH For profit - Corporation N 4366187 MINERVA ELDERCARE CENTER MINERVA OH For profit - Corporation N 4365925 PREMIER ESTATES OF CINCINNATI-RIVERSIDE CINCINNATI OH For profit - Corporation N 4365743 WRIGHT NURSING AND REHAB CTR FAIRBORN OH For profit - Corporation N 4365890 COSHOCTON SPRINGS HEALTH AND REHAB CENTER COSHOCTON OH For profit - Corporation N 4366246 CHERITH CARE CENTER AT WILLOW BROOK DELAWARE OH Non profit - Church related N 4366303 HIGHBANKS CARE CENTER COLUMBUS OH For profit - Corporation N 4366391 ASTORIA SKILLED NURSING AND REHABILITATION CANTON OH For profit - Individual N 4366400 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF BEAVER BEAVER CREEK OH For profit - Corporation N 3366247 AUGLAIZE ACRES WAPAKONETA OH Government - County N 3366236 GOOD SHEPHERD VILLAGE SPRINGFIELD OH For profit - Individual N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 153: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365922 SIENNA HILLS NURSING & REHABILITATION ADENA OH For profit - Corporation N 3365972 CAMELOT ARMS CARE CENTER YOUNGSTOWN OH For profit - Corporation N 3365978 SCARLET OAKS NURSING AND REHABILITATION CENTER CINCINNATI OH For profit - Corporation N 3366218 AUBURN SKILLED NURSING AND REHAB SALEM OH For profit - Corporation N 3366107 REST HAVEN NURSING HOME MCDERMOTT OH For profit - Corporation N 3366130 RIVERSIDE LANDING NURSING AND REHABILITATION MCCONNELSVILLE OH For profit - Corporation N 3366032 HILTY MEMORIAL HOME INC PANDORA OH Non profit - Corporation N 3366040 HILLANDALE HEALTH CARE HAMILTON OH For profit - Corporation N 3365320 SAPPHIRE HEALTH AND REHAB AKRON OH For profit - Corporation N 3365254 VANCREST HEALTH CARE CENTER VAN WERT OH For profit - Corporation N 3365612 SUMMIT ACRES NURSING HOME CALDWELL OH For profit - Corporation N 3365648 PREMIER ESTATES OF MIDDLETOWN MIDDLETOWN OH For profit - Corporation N 3365718 ARBORS AT STREETSBORO STREETSBORO OH For profit - Corporation N 3365453 HEARTLAND OF OREGON OREGON OH For profit - Corporation N 3365147 HIGHLAND OAKS HEALTH CENTER MCCONNELSVILLE OH For profit - Corporation N 3365222 LAURELS OF NORWORTH THE WORTHINGTON OH For profit - Corporation N 3365303 LIMA MANOR LIMA OH For profit - Corporation N 3365480 RESIDENCE AT SALEM WOODS, THE CINCINNATI OH For profit - Corporation N 3365695 DOYLESTOWN HEALTH CARE CENTER DOYLESTOWN OH For profit - Partnership N 3365711 CHARDON CENTER CHARDON OH For profit - Corporation N 3365818 BAYLEY PLACE CINCINNATI OH Non profit - Corporation N 3366441 SEVEN HILLS HEALTH & REHAB CENTER SEVEN HILLS OH For profit - Corporation N 3366376 OTTERBEIN MIDDLETOWN FRANKLIN OH For profit - Corporation N 3366393 OTTERBEIN AT MAINEVILLE MAINEVILLE OH Non profit - Church related N 3366397 STERLING TRANSITIONAL SUITES ZANESVILLE OH For profit - Corporation N 3366306 VALLEY OAKS CARE CENTER EAST LIVERPOOL OH For profit - Corporation N 3366308 ALGART HEALTH CARE CLEVELAND OH For profit - Corporation N 3366318 ALTERCARE AT SAINT JOSEPH CENTER INC CLEVELAND OH For profit - Corporation N 3366240 WESTERN RESERVE MASONIC COMM MEDINA OH Non profit - Other N 3366131 BELLEVUE CARE CENTER BELLEVUE OH For profit - Corporation N 3366141 OAKHILL MANOR CARE CENTER LOUISVILLE OH For profit - Corporation N 3366179 SOLON POINTE AT EMERALD RIDGE SOLON OH For profit - Corporation N 3365876 CARRIAGE INN OF DAYTON DAYTON OH For profit - Corporation N 3365943 EUCLID SUBACUTE CARE CENTER EUCLID OH Non profit - Corporation Y 3366058 RAE-ANN WEST PARK CLEVELAND OH For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 154: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

366052 GABLES CARE CENTER INC HOPEDALE OH For profit - Corporation N 2365997 PARKVUE HEALTH CARE CENTER SANDUSKY OH Non profit - Corporation N 2366011 ALTERCARE OF MENTOR MENTOR OH For profit - Corporation N 2365885 CONCORD CARE AND REHABILITATION CENTER SANDUSKY OH For profit - Partnership N 2366188 LUTHERAN HOME AT TOLEDO TOLEDO OH Non profit - Corporation N 2366177 CUMBERLAND POINTE CARE CENTER ST CLAIRSVILLE OH For profit - Corporation N 2366075 VALLEY VIEW ALZHEIMER'S CARE CTR FRANKFORT OH For profit - Corporation N 2366134 HARDIN HILLS HEALTH CENTER KENTON OH Government - County N 2366158 MOUNT ROYAL VILLA NORTH ROYALTON OH For profit - Individual N 2366242 SUNSET VILLAGE SYLVANIA OH Non profit - Corporation N 2366260 BEACON POINTE REHAB CENTER UHRICHSVILLE OH For profit - Corporation N 2366302 SHILOH SPRINGS CARE CENTER INC TROTWOOD OH For profit - Corporation N 2366290 FAIRLAWN HAVEN ARCHBOLD OH Non profit - Church related N 2366342 ST MARY OF THE WOODS AVON OH For profit - Corporation N 2366390 NORTH PARK CARE CENTER BROOK PARK OH For profit - Corporation N 2366381 CONCORD HEALTH & REHAB CTR WHEELERSBURG OH For profit - Corporation N 2365810 PARK EAST CARE AND REHAB CENTER BEACHWOOD OH For profit - Corporation N 2365745 SWANTON VALLEY CENTER SWANTON OH For profit - Corporation N 2365750 ALTERCARE SOMERSET INC. SOMERSET OH For profit - Corporation N 2365658 CARDINAL WOODS SKILLED NURSING & REHAB CTR MADISON OH For profit - Corporation N 2365571 OTTERBEIN PORTAGE VALLEY PEMBERVILLE OH Non profit - Church related N 2365431 JENKINS MEMORIAL HEALTH FACILITY WELLSTON OH Non profit - Corporation N 2365440 ARLINGTON CARE CENTER NEWARK OH For profit - Corporation N 2365450 ARBORS AT POMEROY POMEROY OH For profit - Corporation N 2365499 SUMMIT'S TRACE HEALTHCARE CENTER COLUMBUS OH For profit - Corporation N 2365515 PINNACLE POINTE NURSING & REHABILITATION CENTER DAYTON OH For profit - Individual N 2365315 CAPITAL CITY GARDENS REHABILITATION AND NURSING CE COLUMBUS OH For profit - Corporation N 2365298 SHEPHERD OF THE VALLEY - NILES NILES OH Non profit - Church related N 2365293 MT AIRY GARDENS REHABILITATION AND NURSING CENTER CINCINNATI OH For profit - Individual N 2365392 ROCKY RIVER GARDENS REHAB AND NURSING CTR CLEVELAND OH For profit - Corporation N 2365354 LONGMEADOW CARE CENTER RAVENNA OH For profit - Corporation N 2365456 CIRCLEVILLE CENTER CIRCLEVILLE OH For profit - Corporation N 2365462 OAK HILLS NURSING AND REHAB CHEVIOT OH For profit - Individual N 2365284 CRESTWOOD CARE CENTER SHELBY OH For profit - Corporation N 2365385 GALION POINTE, INC GALION OH For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 155: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365417 COUNTRY CLUB CENTER I DOVER OH For profit - Individual N 2365494 CHAPEL HILL COMMUNITY CANAL FULTON OH Non profit - Corporation N 2365505 VILLAGE GREEN HEALTH CAMPUS GREENVILLE OH For profit - Corporation N 2365476 SILVERTON POINTE NURSING & REHABILITATION CINCINNATI OH For profit - Corporation N 2365737 HEATHERDOWNS REHAB & RESIDENTI TOLEDO OH For profit - Corporation N 2365789 SANCTUARY AT WILMINGTON PLACE DAYTON OH Non profit - Other N 2365759 HEALTH CENTER AT THE RENAISSAN OLMSTED TWP OH For profit - Corporation N 2365271 CARRIAGE INN OF STEUBENVILLE STEUBENVILLE OH For profit - Corporation N 2365081 PREMIER ESTATES OF THREE RIVERS CINCINNATI OH For profit - Corporation N 2365006 HILLSIDE PLAZA CLEVELAND OH For profit - Corporation N 2366044 GARDENS OF PAULDING THE PAULDING OH For profit - Corporation N 2366085 LEGENDS CARE CENTER MASSILLON OH For profit - Corporation N 2366159 BIRCHWOOD CARE CENTER HAMILTON OH For profit - Corporation N 2366209 WOODS EDGE REHAB AND NURSING CINCINNATI OH For profit - Corporation N 2365961 PIKETON NURSING CENTER PIKETON OH For profit - Corporation N 2365849 HEARTLAND - HOLLY GLEN TOLEDO OH For profit - Corporation N 2365851 ARBORS EAST SUBACUTE AND REHAB CTR COLUMBUS OH For profit - Corporation N 2365858 BRIARWOOD THE STOW OH For profit - Corporation N 2365799 WEST PARK CARE CENTER LLC COLUMBUS OH For profit - Corporation N 2366232 WESTOVER RETIREMENT COMMUNITY HAMILTON OH Non profit - Corporation N 2366251 HOME AT HEARTHSTONE, THE CINCINNATI OH For profit - Corporation N 2366263 GRACE BRETHREN VILLAGE ENGLEWOOD OH Non profit - Corporation N 2366274 THE LAURELS OF CHAGRIN FALLS CHAGRIN FALLS OH For profit - Corporation N 2366279 ROSARY CARE CENTER SYLVANIA OH Non profit - Corporation N 2366384 CYPRESS POINTE HEALTH CAMPUS ENGLEWOOD OH For profit - Corporation N 2366408 ATLANTES THE CINCINNATI OH For profit - Partnership N 2366309 ORCHARDS OF EAST LIVERPOOL, THE EAST LIVERPOOL OH For profit - Corporation N 2366326 GENEVA VILLAGE RETIREMENT COMMUNITY, LTD GENEVA OH For profit - Individual N 2366331 SIENNA SKILLED NURSING & REHABILITATION WINTERSVILLE OH For profit - Corporation N 2366332 HOME AT TAYLOR'S POINTE CINCINNATI OH For profit - Corporation N 2366424 OTTERBEIN NEW ALBANY NEW ALBANY OH Non profit - Corporation N 2366352 EMERALD POINTE HEALTH AND REHAB CTR BARNESVILLE OH For profit - Corporation N 1366361 OTTERBEIN MONCLOVA MONCLOVA OH Non profit - Corporation N 1366416 VILLA VISTA ROYALE LLC STEUBENVILLE OH For profit - Corporation N 1366403 BATH CREEK ESTATES CUYAHOGA FALLS OH For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 156: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

366399 COVENANT VILLAGE OF GREEN TOWNSHIP CINCINNATI OH For profit - Corporation N 1366280 ST LUKE LUTHERAN COMMUNITY-PORTAGE LAKES AKRON OH Non profit - Corporation N 1366253 AMBERWOOD MANOR NEW PHILADELPHIA OH For profit - Corporation N 1366238 PREMIER ESTATES OF NORWOOD TOWERS CINCINNATI OH For profit - Partnership N 1365813 HAWTHORN GLEN NURSING CENTER MIDDLETOWN OH For profit - Corporation N 1365795 OASIS CENTER FOR REHAB AND HEALING YOUNGSTOWN OH For profit - Corporation N 1365829 VILLA SPRINGFIELD SPRINGFIELD OH For profit - Individual N 1365832 UNIVERSITY MANOR HEALTH & REHA CLEVELAND OH For profit - Individual N 1365839 COLUMBUS ALZHEIMER'S CARE CTR COLUMBUS OH For profit - Corporation N 1365892 BURLINGTON HOUSE NURSING HOME CINCINNATI OH For profit - Corporation N 1365877 RIVERSIDE NURSING AND REHABILITATION CENTER DAYTON OH For profit - Corporation N 1365968 ADMIRAL'S POINTE NURSING AND REHABILITATION HURON OH For profit - Corporation N 1365932 EDGEWOOD MANOR OF LUCASVILLE II LUCASVILLE OH For profit - Corporation N 1365942 DUAL MANOR HEALTH CARE CENTER CINCINNATI OH For profit - Corporation N 1365952 RIDGEWOOD MANOR MAUMEE OH For profit - Corporation N 1365987 CALCUTTA HEALTH CARE CENTER CALCUTTA OH For profit - Corporation N 1366021 SHAKER GARDENS NURSING & REHAB CTR SHAKER HEIGHTS OH For profit - Corporation N 1366214 CANTERBURY VILLA OF ALLIANCE ALLIANCE OH For profit - Corporation N 1366225 STRATFORD CARE AND REHABILITATION GLENWILLOW OH For profit - Corporation N 1366112 BROWN MEMORIAL HOME INC CIRCLEVILLE OH Non profit - Church related N 1366092 BURTON HEALTH CARE CENTER BURTON OH For profit - Corporation N 1366047 RAE ANN GENEVA GENEVA OH For profit - Corporation N 1366039 POINT PLACE CARE AND REHABILITATION CENTER TOLEDO OH For profit - Corporation N 1365065 HARRISON PAVILION CARE CENTER CINCINNATI OH For profit - Corporation N 1365076 BOWLING GREEN CARE CENTER BOWLING GREEN OH For profit - Corporation N 1365279 MERIT HOUSE LLC TOLEDO OH For profit - Partnership N 1365005 THE CHATEAU AT MOUNTAIN CREST NURSING & REHAB CTR CINCINNATI OH For profit - Partnership N 1365764 PRISTINE SENIOR LIVING & POST-ACUTE CARE OF DAYTON DAYTON OH For profit - Corporation N 1365768 LOGAN ACRES BELLEFONTAINE OH Government - County N 1365742 NATIONAL CHURCH RESIDENCES BRISTOL VILLAGE WAVERLY OH Non profit - Corporation N 1365753 ROYAL OAK NURSING & REHAB CTR MIDDLEBURG HEIGHTS OH For profit - Corporation N 1365732 MERIDIAN ARMS LIVING CENTER YOUNGSTOWN OH For profit - Corporation N 1365642 COUNTRY CLUB RET CENTER I I I ASHTABULA OH For profit - Corporation N 1365644 WINCHESTER CARE & REHABILITATION CANAL WINCHESTER OH For profit - Corporation N 1365712 BROOKWOOD RETIREMENT COMMUNITY CINCINNATI OH For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 157: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365716 GRAFTON OAKS NURSING AND REHABILITATION CENTER DAYTON OH For profit - Partnership N 1365686 COLUMBUS HEALTHCARE CENTER COLUMBUS OH For profit - Corporation N 1365699 COUNTRY CLUB RETIREMENT CTR IV BELLAIRE OH For profit - Corporation N 1365478 FAIRHAVEN COMMUNITY UPPER SANDUSKY OH Non profit - Corporation N 1365481 ALTERCARE NEWARK NORTH INC. NEWARK OH For profit - Corporation N 1365485 FLINT RIDGE NRSG & REHAB CTR NEWARK OH For profit - Corporation N 1365529 GARDEN PARK HEALTH CARE CENTER CINCINNATI OH For profit - Corporation N 1365533 JOSHUA TREE CARE CENTER NORTH OLMSTED OH For profit - Corporation N 1365538 FRIENDS EXTENDED CARE CENTER YELLOW SPRINGS OH Non profit - Corporation N 1365554 GLEN MEADOWS HAMILTON OH For profit - Corporation N 1365585 EDGEWOOD MANOR OF LUCASVILLE I LUCASVILLE OH For profit - Corporation N 1365376 OHIO VALLEY MANOR NURSING AND REHABILITATION RIPLEY OH For profit - Corporation N 1365427 LOVELAND HEALTH CARE CENTER LOVELAND OH For profit - Corporation N 1365454 GREENEWOOD MANOR XENIA OH Government - County N 1365455 IVY WOODS CARE CENTER CINCINNATI OH For profit - Corporation N 1365342 CARRIAGE INN OF CADIZ INC CADIZ OH For profit - Corporation N 1365404 LAURELS OF MT VERNON THE MOUNT VERNON OH For profit - Corporation N 1365309 FRIENDSHIP VILLAGE DAYTON OH For profit - Corporation N 1365228 WILMINGTON NURSING & REHAB WILMINGTON OH For profit - Corporation N 1365232 VANCREST OF ST MARY'S ST MARYS OH For profit - Corporation N 1365286 CARINGTON PARK ASHTABULA OH For profit - Corporation N 1365221 EDGEWOOD MANOR OF GREENFIELD I GREENFIELD OH For profit - Corporation N 1365134 HICKORY RIDGE NURSING & REHAB CENTER AKRON OH For profit - Corporation N 1365525 CENTERBURG RESPIRATORY & SPECIALTY REHAB CTR CENTERBURG OH For profit - Corporation N 1365530 PREMIER ESTATES OF CINCINNATI-RIVERVIEW CINCINNATI OH For profit - Individual N 1365470 OHIO LIVING LLANFAIR CINCINNATI OH Non profit - Corporation N 1365492 GRAND RIVER HEALTH & REHAB CENTER PAINESVILLE OH For profit - Corporation N 1365551 CLOVERNOOK HEALTH CARE PAVILION CINCINNATI OH For profit - Corporation N 1365558 WELLINGTON MANOR HAMILTON OH For profit - Corporation N 1365564 HARBOR HEALTHCARE OF IRONTON IRONTON OH For profit - Corporation N 1365584 HEARTLAND OF PORTSMOUTH PORTSMOUTH OH For profit - Corporation N 1365616 HEARTLAND OF KETTERING KETTERING OH For profit - Corporation N 1365669 FOUR WINDS NURSING FACILITY JACKSON OH For profit - Corporation N 1365639 KINGSTON OF VERMILION VERMILION OH For profit - Corporation N 1365643 PRISTINE SENIOR LIVING & POST ACUTE CARE OF PORTSM PORTSMOUTH OH For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 158: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365671 WORTHINGTON CHRISTIAN VILLAGE COLUMBUS OH Non profit - Corporation N 1365696 FOREST HILL RETIREMENT COMMUNITY ST CLAIRSVILLE OH For profit - Corporation N 1365796 WESTPARK NEUROLOGY AND REHABILITATION CENTER CLEVELAND OH For profit - Corporation N 1365798 COURTYARD AT SEASONS CINCINNATI OH For profit - Corporation N 1365815 COUNTRY CLUB RETIREMENT CENTER MOUNT VERNON OH For profit - Individual N 1366385 LEGACY PLACE TWINSBURG TWINSBURG OH For profit - Corporation N 1366444 VANCREST OF ADA ADA OH For profit - Corporation N 1366447 CONCORD VILLAGE SKILLED NURSING & REHABILITATION CONCORD OH For profit - Corporation N 1366437 ARLINGTON POINTE MIDDLETOWN OH For profit - Individual N 1366458 LANDERBROOK TRANSITIONAL CARE MAYFIELD HEIGHTS OH For profit - Individual N 1366348 VENETIAN GARDENS LOVELAND OH For profit - Corporation N 1366358 OTTERBEIN NORTH SHORE LAKESIDE OH Non profit - Church related N 1366359 LARCHWOOD VILLAGE RETIREMENT COMMUNITY CLEVELAND OH For profit - Corporation N 1366360 VINEYARDS AT CONCORD, THE FRANKFORT OH For profit - Corporation N 1366366 PINE GROVE HEALTHCARE CENTER GENEVA OH For profit - Corporation N 1366320 SHAWNEESPRING HEALTH CARE CENTER HARRISON OH For profit - Corporation N 1366341 WAYNE COUNTY CARE CENTER WOOSTER OH Government - County N 1366294 SPRENGER HEALTH CARE OF MASSILLON SNF MASSILLON OH For profit - Corporation N 1366296 CEDARS OF LEBANON CARE CENTER LEBANON OH For profit - Partnership N 1366267 ALTERCARE OF MAYFIELD VILLAGE, INC MAYFIELD VILLAGE OH For profit - Corporation N 1366271 JACKSON RIDGE REHABILITATION AND CARE CENTER CANAL FULTON OH For profit - Corporation N 1366259 SCIOTO COMMUNITY COLUMBUS OH For profit - Corporation N 1366230 COUNTRY POINTE WOOSTER OH For profit - Corporation N 1366233 MORRIS NURSING HOME BETHEL OH For profit - Corporation N 1366162 LUTHERAN HOME NAPOLEON OH Non profit - Corporation N 1366167 ANDERSON, THE CINCINNATI OH For profit - Corporation N 1366123 BRENN-FIELD NURSING CENTER ORRVILLE OH For profit - Corporation N 1366127 WOODLANDS HEALTH AND REHAB CENTER RAVENNA OH For profit - Corporation N 1366129 GILLETTE NURSING HOME WARREN OH For profit - Corporation N 1366215 LANFAIR CENTER FOR REHAB & NSG CARE INC LANCASTER OH For profit - Corporation N 1366216 MASON HEALTH CARE CENTER MASON OH Non profit - Corporation N 1365855 LAURIE ANN NURSING HOME NEWTON FALLS OH For profit - Corporation N 1365834 KENT CENTER KENT OH For profit - Corporation N 1365900 VERSAILLES HEALTH CARE CENTER VERSAILLES OH For profit - Corporation N 1365929 CROWN POINTE CARE CENTER COLUMBUS OH For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 159: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

365934 CRESTWOOD RIDGE SKILLED NURSING AND REHAB HILLSBORO OH For profit - Corporation N 1365977 CIRCLE OF CARE SALEM OH For profit - Partnership N 1366057 SOUTHERN HILLS HEALTH AND REHA MIDDLEBURG HEIGHTS OH For profit - Corporation N 1366048 ASHTABULA COUNTY MEDICAL CENTE ASHTABULA OH Non profit - Corporation Y 1366067 VISTA CARE CENTER OF MILAN MILAN OH For profit - Corporation N 1366073 SWANTON HEALTH CARE RETIREMENT SWANTON OH For profit - Corporation N 1375325 BURFORD MANOR DAVIS OK For profit - Individual N 74375326 MEEKER NURSING CENTER MEEKER OK For profit - Corporation N 65375306 CORDELL CHRISTIAN HOME CORDELL OK Non profit - Church related N 63375317 HERITAGE HILLS LIVING & REHABILITATION CENTER MCALESTER OK For profit - Individual N 62375513 THE GOLDEN RULE HOME SHAWNEE OK For profit - Corporation N 52375285 SAND SPRINGS NURSING AND REHABILITATION SAND SPRINGS OK For profit - Corporation N 48375415 MONROE MANOR JAY OK For profit - Partnership N 45375557 BOYCE MANOR NURSING HOME HOLDENVILLE OK For profit - Corporation N 45375479 ELK CITY NURSING CENTER ELK CITY OK For profit - Partnership N 37375492 HOMESTEAD OF HUGO HUGO OK For profit - Corporation N 35375193 WESTBROOK HEALTHCARE, INC WAURIKA OK For profit - Corporation N 32375182 ENID SENIOR CARE ENID OK For profit - Individual N 29375416 FIRST SHAMROCK CARE CENTER KINGFISHER OK For profit - Partnership N 28375402 HILLCREST MANOR BLACKWELL OK For profit - Corporation N 27375332 WEATHERFORD LIVING CENTER WEATHERFORD OK For profit - Corporation N 27375564 SHATTUCK NURSING CENTER SHATTUCK OK For profit - Corporation N 27375295 COMMUNITY HEALTH CARE OF GORE GORE OK For profit - Individual N 25375451 PLEASANT VALLEY HEALTH CARE CENTER MUSKOGEE OK For profit - Corporation N 24375123 MEMORIAL HEIGHTS NURSING CENTER IDABEL OK For profit - Corporation N 24375482 BARNSDALL NURSING HOME BARNSDALL OK For profit - Individual N 24375421 GREEN COUNTRY CARE CENTER TULSA OK For profit - Corporation N 23375371 RIVERSIDE HEALTH SERVICES LLC ARKOMA OK For profit - Corporation N 22375195 GRACE LIVING CENTER-WOODWARD WOODWARD OK For profit - Partnership N 22375476 INVERNESS VILLAGE TULSA OK Non profit - Corporation N 2237E109 COLONIAL MANOR II HOLLIS OK Government - County N 22375563 TIDWELL LIVING CENTER WILBURTON OK For profit - Corporation N 21375539 RANCH TERRACE NURSING HOME SAPULPA OK For profit - Corporation N 2037E261 HIGHER CALL NURSING CENTER MIAMI OK Non profit - Church related N 19375207 GRACE LIVING CENTER-MANGUM MANGUM OK For profit - Corporation N 19

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 160: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

375234 HILL NURSING HOME, INC. IDABEL OK For profit - Corporation N 19375480 CRESCENT CARE CENTER CRESCENT OK For profit - Corporation N 18375400 WINDSOR HILLS NURSING CENTER OKLAHOMA CITY OK For profit - Individual N 18375514 LEXINGTON NURSING HOME, INC. LEXINGTON OK For profit - Corporation N 17375506 QUINTON MANOR QUINTON OK For profit - Corporation N 17375525 FRANCISCAN VILLA BROKEN ARROW OK For profit - Individual N 17375567 MEMORIAL NURSING CENTER FREDERICK OK Government - City/county N 17375552 EDMOND HEALTH AND REHABILITATION EDMOND OK For profit - Partnership N 17375259 GRACE LIVING CENTER-BUFFALO BUFFALO OK For profit - Partnership N 17375320 RAINBOW HEALTH CARE COMMUNITY BRISTOW OK For profit - Corporation N 16375172 SOUTHERN HILLS REHABILITATION CENTER TULSA OK For profit - Corporation N 16375541 CHICKASHA NURSING CENTER, INC CHICKASHA OK For profit - Corporation N 15375501 FORREST MANOR NURSING CENTER DEWEY OK For profit - Corporation N 15375286 PURCELL CARE CENTER, LLC PURCELL OK Government - City/county N 15375554 SAINT SIMEONS EPISCOPAL HOME TULSA OK Non profit - Church related N 15375436 WILLOW CREEK HEALTH CARE GUTHRIE OK For profit - Corporation N 14375424 WILKINS HEALTH & REHABILITATION COMMUNITY DUNCAN OK For profit - Corporation N 14375367 STROUD HEALTH CARE CENTER SOUTH STROUD OK For profit - Corporation N 13375528 SENIOR SUITES HEALTHCARE BROKEN ARROW OK For profit - Individual N 13375322 PARKHILL NORTH NURSING HOME SALINA OK For profit - Corporation N 13375189 GRACE LIVING CENTER-WILSHIRE & BROADWAY OKLAHOMA CITY OK For profit - Partnership N 12375529 EASTWOOD MANOR COMMERCE OK For profit - Individual N 12375497 HASKELL COUNTY NURSING CENTER, INC STIGLER OK For profit - Individual N 12375372 CHOCTAW NATION NURSING HOME ANTLERS OK For profit - Corporation N 12375467 FAIRFAX MANOR FAIRFAX OK For profit - Corporation N 12375439 PONCA CITY NURSING & REHABILITATION CENTER PONCA CITY OK For profit - Corporation N 11375545 TOWN OF VICI NURSING HOME VICI OK Government - City N 11375549 ADAMS PARC BARTLESVILLE OK For profit - Corporation N 11375362 SHANOAN SPRINGS NURSING AND REHABILITATION CHICKASHA OK For profit - Corporation N 11375304 COWETA MANOR NURSING HOME COWETA OK For profit - Corporation N 11375110 BARTLESVILLE HEALTH AND REHABILITATION COMMUNITY BARTLESVILLE OK For profit - Corporation N 11375486 HIGHLAND PARK HEALTH CARE OKMULGEE OK For profit - Corporation N 11375173 SEQUOYAH MANOR, LLC SALLISAW OK For profit - Corporation N 11375253 CLINTON THERAPY & LIVING CENTER CLINTON OK Non profit - Corporation N 1137E161 SENIOR VILLAGE NURSING HOME BLANCHARD OK For profit - Partnership N 10

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 161: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

37E082 SEILING NURSING CENTER SEILING OK Government - City N 9375443 CLEVELAND MANOR NURSING & REHAB CLEVELAND OK For profit - Corporation N 9375452 SOUTH PARK EAST OKLAHOMA CITY OK For profit - Corporation N 9375303 WEWOKA HEALTHCARE CENTER WEWOKA OK For profit - Individual N 9375230 LEISURE VILLAGE HEALTH CARE CENTER TULSA OK For profit - Corporation N 9375245 NOBLE HEALTH CARE CENTER NOBLE OK Government - City N 9375314 MUSCOGEE (CREEK) NATION SKILLED NURSING FACILITY OKMULGEE OK Government - Federal N 8375335 WINDRIDGE NURSING AND REHABILITATION CENTER MIAMI OK For profit - Corporation N 8375461 BROOKHAVEN EXTENSIVE CARE NORMAN OK For profit - Partnership N 8375477 ANADARKO NURSING & REHAB ANADARKO OK For profit - Corporation N 8375559 BEAVER COUNTY NURSING HOME BEAVER OK Government - County N 8375515 FAMILY CARE CENTER OF FAIRLAND FAIRLAND OK For profit - Individual N 8375496 MAPLE LAWN NURSING AND REHABILITATION HYDRO OK For profit - Corporation N 7375527 GARLAND ROAD NURSING & REHAB CENTER ENID OK For profit - Corporation N 7375365 SOUTH POINTE REHABILITATION AND CARE CENTER OKLAHOMA CITY OK For profit - Corporation N 7375299 COLONIAL TERRACE CARE CENTER PRYOR OK For profit - Individual N 7375544 WHISPERING OAKS ARDMORE OK For profit - Partnership N 7375339 EDWARDS REDEEMER HEALTH & REHAB OKLAHOMA CITY OK For profit - Corporation N 7375398 BINGER NURSING AND REHABILITATION BINGER OK For profit - Corporation N 7375279 HOBART NURSING & REHAB HOBART OK For profit - Corporation N 7375276 MEADOWBROOK NURSING CENTER CHOUTEAU OK For profit - Corporation N 6375366 GROVE NURSING CENTER GROVE OK For profit - Corporation N 6375569 HENRYETTA COMMUNITY SKILLED HEALTHCARE & REHAB HENRYETTA OK For profit - Corporation N 6375116 GRAND LAKE VILLA GROVE OK For profit - Individual N 6375194 SHAWN MANOR NURSING HOME PONCA CITY OK For profit - Corporation N 6375470 CHANDLER THERAPY & LIVING CENTER LLC CHANDLER OK For profit - Corporation N 6375375 CLAREMORE NURSING HOME CLAREMORE OK For profit - Partnership N 6375395 EUFAULA MANOR NURSING AND REHABILITATION CENTER EUFAULA OK For profit - Corporation N 5375426 MERIDIAN NURSING HOME COMANCHE OK For profit - Partnership N 5375458 THE LIVING CENTER ENID OK For profit - Individual N 537E052 HOLIDAY HEIGHTS NURSING HOME NORMAN OK For profit - Individual N 5375122 GRACE LIVING CENTER-NORMAN NORMAN OK For profit - Partnership N 5375235 BROOKSIDE NURSING CENTER MADILL OK Non profit - Corporation N 5375166 THE OAKS HEALTHCARE CENTER POTEAU OK For profit - Corporation N 5375313 ANTLERS MANOR ANTLERS OK For profit - Corporation N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 162: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

375393 WOODVIEW HOME, INC. ARDMORE OK For profit - Corporation N 5375328 TALIHINA MANOR TALIHINA OK For profit - Individual N 5375331 HILLCREST NURSING CENTER MOORE OK For profit - Individual N 5375333 STILWELL NURSING HOME, LLC STILWELL OK For profit - Corporation N 5375465 COLONIAL MANOR NURSING HOME, INC TULSA OK For profit - Corporation N 5375521 VIA CHRISTI VILLAGE PONCA CITY, INC. PONCA CITY OK Non profit - Corporation N 5375543 MOORELAND HERITAGE MANOR MOORELAND OK For profit - Corporation N 4375505 PLANTATION VILLAGE NURSING CENTER ALTUS OK For profit - Partnership N 4375418 SEMINOLE CARE AND REHABILITATION CENTER SEMINOLE OK For profit - Corporation N 4375344 SEQUOYAH POINTE LIVING CENTER OWASSO OK For profit - Individual N 4375347 MCLOUD NURSING CENTER MCLOUD OK For profit - Corporation N 4375562 MCMAHON-TOMLINSON NURSING CENTER LAWTON OK Government - County N 4375556 SHERWOOD MANOR NURSING HOME TULSA OK For profit - Individual N 437E624 CALLAWAY NURSING HOME SULPHUR OK For profit - Corporation N 4375310 LAKE COUNTRY NURSING CENTER MARIETTA OK Non profit - Corporation N 4375547 ZARROW POINTE TULSA OK Non profit - Corporation N 4375531 UNIVERSITY VILLAGE RETIREMENT COMMUNITY TULSA OK For profit - Corporation N 4375449 INOLA HEALTH & REHABILITATION INOLA OK For profit - Corporation N 4375463 PAULS VALLEY CARE CENTER PAULS VALLEY OK Government - City/county N 4375383 GRACE LIVING CENTER-WILDEWOOD OKLAHOMA CITY OK For profit - Partnership N 4375373 PERRY GREEN VALLEY NURSING CENTER, LLC PERRY OK For profit - Corporation N 4375349 BELLEVUE HEALTH & REHABILITATION CENTER OKLAHOMA CITY OK For profit - Partnership N 4375334 SHADY REST CARE CENTER PRYOR OK For profit - Individual N 3375481 PAWHUSKA NURSING HOME, LLC PAWHUSKA OK For profit - Individual N 3375532 HENSLEY NURSING HOME SAYRE OK For profit - Corporation N 3375560 SPANISH COVE HOUSING AUTHORITY YUKON OK Non profit - Other N 3375289 ARTESIAN HOME SULPHUR OK For profit - Individual N 3375186 GRACE LIVING CENTER-DEL CITY DEL CITY OK For profit - Corporation N 3375171 VILLAGE HEALTH CARE CENTER BROKEN ARROW OK For profit - Corporation N 3375570 ACCEL AT CRYSTAL PARK OKLAHOMA CITY OK For profit - Corporation N 3375312 RUTH WILSON HURLEY MANOR COALGATE OK Non profit - Corporation N 3375255 SOUTHBROOK HEALTHCARE, INC ARDMORE OK For profit - Corporation N 3375241 ROLLING HILLS CARE CENTER CATOOSA OK For profit - Corporation N 3375487 MCALESTER NURSING & REHAB MCALESTER OK For profit - Individual N 3375468 WILDWOOD CARE CENTER, INC TULSA OK For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 163: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

375495 COUNTRY CLUB CARE DUNCAN OK For profit - Corporation N 3375519 CALERA MANOR, LLC CALERA OK For profit - Corporation N 2375551 MEDICAL PARK WEST REHABILITATION & SKILLED CARE NORMAN OK Government - City/county N 2375457 BETTY ANN NURSING CENTER GROVE OK For profit - Individual N 2375385 PARKLAND MANOR LIVING CENTER PRAGUE OK For profit - Corporation N 2375417 WESTHAVEN NURSING HOME STILLWATER OK For profit - Corporation N 2375199 HERITAGE VILLAGE NURSING HOME HOLDENVILLE OK For profit - Corporation N 2375209 GRACE LIVING CENTER-NORTHWEST OKC OKLAHOMA CITY OK For profit - Partnership N 2375124 GRACE LIVING CENTER-TAHLEQUAH EAST SHAWNEE TAHLEQUAH OK For profit - Partnership N 2375144 GRACE LIVING CENTER-CHICKASHA CHICKASHA OK For profit - Partnership N 2375135 EMERALD CARE CENTER SOUTHWEST LLC OKLAHOMA CITY OK For profit - Corporation N 2375246 SHAWNEE CARE CENTER SHAWNEE OK For profit - Corporation N 2375555 WILLOW HAVEN NURSING HOME TONKAWA OK For profit - Individual N 2375530 CORN HERITAGE VILLAGE AND REHAB OF WEATHERFORD WEATHERFORD OK Non profit - Church related N 2375485 HENNESSEY NURISNG & REHAB HENNESSEY OK For profit - Corporation N 2375464 ADA CARE CENTER ADA OK For profit - Corporation N 2375352 SERVANT LIVING CENTER MEDFORD OK For profit - Corporation N 2375440 SUNSET ESTATES OF PURCELL PURCELL OK For profit - Corporation N 2375388 MIAMI NURSING CENTER, LLC MIAMI OK For profit - Individual N 1375396 THE LAKES OKLAHOMA CITY OK For profit - Corporation N 1375406 GOLDEN OAKS VILLAGE ENID OK For profit - Corporation N 1375358 GRACE LIVING CENTER-JENKS JENKS OK For profit - Partnership N 1375350 SEMINOLE PIONEER NURSING HOME SEMINOLE OK For profit - Individual N 1375459 KENWOOD MANOR ENID OK For profit - Corporation N 1375488 THE COMMONS ENID OK Non profit - Corporation N 1375493 HEARTSWORTH CENTER FOR NURSING & REHABILITATION VINITA OK For profit - Individual N 1375494 REBOLD MANOR OKMULGEE OK For profit - Partnership N 1375518 THE HEALTH CENTER AT CONCORDIA OKLAHOMA CITY OK Non profit - Corporation N 1375566 ELK CROSSING DUNCAN OK For profit - Partnership N 1375263 BALLARD NURSING CENTER ADA OK For profit - Corporation N 1375238 FOUR SEASONS REHABILITATION & CARE DURANT OK Non profit - Corporation N 1375293 SKIATOOK NURSING HOME,LLC SKIATOOK OK For profit - Individual N 1375302 BLUE RIVER HEALTHCARE, INC TISHOMINGO OK For profit - Corporation N 1375141 GRACE LIVING CENTER-CLINTON CLINTON OK For profit - Corporation N 1375094 EMERALD CARE CENTER TULSA TULSA OK For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 164: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

375185 GRACE LIVING CENTER-TAHLEQUAH UNIVERSITY NORTHWEST TAHLEQUAH OK For profit - Partnership N 1375148 GLENNWOOD HEALTHCARE GLENPOOL OK For profit - Partnership N 1375109 HERITAGE VILLA NURSING CENTER BARTLESVILLE OK For profit - Corporation N 1375222 CEDAR CREEK NURSING CENTER NORMAN OK For profit - Individual N 1375190 EASTGATE VILLAGE RETIREMENT CENTER MUSKOGEE OK For profit - Corporation N 1375405 HARRAH NURSING CENTER HARRAH OK For profit - Corporation N 1375408 THE GARDENS SAPULPA OK For profit - Corporation N 1375399 BELL AVENUE NURSING CENTER ELK CITY OK For profit - Corporation N 1375360 OAKRIDGE NURSING CENTER DURANT OK Non profit - Corporation N 1375256 MEADOWLAKE ESTATES OKLAHOMA CITY OK Government - City/county N 1375290 COMMUNITY HEALTH CENTER WAKITA OK Non profit - Corporation N 1375446 SUNSET ESTATES TECUMSEH OK For profit - Partnership N 1375428 TUTTLE CARE CENTER TUTTLE OK For profit - Corporation N 1375471 LINWOOD VILLAGE NURSING & RETIREMENT APTS CUSHING OK For profit - Corporation N 1375472 THE WOLFE LIVING CENTER AT SUMMIT RIDGE HARRAH OK Non profit - Church related N 1375490 MARLOW NURSING & REHAB MARLOW OK For profit - Corporation N 1375536 TUSCANY VILLAGE NURSING CENTER OKLAHOMA CITY OK For profit - Corporation N 1385145 ROBISON JEWISH HEALTH CENTER PORTLAND OR Non profit - Corporation N 65385181 EAST CASCADE RETIREMENT COMMUNITY, LLC MADRAS OR For profit - Corporation N 51385269 VILLAGE AT HILLSIDE MCMINNVILLE OR For profit - Corporation N 30385039 BAYCREST HEALTH CENTER NORTH BEND OR For profit - Corporation N 25385232 LAUREL HILL NURSING CENTER GRANTS PASS OR For profit - Corporation N 23385272 PACIFIC HEALTH AND REHABILITATION TIGARD OR For profit - Corporation N 23385219 CARE CENTER EAST HEALTH & SPECIALTY CARE CENTER PORTLAND OR For profit - Corporation N 18385120 VALLEY WEST HEALTH CARE CENTER EUGENE OR For profit - Corporation N 17385220 REGENCY ALBANY ALBANY OR For profit - Corporation N 17385277 CREEKSIDE REHABILITATION AND NURSING PORTLAND OR For profit - Corporation N 17385262 MARQUIS SILVER GARDENS SILVERTON OR For profit - Corporation N 12385264 SECORA REHABILITATION OF CASCADIA PORTLAND OR For profit - Partnership N 12385211 LAGRANDE POST ACUTE REHAB LA GRANDE OR For profit - Corporation N 12385182 CRESWELL HEALTH AND REHABILITATION CENTER CRESWELL OR For profit - Corporation N 12385152 COAST FORK NURSING CENTER COTTAGE GROVE OR For profit - Corporation N 12385107 TIMBERVIEW CARE CENTER ALBANY OR For profit - Corporation N 1138E040 BLUE MOUNTAIN CARE CENTER PRAIRIE CITY OR Non profit - Corporation Y 11385242 AVAMERE TWIN OAKS OF SWEET HOME SWEET HOME OR For profit - Corporation N 10

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 165: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

385207 DALLAS RET VILLAGE HEALTH CENTER DALLAS OR Non profit - Corporation N 10385197 LINDA VISTA NURSING & REHAB CENTER ASHLAND OR For profit - Corporation N 8385222 MEADOW PARK HEALTH & SPECIALTY CARE CENTER SAINT HELENS OR For profit - Corporation N 6385136 GLISAN CARE CENTER PORTLAND OR For profit - Corporation N 6385233 AVAMERE COURT AT KEIZER KEIZER OR For profit - Corporation N 5385241 SHERWOOD PARK NURSING & REHAB CENTER KEIZER OR For profit - Corporation N 5385258 PARK FOREST CARE CENTER PORTLAND OR For profit - Corporation N 5385229 AVAMERE REHABILITATION OF JUNCTION CITY JUNCTION CITY OR For profit - Corporation N 5385147 GOOD SAMARITAN SOCIETY - EUGENE VILLAGE EUGENE OR Non profit - Corporation N 5385172 THE DALLES HEALTH AND REHABILITATION CENTER THE DALLES OR For profit - Corporation N 5385151 ROSE HAVEN NURSING CENTER ROSEBURG OR For profit - Corporation N 4385072 CORVALLIS MANOR CORVALLIS OR For profit - Corporation N 438E188 GRACELEN TERRACE NF PORTLAND OR For profit - Corporation N 4385281 HEALTHCARE AT FOSTER CREEK PORTLAND OR For profit - Partnership N 438A026 MARQUIS AUTUMN HILLS MEMORY CARE PORTLAND OR For profit - Corporation N 4385275 SHERIDAN CARE CENTER SHERIDAN OR For profit - Corporation N 4385217 EMPRES HILLSBORO HEALTH AND REHABILITATION CENTER HILLSBORO OR For profit - Corporation N 4385239 AVAMERE REHABILITATION OF COOS BAY COOS BAY OR For profit - Corporation N 3385168 AVAMERE REHABILITATION OF LEBANON LEBANON OR For profit - Corporation N 3385276 CASCADE MANOR EUGENE OR Non profit - Corporation N 3385230 REGENCY REDMOND REHABILITATION AND NURSING CENTER REDMOND OR For profit - Corporation N 3385068 VILLAGE HEALTH CARE GRESHAM OR For profit - Partnership N 3385199 CHEHALEM HEALTH & REHAB NEWBERG OR For profit - Corporation N 3385150 MOLALLA MANOR CARE CENTER MOLALLA OR For profit - Corporation N 3385117 FRENCH PRAIRIE NURSING AND REHABILITATION CENTER WOODBURN OR For profit - Corporation N 2385044 PRESTIGE CARE AND REHABILITATION - MENLO PARK PORTLAND OR For profit - Corporation N 2385221 MARQUIS OREGON CITY POST ACUTE REHAB OREGON CITY OR For profit - Corporation N 2385225 PRESTIGE POST-ACUTE & REHAB CENTER - MCMINNVILLE MCMINNVILLE OR For profit - Corporation N 238E032 REGENCY CARE OF CENTRAL OREGON BEND OR For profit - Corporation N 2385263 REGENCY HERMISTON NURSING & REHAB CENTER HERMISTON OR For profit - Corporation N 2385185 AVAMERE RIVERPARK OF EUGENE EUGENE OR For profit - Corporation N 2385188 INDEPENDENCE HEALTH AND REHABILITATION CENTER INDEPENDENCE OR For profit - Corporation N 2385201 WILLOWBROOK TERRACE PENDLETON OR For profit - Corporation N 2385148 ROYALE GARDENS HEALTH AND REHABILITATION CENTER GRANTS PASS OR For profit - Corporation N 2385115 LAKEVIEW GARDENS LAKEVIEW OR Non profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 166: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

385053 AVAMERE REHABILITATION OF EUGENE EUGENE OR For profit - Corporation N 1385077 MARQUIS SPRINGFIELD SPRINGFIELD OR For profit - Corporation N 1385164 AIDAN SENIOR LIVING AT REEDSPORT REEDSPORT OR For profit - Corporation N 138E075 TIERRA ROSE CARE CENTER SALEM OR For profit - Corporation N 138E157 ROSE CITY NURSING HOME PORTLAND OR For profit - Corporation N 1385250 ROGUE VALLEY MANOR MEDFORD OR Non profit - Corporation N 1385253 BEND TRANSITIONAL CARE BEND OR For profit - Corporation N 1385254 MYRTLE POINT CARE CENTER MYRTLE POINT OR For profit - Partnership N 1385266 MARQUIS WILSONVILLE POST ACUTE REHAB WILSONVILLE OR For profit - Corporation N 1385046 HILLSIDE HEIGHTS REHAB CT EUGENE OR For profit - Corporation N 1385132 AVAMERE REHABILITATION OF KING CITY TIGARD OR For profit - Corporation N 1385024 AVAMERE HEALTH SERVICES OF ROGUE VALLEY MEDFORD OR For profit - Corporation N 1385180 MARQUIS NEWBERG NEWBERG OR For profit - Corporation N 1385155 FOREST GROVE REHABILITATION AND CARE CENTER FOREST GROVE OR For profit - Corporation N 1385161 MILTON FREEWATER HEALTH AND REHABILITATION CENTER MILTON FREEWATER OR For profit - Corporation N 1385165 GOOD SAMARITAN SOCIETY - CURRY VILLAGE BROOKINGS OR Non profit - Corporation N 1385171 LIFE CARE CENTER OF MCMINNVILLE MCMINNVILLE OR For profit - Corporation N 1395330 CHELTENHAM NURSING AND REHAB C PHILADELPHIA PA Non profit - Corporation N 31395582 MOUNTAIN CITY NURSING & REHABILITATION CENTER HAZLETON PA Non profit - Other N 28395912 SUBURBAN WOODS HEALTH & REHA NORRISTOWN PA Non profit - Corporation N 22395688 FRIENDSHIP VILLAGE OF SOUTH HI PITTSBURGH PA Non profit - Corporation N 13395518 COURTYARD GARDENS NURSING AND REHAB CTR MIDDLETOWN PA Non profit - Corporation N 13396063 SETON MANOR NURSING AND REHABILITATION CENTER ORWIGSBURG PA For profit - Corporation N 12395318 GREEN HOME, INC, THE WELLSBORO PA Non profit - Corporation N 12395193 ROSEMONT CARE AND REHABILITATION CENTER ROSEMONT PA For profit - Corporation N 12395226 SPRUCE MANOR NURSING & REHABILITATION CENTER WEST READING PA Non profit - Corporation N 8395583 SOUTH MOUNTAIN RESTORATION CEN SOUTH MOUNTAIN PA Government - State N 8395697 WOODLAND PARK REHAB CENTER ORBISONIA PA For profit - Corporation N 8395290 PLEASANT ACRES NURSING AND REHAB CENTER YORK PA Government - County N 8395381 VALENCIA WOODS AT ST BARNABAS VALENCIA PA Non profit - Corporation N 7395651 BIRCHWOOD NURSING AND REHABILITATION CENTER NANTICOKE PA For profit - Corporation N 6395334 CHESTNUT HILL LODGE HEALTH AND REHAB CTR WYNDMOOR PA For profit - Corporation N 6396088 MAPLE WINDS HEALTHCARE AND REHABILITATION, LLC PORTAGE PA For profit - Individual N 6395844 ELIZABETHTOWN HEALTHCARE AND REHAB CENTER ELIZABETHTOWN PA For profit - Corporation N 6395586 BRADFORD COUNTY MANOR TROY PA Government - County N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 167: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

395177 ROSE CITY NURSING AND REHAB AT LANCASTER LANCASTER PA For profit - Corporation N 5395926 SACRED HEART HOSPITAL TCF ALLENTOWN PA Non profit - Corporation Y 4395570 MILTON REHABILITATION AND NURSING CENTER MILTON PA For profit - Corporation N 4395853 CRAWFORD COUNTY CARE CENTER SAEGERTOWN PA Government - County N 3396092 VILLAGE AT PENN STATE, THE STATE COLLEGE PA Non profit - Corporation N 3395865 MAPLEWOOD NURSING AND REHAB CENTER PHILADELPHIA PA For profit - Partnership N 2395423 FORBES CENTER FOR REHAB AND HEALTHCARE LLC PITTSBURGH PA For profit - Corporation N 2395484 GARDENS AT BUTLER, THE DRUMS PA For profit - Corporation N 2395929 RIDGEVIEW HEALTHCARE & REHAB CENTER SHENANDOAH PA For profit - Corporation N 2395922 ARTMAN LUTHERAN HOME AMBLER PA Non profit - Corporation N 2395930 ALLIED SERVICES TRANSITIONAL CARE SCRANTON PA Non profit - Corporation N 1395625 HOLY FAMILY RESIDENCE SCRANTON PA Non profit - Corporation N 1395890 SNU ARMSTRONG CO MEMORIAL HOSP KITTANNING PA Non profit - Other Y 1395232 HOSPITALITY CARE CENTER OF HER HERMITAGE PA For profit - Corporation N 1395273 GARDENS AT SCRANTON, THE SCRANTON PA For profit - Corporation N 1395176 AMBLER EXTENDED CARE CENTER AMBLER PA For profit - Corporation N 1396053 COUNTRY MEADOWS NURSING CENTER OF BETHLEHEM BETHLEHEM PA For profit - Partnership N 1395749 PRESBYTERIAN CTR FOR CONT CARE PHILADELPHIA PA Non profit - Corporation N 1395842 VINCENTIAN DE MARILLAC PITTSBURGH PA Non profit - Corporation N 1395539 SAINT ANNE HOME GREENSBURG PA Non profit - Corporation N 1395869 BUTLER MEMORIAL HOSP TCF BUTLER PA Non profit - Other N 1395876 CUMBERLAND CROSSINGS RETIREMENT COMMUNITY CARLISLE PA Non profit - Church related N 1396137 ATHENS HEALTH AND REHABILITATION CENTER ATHENS PA For profit - Corporation N 1395180 CORNWALL MANOR CORNWALL PA Non profit - Church related N 1415024 HALLWORTH HOUSE PROVIDENCE RI Non profit - Church related N 11415066 CRA-MAR MEADOWS CRANSTON RI For profit - Corporation N 2415097 MANSION NURSING AND REHAB CENTER CENTRAL FALLS RI For profit - Corporation N 1415060 AVALON NURSING HOME WARWICK RI For profit - Corporation N 1425154 HERITAGE HOME OF FLORENCE INC FLORENCE SC For profit - Corporation N 61425131 THE METHODIST OAKS ORANGEBURG SC Non profit - Corporation N 26425024 WHITE OAK MANOR - SPARTANBURG SPARTANBURG SC For profit - Corporation N 21425403 PRESBYTERIAN HOME OF SC - FOOTHILLS EASLEY SC Non profit - Church related N 19425319 LAUREL BAYE HEALTHCARE BLACKVILLE BLACKVILLE SC For profit - Corporation N 18425370 COUNTRYWOOD NURSING CENTER, LLC HOPKINS SC For profit - Corporation N 15425090 MAGNOLIA MANOR - GREENVILLE GREENVILLE SC For profit - Corporation N 15

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 168: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

425140 PRUITTHEALTH-MONCKS CORNER MONCKS CORNER SC For profit - Corporation N 14425158 BLUE RIDGE IN THE FIELDS, LLC RIDGEWAY SC For profit - Corporation N 13425402 COVENANT PLACE NURSING CENTER SUMTER SC Non profit - Corporation N 13425067 BAYVIEW MANOR BEAUFORT SC For profit - Corporation N 12425316 GOLDEN AGE - INMAN INMAN SC For profit - Corporation N 12425404 SAVANNAH GRACE AT THE PALMS OF MT PLEASANT MOUNT PLEASANT SC For profit - Corporation N 12425179 WOODRUFF MANOR WOODRUFF SC For profit - Corporation N 9425306 HERITAGE HEALTHCARE OF PICKENS SIX MILE SC For profit - Corporation N 9425048 BLUE RIDGE IN GEORGETOWN GEORGETOWN SC For profit - Corporation N 9425157 SOUTHLAND HEALTH CARE CENTER FLORENCE SC For profit - Corporation N 8425053 PRUITTHEALTH-WALTERBORO WALTERBORO SC For profit - Corporation N 7425127 PRUITTHEALTH- ROCK HILL ROCK HILL SC For profit - Corporation N 7425298 CAPSTONE REHABILITATION AND HEALTHCARE, LLC EASLEY SC For profit - Individual N 7425149 LAKE CITY SCRANTON HEALTHCARE CENTER SCRANTON SC For profit - Corporation N 7425308 PEPPER HILL NURSING & REHAB CENTER, LLC AIKEN SC For profit - Corporation N 7425160 ROLLING GREEN VILLAGE GREENVILLE SC Non profit - Corporation N 6425170 SAINT MATTHEWS HEALTH CARE, LLC SAINT MATTHEWS SC For profit - Corporation N 6425406 PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA-FLORENC FLORENCE SC Non profit - Corporation N 6425376 ROSECREST REHABILITATION AND HEALTHCARE CENTER INMAN SC Non profit - Church related N 6425393 PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA- CLINTO CLINTON SC Non profit - Church related N 5425061 CHESTER NURSING CENTER CHESTER SC For profit - Corporation N 5425068 WHITE OAK MANOR - COLUMBIA COLUMBIA SC For profit - Corporation N 5425172 MAGNOLIA MANOR - GREENWOOD GREENWOOD SC For profit - Corporation N 5425395 THE RETREAT AT BRIGHTWATER MYRTLE BEACH SC For profit - Corporation N 4425337 LIFE CARE CENTER OF COLUMBIA COLUMBIA SC For profit - Corporation N 4425155 LANCASTER CONVALESCENT CENTER LANCASTER SC For profit - Corporation N 4425309 DR RONALD E MCNAIR NURSING & REHABILITATION CENTER LAKE CITY SC For profit - Corporation N 4425116 ORANGEBURG REHABILITATION AND HEALTHCARE CENTER ORANGEBURG SC For profit - Corporation N 4425085 PRUITTHEALTH-ORANGEBURG ORANGEBURG SC For profit - Corporation N 4425013 PRUITTHEALTH- COLUMBIA COLUMBIA SC For profit - Corporation N 3425174 MCCOY MEMORIAL NURSING CENTER BISHOPVILLE SC For profit - Corporation N 3425394 THE ARBORETUM AT THE WOODLANDS GREENVILLE SC Non profit - Corporation N 3425372 BETHEA BAPTIST HEALTHCARE CENTER DARLINGTON SC Non profit - Church related N 3425334 MARTHA FRANKS BAPTIST RETIREMENT CENTER LAURENS SC Non profit - Church related N 3425351 BROAD CREEK CARE CENTER HILTON HEAD ISLAND SC For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 169: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

425375 WILLOW BROOK COURT AT PARK POINTE VILLAGE ROCK HILL SC Non profit - Corporation N 3425317 IVA REHABILITATION AND HEALTHCARE CENTER, LLC IVA SC For profit - Corporation N 3425307 RIVER FALLS REHABILITATION AND HEALTHCARE CENTER, MARIETTA SC For profit - Corporation N 3425295 PRINCE GEORGE HEALTHCARE CENTER GEORGETOWN SC For profit - Corporation N 3425163 CARLYLE SENIOR CARE OF FLORENCE FLORENCE SC For profit - Corporation N 3425096 VALLEY FALLS TERRACE SPARTANBURG SC For profit - Corporation N 3425102 POINSETT REHABILITATION AND HEALTHCARE CENTER, LLC GREENVILLE SC For profit - Corporation N 2425132 RIDGELAND NURSING CENTER INC RIDGELAND SC For profit - Corporation N 2425143 ST GEORGE HEALTHCARE CENTER SAINT GEORGE SC For profit - Corporation N 2425110 MOUNT PLEASANT MANOR MT PLEASANT SC For profit - Corporation N 2425303 LAKE EMORY POST ACUTE CARE INMAN SC For profit - Corporation N 2425089 WHITE OAK MANOR - YORK YORK SC For profit - Corporation N 2425293 THE RIDGE REHABILITATION AND HEALTHCARE CENTER, LL EDGEFIELD SC For profit - Corporation N 2425379 OPUS POST ACUTE REHABILITATION WEST COLUMBIA SC For profit - Corporation N 2425150 FRASER HEALTH CENTER HILTON HEAD ISLAND SC Non profit - Corporation N 2425312 MULLINS NURSING CENTER MULLINS SC For profit - Corporation N 2425314 HOSANNA HEALTH AND REHAB OF PIEDMONT PIEDMONT SC For profit - Corporation N 2425320 NHC HEALTHCARE - NORTH AUGUSTA NORTH AUGUSTA SC For profit - Corporation N 2425075 GHS LILA DOYLE SENECA SC Non profit - Other Y 2425095 PEACHTREE CENTRE GAFFNEY SC For profit - Corporation N 2425057 ABBEVILLE NURSING HOME, INC. ABBEVILLE SC For profit - Corporation N 1425009 FAITH HEALTHCARE CENTER FLORENCE SC For profit - Corporation N 1425302 CHESTERFIELD CONVALESCENT CENTER CHERAW SC For profit - Corporation N 1425315 PRUITTHEALTH- ESTILL ESTILL SC For profit - Corporation N 1425176 MEDFORD NURSING CENTER DARLINGTON SC For profit - Corporation N 1425290 WHITE OAK ESTATES SPARTANBURG SC For profit - Corporation N 1425296 PRUITTHEALTH- NORTH AUGUSTA NORTH AUGUSTA SC For profit - Corporation N 1425400 PRUITTHEALTH-BLYTHEWOOD COLUMBIA SC For profit - Corporation N 1425121 CONWAY MANOR CONWAY SC For profit - Partnership N 1425078 HEALTHCARE CENTER OF WESLEY COMMONS GREENWOOD SC Non profit - Corporation N 1425165 MAGNOLIA MANOR - ROCK HILL ROCK HILL SC For profit - Corporation N 1425107 SUMTER EAST HEALTH & REHABILITATION CENTER SUMTER SC For profit - Corporation N 1425018 FLEETWOOD REHABILITATION AND HEALTHCARE CENTER, LL EASLEY SC For profit - Corporation N 1435113 MENNO-OLIVET CARE CENTER MENNO SD Non profit - Corporation N 81435097 LAKE ANDES SENIOR LIVING LAKE ANDES SD For profit - Corporation N 13

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 170: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

435131 HUDSON CARE AND REHAB CENTER, LLC HUDSON SD For profit - Corporation N 12435105 WHEATCREST HILLS HEALTHCARE COMMUNITY BRITTON SD For profit - Corporation N 1043A135 EASTERN STAR HOME OF SOUTH DAKOTA, INC REDFIELD SD Non profit - Corporation N 9435092 HIGHMORE HEALTH HIGHMORE SD For profit - Corporation N 9435115 PALISADE HEALTHCARE COMMUNITY GARRETSON SD For profit - Corporation N 8435055 IPSWICH CARE AND REHABILITATION CENTER IPSWICH SD For profit - Corporation N 743A075 BENNETT COUNTY HOSPITAL AND NURSING HOME MARTIN SD Non profit - Corporation N 7435043 DAVID M DORSETT HEALTHCARE COMMUNITY SPEARFISH SD For profit - Corporation N 643A103 KADOKA NURSING HOME KADOKA SD Non profit - Corporation N 6435117 GOOD SAMARITAN SOCIETY DEUEL COUNTY CLEAR LAKE SD Non profit - Corporation N 5435062 ALCESTER CARE AND REHAB CENTER, INC ALCESTER SD For profit - Corporation N 5435056 WINNER REGIONAL HEALTHCARE CENTER WINNER SD Non profit - Other Y 5435058 CLARK CARE AND REHABILITATION CENTER CLARK SD For profit - Corporation N 4435118 PRAIRIE VIEW HEALTHCARE COMMUNITY WOONSOCKET SD For profit - Corporation N 4435125 STRAND-KJORSVIG COMMUNITY REST HOME ROSLYN SD Non profit - Corporation N 3435102 REGIONAL HEALTH CARE CENTER STURGIS SD Non profit - Other N 3435084 FAULKTON SENIOR LIVING FAULKTON SD For profit - Corporation N 3435088 CENTERVILLE CARE AND REHAB CENTER CENTERVILLE SD Non profit - Corporation N 3435089 GOOD SAMARITAN SOCIETY CORSICA CORSICA SD Non profit - Church related N 3435091 GOOD SAMARITAN SOCIETY TRIPP TRIPP SD Non profit - Other N 3435101 GOOD SAMARITAN SOCIETY CANTON CANTON SD Non profit - Corporation N 3435122 ST WILLIAM'S CARE CENTER MILBANK SD Non profit - Corporation N 3435124 GOOD SAMARITAN SOCIETY MILLER MILLER SD Non profit - Church related N 3435087 GOOD SAMARITAN SOCIETY CANISTOTA CANISTOTA SD Non profit - Corporation N 2435096 BETHANY HOME SIOUX FALLS SIOUX FALLS SD Non profit - Church related N 2435060 BELLA VISTA CARE AND REHABILITATION CENTER RAPID CITY SD For profit - Corporation N 2435054 REDFIELD CARE AND REHABILITATION CENTER REDFIELD SD For profit - Corporation N 1435082 GOOD SAMARITAN SOCIETY LENNOX LENNOX SD Non profit - Church related N 1435038 TEKAKWITHA LIVING CENTER SISSETON SD Non profit - Corporation N 1435129 DELLS NURSING AND REHAB CENTER INC DELL RAPIDS SD For profit - Corporation N 1435106 GOOD SAMARITAN SOCIETY WAGNER WAGNER SD Non profit - Corporation N 1435064 BLACK HILLS CARE AND REHABILITATION CENTER RAPID CITY SD For profit - Corporation N 1435041 ABERDEEN HEALTH AND REHAB ABERDEEN SD For profit - Corporation N 144E445 TRINITY HEALTH AND REHABILITATION CENTER LENOIR CITY TN Non profit - Corporation N 31445233 WHITEHAVEN COMMUNITY LIVING MEMPHIS TN For profit - Corporation N 30

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 171: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

445443 MEADOWBROOK NURSING CENTER PULASKI TN For profit - Corporation N 27445388 GENERATIONS CENTER OF SPENCER SPENCER TN Non profit - Corporation N 22445447 MISSION CONVALESCENT HOME JACKSON TN Non profit - Church related N 21445462 PARIS HEALTH CARE NURSING & REHABILITATION CTR PARIS TN For profit - Corporation N 14445279 LYNCHBURG NURSING CENTER LYNCHBURG TN For profit - Corporation N 14445238 LIFE CARE CENTER OF TULLAHOMA TULLAHOMA TN For profit - Corporation N 13445439 MT JULIET HEALTH CARE CENTER MOUNT JULIET TN For profit - Corporation N 12445387 PARKWAY HEALTH AND REHABILITATION CENTER MEMPHIS TN For profit - Partnership N 11445223 RENAISSANCE TERRACE HARRIMAN TN For profit - Corporation N 11445150 MAJESTIC GARDENS AT MEMPHIS REHAB & SNC MEMPHIS TN For profit - Partnership N 10445354 LAUDERDALE COMMUNITY LIVING CENTER RIPLEY TN For profit - Corporation N 9445172 CONCORDIA NURSING AND REHABILITATION-SMITH COUNTY CARTHAGE TN For profit - Corporation N 9445157 CLAIBORNE AND HUGHES HLTH CNTR FRANKLIN TN For profit - Partnership N 8445253 CONCORDIA NURSING AND REHABILITATION -LOUDON LOUDON TN For profit - Partnership N 8445465 SIGNATURE HEALTHCARE OF COLUMBIA COLUMBIA TN For profit - Corporation N 844E166 HARDIN HOME SAVANNAH TN For profit - Corporation N 7445502 THE WATERS OF SMYRNA, LLC SMYRNA TN For profit - Corporation N 7445256 HARTSVILLE CONVALESCENT CENTER HARTSVILLE TN For profit - Corporation N 7445306 SIGNATURE HEALTH OF PORTLAND REHAB & WELLNESS CENT PORTLAND TN For profit - Individual N 7445434 DOUGLAS NURSING HOME MILAN TN For profit - Corporation N 7445437 WEAKLEY COUNTY NURSING HOME DRESDEN TN Government - County N 6445272 MABRY HEALTH CARE GAINESBORO TN For profit - Corporation N 6445155 DIVERSICARE OF DOVER DOVER TN For profit - Corporation N 6445459 HANCOCK MANOR NURSING HOME SNEEDVILLE TN For profit - Corporation N 644E175 HICKMAN COMMUNITY NURSING HOME CENTERVILLE TN Non profit - Corporation N 6445515 NHC HEALTHCARE, TULLAHOMA TULLAHOMA TN For profit - Corporation N 6445184 PALMYRA HEALTH CARE CENTER PALMYRA TN For profit - Corporation N 6445413 LAURELWOOD HEALTHCARE CENTER JACKSON TN For profit - Corporation N 6445318 THE WATERS OF CHEATHAM, LLC ASHLAND CITY TN For profit - Individual N 6445319 WILLOWS AT WINCHESTER CARE & REHABILITATION CENTER WINCHESTER TN For profit - Corporation N 6445333 BRIARWOOD COMMUNITY LIVING CTR LEXINGTON TN For profit - Corporation N 5445262 CUMBERLAND HEALTH CARE AND REHABILITATION INC NASHVILLE TN For profit - Corporation N 544E446 PARK REST HARDIN COUNTY HEALTH CENTER SAVANNAH TN Government - County N 5445526 LAKESHORE HEARTLAND NASHVILLE TN Non profit - Corporation N 5445314 LIFE CARE CENTER OF MORRISTOWN MORRISTOWN TN For profit - Individual N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 172: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

445442 CRESTVIEW HEALTH CARE CENTER OF BROWNSVILLE, INC BROWNSVILLE TN For profit - Corporation N 5445489 HUMPHREYS CO NURSING HOME WAVERLY TN Non profit - Corporation N 5445421 LIFE CARE CENTER OF SPARTA SPARTA TN For profit - Corporation N 4445252 LIFE CARE CENTER OF CENTERVILLE CENTERVILLE TN For profit - Corporation N 4445268 LEBANON HEALTH AND REHABILITATION CENTER LEBANON TN For profit - Corporation N 4445509 LIFE CARE CENTER OF OLD HICKORY VILLAGE OLD HICKORY TN For profit - Corporation N 4445281 GRACE HEALTHCARE OF WHITES CREEK WHITES CREEK TN For profit - Corporation N 4445210 HUNTINGDON HEALTH & REHAB CENTER HUNTINGDON TN For profit - Corporation N 4445367 HILLVIEW COMMUNITY LIVING CENTER DRESDEN TN For profit - Corporation N 4445451 DECATUR COUNTY HEALTH CARE AND REHABILITATION, INC PARSONS TN For profit - Corporation N 4445430 LEWIS COUNTY NURSING AND REHABILITATION CENTER HOHENWALD TN For profit - Corporation N 4445476 ISLAND HOME PARK HEALTH AND REHAB KNOXVILLE TN Non profit - Corporation N 3445511 LIFE CARE CENTER OF OOLTEWAH OOLTEWAH TN For profit - Corporation N 3445529 GRACE HEALTHCARE OF DECATUR DECATUR TN For profit - Corporation N 344E132 TENNOVA NEWPORT CONVALESCENT CENTER NEWPORT TN For profit - Corporation Y 3445234 GLEN OAKS HEALTH AND REHABILITATION SHELBYVILLE TN For profit - Corporation N 3445251 WAVERLY HEALTH CARE & REHABILITATION CENTER WAVERLY TN For profit - Corporation N 3445098 NHC HEALTHCARE, KNOXVILLE KNOXVILLE TN For profit - Corporation N 3445516 CREEKSIDE HEALTH AND REHABILITATION CENTER MADISON TN For profit - Corporation N 3445249 DIVERSICARE OF MARTIN MARTIN TN For profit - Corporation N 3445189 KIRBY PINES MANOR MEMPHIS TN For profit - Corporation N 3445426 BRIGHT GLADE HEALTH AND REHABILITATION CENTER INC MEMPHIS TN For profit - Corporation N 3445156 DIVERSICARE OF CLAIBORNE NEW TAZEWELL TN For profit - Corporation N 3445127 NHC HEALTHCARE, FRANKLIN FRANKLIN TN For profit - Corporation N 3445137 THE WATERS OF ROBERTSON, LLC SPRINGFIELD TN For profit - Corporation N 3445140 SIGNATURE HEALTHCARE OF PRIMACY MEMPHIS TN For profit - Corporation N 2445174 BROOKHAVEN MANOR KINGSPORT TN For profit - Corporation N 2445310 LIFE CARE CENTER OF COPPER BASIN DUCKTOWN TN For profit - Corporation N 2445358 LAKEBRIDGE, A WATERS COMMUNITY, LLC JOHNSON CITY TN For profit - Corporation N 2445436 SKYLINE OF MIDSOUTH HEALTHCARE AND REHABILITATION MEMPHIS TN For profit - Corporation N 2445280 COUNTRYSIDE HEALTHCARE AND REHABILITATION LAWRENCEBURG TN For profit - Individual N 2445302 LIFE CARE CENTER OF ELIZABETHTON ELIZABETHTON TN For profit - Corporation N 2445320 FAYETTEVILLE HEALTH AND REHABILITATION CENTER FAYETTEVILLE TN For profit - Corporation N 2445326 LIFE CARE CENTER OF BRUCETON-HOLLOW ROCK BRUCETON TN For profit - Partnership N 2445485 ALLENBROOKE NURSING AND REHABILITATION CENTER MEMPHIS TN For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 173: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

445277 STARR REGIONAL HEALTH & REHABILITATION ETOWAH TN For profit - Corporation Y 2445259 SUMMIT VIEW OF ROCKY TOP ROCKY TOP TN For profit - Partnership N 2445260 BRIARCLIFF HEALTH CARE CENTER OAK RIDGE TN For profit - Corporation N 2445460 VANCO MANOR NURSING AND REHABILITATION CENTER, INC GOODLETTSVILLE TN For profit - Corporation N 2445493 ST CLARE HEALTH AND REHAB, LLC MEMPHIS TN Non profit - Corporation N 2445528 LIFE CARE CENTER OF EAST RIDGE CHATTANOOGA TN For profit - Corporation N 2445468 DYER NURSING AND REHABILITATION CENTER DYER TN For profit - Corporation N 2445449 WESTWOOD HEALTH CARE AND REHABILITATION CENTER DECATURVILLE TN For profit - Corporation N 2445329 THE PALACE HEALTH CARE AND REHABILITATION CENTER RED BOILING SPRINGS TN For profit - Corporation N 2445316 HILLCREST HEALTHCARE CENTER ASHLAND CITY TN For profit - Corporation N 2445295 HOLSTON MANOR KINGSPORT TN For profit - Corporation N 2445297 CONCORDIA NURSING AND REHABILITATION-NORTHHAVEN KNOXVILLE TN For profit - Corporation N 2445300 RIDGEVIEW TERRACE OF LIFE CARE RUTLEDGE TN For profit - Corporation N 1445303 NORRIS HEALTH AND REHABILITATION CENTER ANDERSONVILLE TN For profit - Corporation N 1445321 ARDMORE HEALTH AND REHABILITATION CENTER ARDMORE TN For profit - Corporation N 1445327 SIGNATURE HEALTHCARE OF RIDGELY REHAB&WELLNESS CT RIDGELY TN For profit - Corporation N 1445419 OVERTON COUNTY HEALTH AND REHAB CENTER LIVINGSTON TN Government - County N 1445422 ETOWAH HEALTH CARE CENTER ETOWAH TN For profit - Corporation N 1445423 VANAYER HEALTHCARE AND REHAB CENTER, INC MARTIN TN For profit - Corporation N 1445393 SIGNATURE HEALTHCARE OF MONTEAGLE REHAB & WELLNESS MONTEAGLE TN For profit - Corporation N 1445406 COMMUNITY CARE OF RUTHERFORD MURFREESBORO TN Government - County N 1445440 GALLAWAY HEALTH AND REHAB GALLAWAY TN For profit - Corporation N 1445441 HUMBOLDT NURSING AND REHABILITATION CENTER HUMBOLDT TN For profit - Corporation N 1445445 CELINA HEALTH AND REHABILITATION CENTER CELINA TN For profit - Corporation N 1445452 MCNAIRY COUNTY HEALTH CARE CENTER SELMER TN For profit - Corporation N 1445457 MADISONVILLE HEALTH AND REHAB CENTER MADISONVILLE TN Non profit - Corporation N 1445480 THE WATERS OF SPRINGFIELD LLC SPRINGFIELD TN For profit - Corporation N 144E232 BLEDSOE COUNTY NURSING HOME PIKEVILLE TN Government - County N 1445510 WHARTON NURSING HOME PLEASANT HILL TN Non profit - Corporation N 1445521 REGIONAL ONE HEALTH SUBACUTE CARE MEMPHIS TN Non profit - Corporation N 1445522 CHRISTIAN CARE CENTER OF MEMPHIS MEMPHIS TN For profit - Corporation N 1445222 SOUTHERN TENN MEDICAL CENTER SNF WINCHESTER TN For profit - Corporation Y 1445284 WILLOW RIDGE CENTER MAYNARDVILLE TN For profit - Corporation N 1445288 HUNTSVILLE MANOR HUNTSVILLE TN For profit - Corporation N 1445119 NHC HEALTHCARE, SOMERVILLE SOMERVILLE TN For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 174: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

445002 NHC HEALTHCARE, OAKWOOD LEWISBURG TN For profit - Corporation N 1445207 WEXFORD HOUSE, THE KINGSPORT TN Non profit - Other N 1445170 GOOD SAMARITAN HEALTH AND REHAB CENTER ANTIOCH TN For profit - Corporation N 1445461 RIVER TERRACE HEALTH AND REHAB CENTER COVINGTON TN For profit - Corporation N 1445471 HENDERSON HEALTH AND REHABILITATION CENTER HENDERSON TN For profit - Corporation N 1445335 OAKWOOD COMMUNITY LIVING CENTER DYERSBURG TN For profit - Corporation N 1445293 MEMPHIS JEWISH HOME CORDOVA TN Non profit - Corporation N 1445294 LIFE CARE CENTER OF COLLEGEDALE COLLEGEDALE TN For profit - Corporation N 1445216 RAINTREE MANOR MC MINNVILLE TN For profit - Partnership N 1445239 LIFE CARE CENTER OF MORGAN COUNTY WARTBURG TN For profit - Individual N 1445242 GREYSTONE HEALTH CARE CENTER BLOUNTVILLE TN For profit - Corporation N 1445446 DYERSBURG NURSING AND REHABILITATION, INC DYERSBURG TN For profit - Corporation N 1445490 AVE MARIA HOME BARTLETT TN Non profit - Corporation N 1445492 RIPLEY HEALTHCARE AND REHAB CENTER RIPLEY TN For profit - Corporation N 1445500 PAVILION-THS, LLC LEBANON TN For profit - Corporation N 1445508 OBION COUNTY NURSING HOME UNION CITY TN Government - County N 1445383 HORIZON HEALTH AND REHAB CENTER MANCHESTER TN Non profit - Corporation N 1445397 ADAMSVILLE HEALTHCARE AND REHABILITATION CENTER ADAMSVILLE TN For profit - Corporation N 1445411 APPLINGWOOD HEALTH CARE CENTER CORDOVA TN For profit - Corporation N 1445154 QUALITY CENTER FOR REHABILITATION AND HEALING LLC LEBANON TN For profit - Partnership N 1445138 THE WATERS OF UNION CITY , LLC UNION CITY TN For profit - Corporation N 1676307 OAK VILLAGE HEALTHCARE LTC PARTNERS INC LAKE JACKSON TX For profit - Corporation N 90675439 MULLICAN CARE CENTER SAVOY TX For profit - Corporation N 87675055 CHILDRESS HEALTHCARE CENTER CHILDRESS TX For profit - Corporation N 80455601 ALVARADO LTC PARTNERS INC ALVARADO TX For profit - Corporation N 74675484 SHEPHERD LTC PARTNERS INC. SHEPHERD TX For profit - Corporation N 73455653 SKYLINE NURSING CENTER DALLAS TX For profit - Corporation N 69675884 TEAGUE LTC PARTNERS INC TEAGUE TX For profit - Corporation N 68455913 HEALTHCARE CENTER AT THE FORUM AT PARK LANE DALLAS TX For profit - Corporation N 68675831 REGENT CARE CENTER OF EL PASO EL PASO TX For profit - Corporation N 65675903 MEXIA LTC NURSING AND REHABILITATION MEXIA TX For profit - Corporation N 65675922 PARKVIEW MANOR NURSING AND REHABILITATION WEIMAR TX For profit - Corporation N 64676163 BENDER TERRACE OF LUBBOCK LUBBOCK TX For profit - Corporation N 64675387 CARTHAGE LTC PARTNERS INC CARTHAGE TX For profit - Corporation N 60675587 REGENCY MANOR HEALTHCARE CENTER TEMPLE TX For profit - Partnership N 60

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 175: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675664 SUNNY SPRINGS NURSING & REHAB SULPHUR SPRINGS TX For profit - Partnership N 60676103 WELLS LTC PARTNERS INC WELLS TX For profit - Corporation N 59676071 GROESBECK LTC PARTNERS INC GROESBECK TX For profit - Corporation N 58675940 HEMPHILL CARE CENTER HEMPHILL TX For profit - Corporation N 57676117 BERTRAM NURSING AND REHAB CENTER BERTRAM TX For profit - Corporation N 56675959 SONGBIRD LODGE BROWNWOOD TX For profit - Corporation N 54675978 ARBOR GRACE WELLNESS CENTER LITTLEFIELD TX For profit - Corporation N 51676140 REFUGIO NURSING & REHAB CENTER REFUGIO TX For profit - Corporation N 50675139 WINDSOR HEALTHCARE RESIDENCE GROESBECK TX For profit - Corporation N 50675911 GRANGER VILLA GRANGER TX For profit - Corporation N 49675836 HILL COUNTRY CARE CENTER JUNCTION TX Non profit - Corporation N 49675434 SILVER PINES NURSING AND REHABILITATION LP BASTROP TX For profit - Corporation N 49675432 REGENT CARE CENTER OF SAN ANTONIO SAN ANTONIO TX For profit - Corporation N 47676304 CREEKSIDE VILLAGE HEALTHCARE LTC PARTNERS INC CLUTE TX For profit - Individual N 46676089 WINNIE L LTC PARTNERS INC CAMERON TX For profit - Corporation N 45455870 THE FORUM AT LINCOLN HEIGHTS SAN ANTONIO TX For profit - Corporation N 45675931 CEDAR HILLS GERIATRIC CENTER CAMP WOOD TX For profit - Partnership N 43675842 MI CASITA LTC PARTNERS INC LUBBOCK TX For profit - Partnership N 43675902 PILOT POINT CARE CENTER PILOT POINT TX For profit - Corporation N 43676068 WEST TEXAS LTC PARTNERS INC SAN ANGELO TX For profit - Corporation N 4245E629 THE SARAH ROBERTS FRENCH HOME SAN ANTONIO TX Non profit - Corporation N 42676226 REGENT CARE CENTER OF SAN MARCOS SAN MARCOS TX For profit - Partnership N 38676290 SPJST REST HOME 1 TAYLOR TX Non profit - Corporation N 38675485 LOCKNEY HEALTH AND REHABILITATION CENTER LOCKNEY TX For profit - Corporation N 38675367 GREENVILLE GARDENS GREENVILLE TX For profit - Corporation N 37675079 FOCUSED CARE AT ALLENBROOK BAYTOWN TX For profit - Corporation N 37676235 ROCK CREEK HEALTH AND REHABILITATION LLC SULPHUR SPRINGS TX For profit - Corporation N 37676164 COLONIAL BELLE NURSING HOME BELLVILLE TX For profit - Corporation N 34675798 ARBORETUM NURSING AND REHABILITATION CENTER OF WIN WINNIE TX For profit - Corporation N 30675982 PARK PLAZA LTC PARTNERS, INC. SAN ANGELO TX For profit - Corporation N 30675101 OAKLAND MANOR NURSING CENTER GIDDINGS TX Government - Hospital district N 30455515 COPPERAS COVE LTC PARTNERS INC COPPERAS COVE TX For profit - Corporation N 30455702 KARNES CITY HEALTH AND REHABILITATION CENTER KARNES CITY TX For profit - Corporation N 2945F199 MEMORIAL NURSING AND REHABILITATION CENTER DUMAS TX Government - Hospital district N 29675936 PONDEROSA NURSING AND REHABILITATION CENTER DE KALB TX For profit - Corporation N 29

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 176: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675546 TRINITY CARE CENTER ROUND ROCK TX For profit - Corporation N 29676034 BRADY WEST REHAB & NURSING BRADY TX Government - Hospital district N 28676433 THE MEDICAL RESORT AT WILLOWBROOK HOUSTON TX For profit - Individual N 28676241 GREENHILL VILLAS MOUNT PLEASANT TX For profit - Corporation N 28675399 NAVASOTA NURSING AND REHABILITATION LP NAVASOTA TX For profit - Corporation N 27676346 SENIOR CARE OF EDINBURG EDINBURG TX For profit - Corporation N 26675377 BANGS NURSING AND REHABILITATION CENTER BANGS TX For profit - Corporation N 26455794 WILLOWBROOK RESIDENCE AND REHABILITATION CENTER HOUSTON TX For profit - Corporation N 26675407 RALLS NURSING HOME RALLS TX For profit - Corporation N 25675311 FAIRVIEW HEALTHCARE RESIDENCE FAIRFIELD TX Government - Hospital district N 25676186 CAMBRIDGE LTC PARTNERS INC DIMMITT TX For profit - Corporation N 25675344 SWEENY HOUSE SWEENY TX For profit - Partnership N 25675259 CISCO NURSING & REHABILITATION CISCO TX For profit - Corporation N 25675830 AUTUMN LEAVES DALLAS TX For profit - Corporation N 25675002 RETAMA MANOR NURSING CENTER/SAN ANTONIO WEST SAN ANTONIO TX For profit - Corporation N 24675052 LAPORTE HEALTHCARE CENTER LA PORTE TX For profit - Corporation N 24675553 HERITAGE HEALTHCARE RESIDENCE QUITMAN TX For profit - Corporation N 24455676 COMMUNITY CARE CENTER OF HONDO HONDO TX For profit - Corporation N 24455709 POTEET MANOR POTEET TX For profit - Corporation N 23675336 KIRKLAND COURT HEALTH AND REHABILITATION CENTER AMARILLO TX For profit - Corporation N 23675889 PLEASANT MANOR HEALTH & REHABILITATION CENTER WAXAHACHIE TX For profit - Corporation N 23675159 SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTE EDNA TX Government - County N 23455490 BAY OAKS HEALTH CARE CENTER TEXAS CITY TX For profit - Corporation N 23455643 MATAGORDA HOUSE HEALTHCARE CENTER BAY CITY TX For profit - Corporation N 22455854 THE FORUM AT MEMORIAL WOODS HEALTHCARE CENTER HOUSTON TX For profit - Corporation N 22676269 RAYBURN HEALTH CARE & REHABILITATION JASPER TX For profit - Partnership N 22675958 CHRISTIAN CARE CENTER TEXARKANA TX For profit - Corporation N 22675989 BRAZOS VALLEY CARE HOME KNOX CITY TX For profit - Corporation N 22675391 PINE ARBOR SILSBEE TX For profit - Corporation N 22675013 CROWELL NURSING CENTER CROWELL TX Government - Hospital district N 22676205 RELIANT REHABILITATION HOSPITAL CENTRAL TEXAS ROUND ROCK TX For profit - Corporation Y 2245F207 LBJ MEDICAL CENTER JOHNSON CITY TX For profit - Corporation N 22455797 PEARSALL NURSING AND REHABILITATION CENTER - NORTH PEARSALL TX For profit - Corporation N 21676100 SENIOR CARE OF SAN ANGELO SAN ANGELO TX For profit - Corporation N 21675008 CHEROKEE ROSE NURSING AND REHABILITATION GLEN ROSE TX For profit - Corporation N 21

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 177: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675034 PENNSYLVANIA NURSING AND REHABILITATION CENTER FORT WORTH TX For profit - Corporation N 21675420 BRAZOSVIEW HEALTHCARE CENTER RICHMOND TX For profit - Corporation N 21675264 ATHENS HEALTHCARE AND REHABILITATION CENTER ATHENS TX For profit - Corporation N 20675065 CENTERVILLE HEALTHCARE CENTER CENTERVILLE TX For profit - Corporation N 20676264 WINCHESTER LODGE HEALTHCARE CENTER ALVIN TX For profit - Corporation N 20676026 WILL-O-BELL BARTLETT TX For profit - Corporation N 20676122 OAK GROVE NURSING HOME GROVES TX For profit - Individual N 20455889 SPRING OAKS NURSING AND REHABILITATION LP LAMPASAS TX For profit - Corporation N 2045E761 MCCAMEY CONVALESCENT CENTER MCCAMEY TX Government - Hospital district N 19455968 GRAHAM OAKS CARE CENTER GRAHAM TX Government - City/county N 19455444 MESA VISTA INN HEALTH CENTER SAN ANTONIO TX For profit - Corporation N 19676042 MCALLEN TRANSITIONAL CARE CENTER MC ALLEN TX For profit - Corporation N 19676222 BASTROP LOST PINES NURSING AND REHABILITATION CENT BASTROP TX Government - Hospital district N 19675924 REGENT CARE CENTER OF WOODWAY WACO TX For profit - Partnership N 19675782 VALLEY VIEW CARE CENTER ANSON TX Non profit - Corporation N 19676387 HIGHLAND MEADOWS HEALTH & REHAB ROCKWALL TX For profit - Corporation N 19675540 LIBERTY HEALTH CARE CENTER LIBERTY TX Non profit - Other N 19676017 RANGER CARE CENTER RANGER TX For profit - Corporation N 19676114 RIVER HILLS HEALTH AND REHABILITATION CENTER KERRVILLE TX Government - Hospital district N 19676093 RENAISSANCE VILLA ROCKDALE TX For profit - Individual N 19675014 HASKELL HEALTHCARE CENTER HASKELL TX For profit - Corporation N 19455586 GRAND TERRACE REHABILITATION AND HEALTHCARE MCALLEN TX For profit - Corporation N 19455565 PALESTINE HEALTHCARE CENTER PALESTINE TX For profit - Corporation N 18675084 TRINITY NURSING AND REHABILITATION OF GRANBURY LP GRANBURY TX For profit - Corporation N 18675494 KLEBERG COUNTY NURSING AND REHABILITATION LP KINGSVILLE TX For profit - Partnership N 18675663 FORT BEND HEALTHCARE CENTER ROSENBERG TX For profit - Corporation N 18675120 WOODVILLE HEALTH AND REHABILITATION CENTER WOODVILLE TX For profit - Corporation N 18676352 STONEMERE REHABILITATION CENTER FRISCO TX For profit - Individual N 18675856 WHITESBORO HEALTH AND REHABILITATION CENTER WHITESBORO TX For profit - Corporation N 18676109 CALDER WOODS BEAUMONT TX Non profit - Corporation N 18455951 REGAL HEALTHCARE RESIDENCE LAMPASAS TX For profit - Corporation N 18455996 THE RENAISSANCE AT KESSLER PARK DALLAS TX For profit - Corporation N 17675171 MERIDIAN CARE SAN ANTONIO TX For profit - Partnership N 17675204 PARK PLAZA NURSING HOME WHITNEY TX For profit - Partnership N 17675681 BRONTE HEALTH AND REHAB CENTER BRONTE TX Government - Hospital district N 17

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 178: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675497 COURTYARD GARDENS WICHITA FALLS TX For profit - Individual N 17675273 VALLEY MILLS NURSING AND REHABILITATION LP VALLEY MILLS TX For profit - Corporation N 17675205 PRINCETON PLACE REHABILITATION & HEALTHCARE MEDICA SAN ANTONIO TX For profit - Partnership N 17675797 SENIOR CARE OF WESTON INN TEMPLE TX For profit - Corporation N 17675471 BONHAM NURSING AND REHABILITATION LP BONHAM TX For profit - Corporation N 17676169 PREMONT REHAB AND NURSING CENTER PREMONT TX For profit - Corporation N 17676252 GRACE CARE CENTER AT VETERANS MEMORIAL HOUSTON TX For profit - Partnership N 17455507 LAKE WORTH NURSING HOME LAKE WORTH TX For profit - Corporation N 17676225 MITCHELL COUNTY NURSING AND REHABILITATION CENTER COLORADO CITY TX For profit - Corporation N 16676383 INSPIRE NEW BOSTON NEW BOSTON TX For profit - Corporation N 16676028 SOUTHERN SPECIALTY REHAB & NURSING LUBBOCK TX For profit - Corporation N 16675985 ROCKWOOD MANOR MIDLAND TX For profit - Corporation N 16676016 LEONARD MANOR LEONARD TX For profit - Corporation N 16675518 THE HILLTOP ON MAIN MERIDIAN TX For profit - Corporation N 16675075 HILLCREST MANOR NURSING AND REHABILITATION CENTER LULING TX For profit - Corporation N 16675390 SUNFLOWER PARK HEALTH CARE KAUFMAN TX For profit - Partnership N 16675905 WOODRIDGE NURSING & REHABILITATION GRAPEVINE TX For profit - Partnership N 16455893 GRACE CARE CENTER OF HENRIETTA HENRIETTA TX Government - Hospital district N 16455582 BAY VILLA HEALTHCARE CENTER BAY CITY TX For profit - Corporation N 16455570 MINERAL WELLS NURSING & REHABILITATION MINERAL WELLS TX For profit - Individual N 16455509 NOLAN NURSING AND REHABILITATION LP SWEETWATER TX For profit - Corporation N 15455923 WOODRIDGE NURSING & REHABILITATION BEEVILLE TX For profit - Corporation N 15675691 HUNTSVILLE HEALTH CARE CENTER HUNTSVILLE TX Non profit - Corporation N 15675217 ELKHART OAKS CARE CENTER ELKHART TX For profit - Corporation N 15675093 LAKESIDE REHABILITATION AND CARE CENTER LUBBOCK TX Government - Hospital district N 15675033 MESQUITE TREE NURSING CENTER MESQUITE TX For profit - Individual N 15675363 RETAMA MANOR NURSING CENTER/WESLACO WESLACO TX For profit - Corporation N 15675475 RETAMA MANOR NURSING CENTER/RAYMONDVILLE RAYMONDVILLE TX For profit - Corporation N 15675619 OAKS NURSING CENTER BURNET TX Government - Hospital district N 15675885 BURLESON ST JOSEPH MANOR CALDWELL TX Non profit - Other N 15676166 COLONIAL BELLE NURSING HOME SEALY SEALY TX For profit - Individual N 15676087 CIMARRON PLACE HEALTH & REHABILITATION CENTER CORPUS CHRISTI TX For profit - Corporation N 15676329 CONTINUING CARE AT HIGHLAND SPRINGS DALLAS TX Non profit - Corporation N 15455589 FORTRESS NURSING AND REHABILITATION LP COLLEGE STATION TX For profit - Partnership N 15455561 BEAUMONT HEALTH CARE CENTER BEAUMONT TX Non profit - Corporation N 15

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 179: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

455742 SAN ANTONIO RESIDENCE AND REHABILITATION CENTER SAN ANTONIO TX For profit - Corporation N 15455808 JACKSBORO HEALTHCARE CENTER JACKSBORO TX For profit - Corporation N 14455901 PROMISE SKILLED NURSING FACILITY OF WICHITA FALLS WICHITA FALLS TX For profit - Corporation N 14455001 PHP THE OAKS AT BEAUMONT BEAUMONT TX For profit - Corporation N 14676318 WINDMILL NURSING & REHAB CENTER LUBBOCK TX For profit - Corporation N 14675687 HOLIDAY HILL INC COLEMAN TX Non profit - Corporation N 14675481 RIVERWOOD HEALTHCARE MADISONVILLE TX For profit - Corporation N 14675220 AVALON PLACE KIRBYVILLE KIRBYVILLE TX For profit - Partnership N 14675365 PASADENA CARE CENTER PASADENA TX For profit - Corporation N 14675848 THE POINTE NURSING & REHAB CENTER WEBSTER TX For profit - Corporation N 14675767 REGENCY HOUSE SAN ANGELO TX For profit - Corporation N 14676133 MAVERICK NURSING AND REHABILITATION CENTER EAGLE PASS TX For profit - Corporation N 14676299 SOUTHPARK MEADOWS NURSING AND REHABILITATION CENTE AUSTIN TX Government - Hospital district N 14455856 VAN HEALTHCARE VAN TX For profit - Corporation N 14455935 EL PASO HEALTH & REHABILITATION CENTER EL PASO TX For profit - Corporation N 14455963 CARTHAGE HEALTHCARE CENTER CARTHAGE TX For profit - Corporation N 13455456 BIVINS MEMORIAL NURSING HOME AMARILLO TX Non profit - Corporation N 13676083 BROWNSVILLE NURSING AND REHABILITATION CENTER BROWNSVILLE TX For profit - Individual N 13676414 MID VALLEY NURSING & REHABILITATION MERCEDES TX For profit - Corporation N 13675319 DELEON NURSING AND REHABILITATION LP DE LEON TX For profit - Corporation N 13675395 VAL VERDE NURSING AND REHABILITATION CENTER DEL RIO TX Government - Hospital district N 13675654 BROOKDALE GUADALUPE RIVER PLAZA KERRVILLE TX For profit - Corporation N 13675525 CLIFTON NURSING AND REHABILITATION LP CLIFTON TX For profit - Corporation N 13675743 OCEANVIEW HEALTHCARE AND REHABILITATION TEXAS CITY TX Government - Hospital district N 13675788 OAK MANOR NURSING AND REHABILITATION LP COMMERCE TX For profit - Partnership N 13676375 ST GILES NURSING AND REHABILITATION CENTER EL PASO TX For profit - Corporation N 13676075 TRISTAR CARE CENTER INC FREDERICKSBURG TX For profit - Partnership N 13675932 ARBOR TERRACE HEALTHCARE CENTER SAN ANGELO TX For profit - Corporation N 13455575 RETAMA MANOR NURSING CENTER CORPUS CHRISTI TX For profit - Corporation N 13455554 WESTVIEW MANOR AND REHABILITATION CENTER MC GREGOR TX For profit - Corporation N 13455850 HURST PLAZA NURSING & REHAB HURST TX For profit - Corporation N 12675979 CRESTVIEW RETIREMENT COMMUNITY BRYAN TX Non profit - Corporation N 12676245 PFLUGERVILLE NURSING AND REHABILITATION CENTER PFLUGERVILLE TX Government - Hospital district N 12675799 BRENHAM NURSING AND REHABILITATION CENTER BRENHAM TX For profit - Individual N 12675066 HONEY GROVE NURSING CENTER HONEY GROVE TX For profit - Corporation N 12

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 180: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675147 FIRESIDE LODGE RETIREMENT CENTER INC FORT WORTH TX For profit - Individual N 12675035 EVERGREEN HEALTHCARE CENTER BURKBURNETT TX For profit - Corporation N 12675625 VISTA NURSING AND REHABILITATION CENTER PASADENA TX For profit - Corporation N 12675421 RETAMA MANOR HEALTH AND REHABILITATION CENTER/RIO RIO GRANDE CITY TX For profit - Corporation N 12675327 PAMPA NURSING CENTER PAMPA TX For profit - Corporation N 12675364 HOMESTEAD NURSING AND REHABILITATION OF BAIRD BAIRD TX Government - Hospital district Y 12675182 BROWNFIELD REHABILITATION AND CARE CENTER BROWNFIELD TX For profit - Corporation N 12676248 FOUNDERS PLAZA NURSING & REHAB WYLIE TX Government - Hospital district N 12675701 LAWRENCE STREET HEALTH CARE CENTER TOMBALL TX Non profit - Corporation N 11675915 PARK PLACE CARE CENTER GEORGETOWN TX For profit - Corporation N 11676024 HALE CENTER HEALTH AND REHABILITATION HALE CENTER TX For profit - Corporation N 11676335 BROADMOOR MEDICAL LODGE ROCKWALL TX For profit - Corporation N 11676338 COON MEMORIAL HOME DALHART TX Government - Hospital district Y 11675231 JACINTO NURSING & REHABILITATION CENTER, LLC HOUSTON TX For profit - Corporation N 11675138 PRINCETON PLACE REHABILITATION & HEALTHCARE BANDER SAN ANTONIO TX For profit - Corporation N 11675564 GIDDINGS RESIDENCE AND REHABILITATION CENTER GIDDINGS TX Government - Hospital district N 1145E631 SCHLEICHER COUNTY MEDICAL CENTER ELDORADO TX Government - Hospital district N 11675042 SEYMOUR REHABILITATION AND HEALTHCARE SEYMOUR TX For profit - Corporation N 11675317 DEERINGS NURSING AND REHABILITATION LP ODESSA TX For profit - Partnership N 11675338 SILSBEE CONVALESCENT CENTER SILSBEE TX For profit - Corporation N 11675440 SOUTH DALLAS NURSING & REHABILITATION DALLAS TX For profit - Corporation N 11675727 THE WESLEYAN AT SCENIC GEORGETOWN TX Government - Hospital district N 11675891 SENIOR CARE HEALTH AND REHABILITATION CENTER - BRI BRIDGEPORT TX For profit - Corporation N 11675820 THE LENNWOOD NURSING AND REHABILITATION DALLAS TX For profit - Partnership N 11675923 MARBRIDGE VILLA MANCHACA TX Non profit - Corporation N 11676183 HUNTINGTON HEALTH CARE & REHABILITATION CENTER HUNTINGTON TX For profit - Corporation N 11455887 SOUTHWOOD CARE CENTER AUSTIN TX Government - Hospital district N 11455608 HACIENDA OAKS AT BEEVILLE BEEVILLE TX For profit - Individual N 10675920 SNYDER HEALTHCARE CENTER SNYDER TX Government - Hospital district N 10675853 LAKERIDGE LTC PARTNERS INC LUBBOCK TX For profit - Corporation N 10675870 LINDAN PARK CARE CENTER LP RICHARDSON TX For profit - Individual N 10675446 REGENCY MANOR NURSING AND REHABILITATION LP FLORESVILLE TX For profit - Corporation N 10675151 MEADOWBROOK CARE CENTER VAN ALSTYNE TX For profit - Corporation N 10675271 SEVEN OAKS NURSING AND REHABILITATION LP BONHAM TX For profit - Corporation N 10455503 THE ROSEWOOD RETIREMENT COMMUNITY KILLEEN TX For profit - Corporation N 10

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 181: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675277 CARE INN OF LA GRANGE LA GRANGE TX For profit - Corporation N 10675284 MISSION MANOR HEALTHCARE RESIDENCE MOUNT VERNON TX For profit - Corporation N 10675021 ELECTRA HEALTHCARE CENTER ELECTRA TX For profit - Corporation N 10676399 SHADY SHORES OF SAN SABA SAN SABA TX For profit - Corporation N 10676389 MATADOR HEALTH AND REHABILITATION CENTER MATADOR TX For profit - Corporation N 10676227 COPPERAS HOLLOW NURSING & REHABILITATION CENTER CALDWELL TX For profit - Corporation N 10676079 PARK VIEW NURSING CARE CENTER MULESHOE TX Non profit - Corporation N 10676072 CORRIGAN LTC PARTNERS INC CORRIGAN TX For profit - Partnership N 9676055 SHADY ACRES HEALTH AND REHABILITATION CENTER NEWTON TX For profit - Corporation N 9676144 DECATUR MEDICAL LODGE WICHITA FALLS TX For profit - Corporation N 9676154 GRACE HILL NURSING CENTER HUGHES SPRINGS TX For profit - Individual N 9675796 MERIDIAN CARE OF HEBBRONVILLE HEBBRONVILLE TX For profit - Corporation N 9676400 MRC THE CROSSINGS LEAGUE CITY TX Non profit - Corporation N 9676360 THE RIO AT MAINLAND CENTER TEXAS CITY TX For profit - Corporation N 9676324 OAK MANOR NURSING HOME NACOGDOCHES TX For profit - Partnership N 9676289 THE ATRIUM OF BELLMEAD LLC BELLMEAD TX For profit - Corporation N 9675044 COLONIAL MANOR ADVANCED REHAB & HEALTHCARE MCALLEN TX For profit - Corporation N 9675132 BREMOND NURSING AND REHABILITATION CENTER BREMOND TX For profit - Individual N 9675279 VILLA HAVEN HEALTH AND REHABILITATION CENTER BRECKENRIDGE TX For profit - Corporation N 9675630 FALFURRIAS NURSING AND REHABILITATION LP FALFURRIAS TX For profit - Corporation N 9675599 ROBERT LEE CARE CENTER ROBERT LEE TX Government - Hospital district N 9675672 TRISUN CARE CENTER-RIVER RIDGE CORPUS CHRISTI TX For profit - Corporation N 9455555 GARDEN TERRACE HEALTHCARE CENTER GRAHAM TX For profit - Corporation N 945F462 BRIARWOOD MANOR CARE CENTER BELLVILLE TX For profit - Partnership N 9455936 SAGE HEALTHCARE CENTER LAMESA TX For profit - Corporation N 9455831 PARIS HEALTHCARE CENTER PARIS TX For profit - Corporation N 9455785 SENIOR CARE OF WESTERN HILLS TEMPLE TX For profit - Corporation N 9675194 METROPLEX NURSING AND REHABILITATION LP GRAND PRAIRIE TX For profit - Corporation N 9675105 COUNTRY VIEW NURSING AND REHABILITATION LP TERRELL TX For profit - Partnership N 9675096 HOMESTEAD NURSING AND REHABILITATION OF HILLSBORO HILLSBORO TX For profit - Corporation N 9675433 FOCUSED CARE AT HUNTSVILLE HUNTSVILLE TX For profit - Partnership N 9675539 THE BRADFORD AT BROOKSIDE LIVINGSTON TX For profit - Corporation N 9676281 SCC AT WESTOVER HILLS REHABILITATION AND HEALTHCAR SAN ANTONIO TX For profit - Corporation N 9676370 HARMONEE HOUSE AMHERST TX For profit - Corporation N 9676429 CARRARA PLANO TX For profit - Partnership N 9

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 182: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

455536 AMISTAD NURSING AND REHABILITATION CENTER UVALDE TX Government - Hospital district N 945E852 CROCKETT COUNTY CARE CENTER OZONA TX Government - County N 9455910 CHANDLER NURSING CENTER CHANDLER TX For profit - Corporation N 9455954 HAMILTON HEALTHCARE CENTER HAMILTON TX For profit - Corporation N 8455278 KNOPP HEALTHCARE AND REHAB CENTER INC FREDERICKSBURG TX For profit - Corporation N 8676408 THE LODGE AT BEAR CREEK GRAPEVINE TX For profit - Corporation N 8676361 EAGLE LAKE NURSING AND REHABILITATION, LP EAGLE LAKE TX For profit - Corporation N 8676006 RICHMOND HEALTH CARE CENTER RICHMOND TX Non profit - Corporation N 8676048 LEGEND OAKS HEALTHCARE AND REHABILITATION CENTER G GLADEWATER TX For profit - Corporation N 8675906 BENBROOK NURSING & REHABILITATION CENTER BENBROOK TX Government - Hospital district N 8675361 WHARTON NURSING AND REHABILITATION CENTER WHARTON TX For profit - Corporation N 8675369 GRANDVIEW NURSING AND REHABILITATION CENTER GRANDVIEW TX Non profit - Corporation N 8675104 LIVE OAK NURSING CENTER GEORGE WEST TX Government - Hospital district N 8455611 GRACE CARE CENTER OF OLNEY OLNEY TX For profit - Corporation N 8455662 RETAMA MANOR NURSING CENTER/MCALLEN MCALLEN TX For profit - Corporation N 8455637 WELLINGTON REHABILITATION AND HEALTHCARE TEMPLE TX For profit - Corporation N 8455904 ROWLETT HEALTH AND REHABILITATION CENTER ROWLETT TX For profit - Corporation N 8455563 DENISON NURSING AND REHABILITATION LP DENISON TX For profit - Partnership N 8455576 RICHLAND HILLS REHABILITATION AND HEALTHCARE CENTE FORT WORTH TX Government - Hospital district N 8675695 COLLEGE STREET HEALTH CARE CENTER BEAUMONT TX Government - Hospital district N 8675493 HIGHLAND PARK CARE CENTER HOUSTON TX Government - Hospital district N 8675240 THE SPRINGS HUGHES SPRINGS TX For profit - Corporation N 8675144 TRINITY NURSING AND REHABILITATION OF BURLESON LP BURLESON TX For profit - Partnership N 8675225 FOCUSED CARE AT BAYTOWN BAYTOWN TX For profit - Corporation N 8676385 CROSSROADS NURSING & REHABILITATION HEARNE TX For profit - Corporation N 8676420 BRIGHTPOINTE AT RIVERSHIRE CONROE TX For profit - Corporation N 8676422 PALOMINO PLACE MESQUITE TX For profit - Corporation N 8675785 EDINBURG NURSING AND REHABILITATION CENTER EDINBURG TX For profit - Corporation N 8675835 CHEROKEE TRAILS NURSING HOME RUSK TX For profit - Partnership N 8675907 TRINITY NURSING AND REHABILITATION OF DIBOLL LP DIBOLL TX For profit - Corporation N 8675867 KERENS CARE CENTER KERENS TX For profit - Corporation N 8675890 REGENT CARE AT MEDICAL CENTER SAN ANTONIO TX For profit - Individual N 8676094 THE MEADOWS OF ORANGE ORANGE TX For profit - Corporation N 8676037 WESLACO NURSING AND REHABILITATION CENTER WESLACO TX For profit - Corporation N 7676259 SHINNERY OAKS COMMUNITY DENVER CITY TX Non profit - Corporation N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 183: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675948 PARK PLACE MANOR INC BELTON TX For profit - Corporation N 7676021 CLAREWOOD HOUSE EXTENDED CARE CENTER HOUSTON TX Non profit - Corporation N 7676007 WILLOW REHAB & NURSING KILGORE TX For profit - Corporation N 7675975 VILLAGE CREEK REHABILITATION AND NURSING CENTER LUMBERTON TX For profit - Corporation N 7675967 NORTHGATE PLAZA NURSING & REHABILITATION CENTER IRVING TX For profit - Corporation N 7676426 LEGENDS OAKS HEALTHCARE AND REHABILITATION - FORT KELLER TX For profit - Corporation N 7676334 CHELSEA GARDENS MISSOURI CITY TX For profit - Partnership N 7675210 HERITAGE HOUSE NURSING AND REHABILITATION ROSEBUD TX For profit - Corporation N 7675141 CRESTVIEW HEALTHCARE RESIDENCE WACO TX For profit - Corporation N 7675080 THE VOSSWOOD NURSING CENTER HOUSTON TX For profit - Corporation N 7675038 CLYDE NURSING CENTER CLYDE TX Government - Hospital district N 7675001 EASTLAND NURSING & REHABILITATION EASTLAND TX For profit - Corporation N 7675321 FAITH MEMORIAL NURSING HOME PASADENA TX For profit - Partnership N 7675502 RETAMA MANOR NURSING CENTER/PLEASANTON NORTH PLEASANTON TX For profit - Corporation N 7455510 BLANCO VILLA NURSING AND REHABILITATION LP SAN ANTONIO TX For profit - Corporation N 7455484 SAN JUAN NURSING HOME INC SAN JUAN TX Non profit - Church related N 7455961 PALO PINTO NURSING CENTER MINERAL WELLS TX Government - Hospital district N 7455594 KOUNTZE NURSING CENTER KOUNTZE TX For profit - Corporation N 7455697 SENIOR CARE OF CORPUS CHRISTI CORPUS CHRISTI TX For profit - Individual N 7675124 TEXAN NURSING & REHAB OF GONZALES GONZALES TX For profit - Corporation N 7675366 MAGNIFIED NURSING AND REHABILITATION LP COLLEGE STATION TX For profit - Corporation N 7675431 RED OAK HEALTH AND REHABILITATION CENTER RED OAK TX For profit - Corporation N 7675816 GREENBRIER NURSING & REHABILITATION CENTER OF PALE PALESTINE TX For profit - Partnership N 7675755 WINDSOR PLACE DAINGERFIELD TX For profit - Partnership N 7675503 BEACON HILL DENISON TX Government - Hospital district N 7675635 EBONY LAKE NURSING AND REHABILITATION CENTER BROWNSVILLE TX For profit - Corporation N 7675646 SNYDER OAKS CARE CENTER SNYDER TX For profit - Corporation N 7675670 TRISUN CARE CENTER-WESTWOOD CORPUS CHRISTI TX For profit - Corporation N 7676020 MENARD MANOR MENARD TX Government - Hospital district N 7675928 SIENNA NURSING AND REHABILITATION LP ODESSA TX For profit - Partnership N 7676102 SENIOR CARE OF JACKSONVILLE JACKSONVILLE TX For profit - Corporation N 7676132 TRAIL LAKE NURSING & REHABILITATION FORT WORTH TX For profit - Corporation N 7676340 ROCK HAVEN NURSING HOME NACOGDOCHES TX For profit - Partnership N 7455522 SENIOR CARE OF MARLANDWOOD WEST TEMPLE TX For profit - Corporation N 745E341 HIGHLAND NURSING CENTER SAN ANTONIO TX For profit - Corporation N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 184: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

455925 VERANDA REHABILITATION AND HEALTHCARE HARLINGEN TX For profit - Corporation N 7455534 HONDO NURSING AND REHABILITATION LP HONDO TX For profit - Partnership N 6455597 MEMORIAL MEDICAL NURSING CENTER SAN ANTONIO TX For profit - Individual N 6455756 ROYAL OAKS RESIDENCE AND REHABILITATION CENTER HOUSTON TX For profit - Corporation N 6676350 THE HEIGHTS OF TOMBALL TOMBALL TX For profit - Corporation N 6676379 PATHWAYS MEMORY CARE AT VILLA TOSCANA HOUSTON TX For profit - Partnership N 6676391 WINDSOR CALALLEN CORPUS CHRISTI TX Government - Hospital district N 6675999 ST JAMES HOUSE OF BAYTOWN BAYTOWN TX For profit - Corporation N 6675597 FREE STATE CRESTWOOD WILLS POINT TX For profit - Corporation N 6675478 PRAIRIE HOUSE LIVING CENTER PLAINVIEW TX For profit - Corporation N 6675537 BROWNWOOD NURSING AND REHABILITATION LP BROWNWOOD TX For profit - Corporation N 6675746 CORONADO NURSING CENTER ABILENE TX For profit - Corporation N 6675851 GEORGIA MANOR NURSING HOME AMARILLO TX For profit - Corporation N 6675372 LA BAHIA NURSING AND REHABILITATION LP GOLIAD TX For profit - Corporation N 6675170 LA PALOMA NURSING CENTER SAN DIEGO TX For profit - Corporation N 6455804 NORTHGATE HEALTH AND REHABILITATION CENTER SAN ANTONIO TX For profit - Corporation N 6455849 ADVANCED REHABILITATION AND HEALTHCARE OF BOWIE BOWIE TX Government - Hospital district N 6455970 RIVER VALLEY HEALTH & REHABILITATION CENTER GAINESVILLE TX For profit - Corporation N 6455577 COMMUNITY CARE CENTER OF CROCKETT CROCKETT TX For profit - Corporation N 6675543 WEST JANISCH HEALTH CARE CENTER HOUSTON TX Non profit - Corporation N 6675581 HERITAGE OAKS RETIREMENT VILLAGE CORSICANA TX For profit - Corporation N 6675645 MESA SPRINGS HEALTHCARE CENTER ABILENE TX For profit - Corporation N 6675406 GOLDEN YEARS NURSING AND REHABILITATION CENTER MARLIN TX For profit - Corporation N 6675414 RETAMA MANOR NURSING CENTER/EDINBURG EDINBURG TX For profit - Corporation N 6675253 AZALEA TRAIL NURSING AND REHABILITATION CENTER GRAND SALINE TX For profit - Individual N 6676378 SORRENTO SAN ANTONIO TX For profit - Corporation N 6675942 TOWERS NURSING HOME SMITHVILLE TX Government - Hospital district N 6675850 TRISUN CARE CENTER-COASTAL PALMS PORTLAND TX For profit - Corporation N 6675878 COUNTRY TRAILS WELLNESS & REHABILITATION CENTER GRAND SALINE TX For profit - Partnership N 6675789 WOODRIDGE NURSING & REHABILITATION HOUSTON TX For profit - Partnership N 6675810 LANCASTER NURSING & REHABILITATION CENTER LANCASTER TX For profit - Partnership N 6675715 PECAN VALLEY HEALTHCARE RESIDENCE SAN SABA TX Government - Hospital district N 6675722 FORT STOCKTON LIVING & REHABILITATION FORT STOCKTON TX For profit - Corporation N 6676238 LEGEND OAKS HEALTHCARE AND REHABILITATION - NORTH AUSTIN TX For profit - Corporation N 6676202 PARK VALLEY INN HEALTH CENTER ROUND ROCK TX For profit - Corporation N 6

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 185: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

676167 BUCKNER WESTMINSTER PLACE LONGVIEW TX Non profit - Corporation N 6676108 VIDOR HEALTH & REHABILITATION CENTER VIDOR TX For profit - Corporation N 6676170 ST DOMINIC VILLAGE NURSING HOME HOUSTON TX Non profit - Corporation N 5676197 RIDGEVIEW REHABILITATION AND SKILLED NURSING CLEBURNE TX Government - Hospital district N 5676188 MILLBROOK HEALTHCARE AND REHABILITATION CENTER LANCASTER TX For profit - Corporation N 5676239 VILLA TOSCANA AT CYPRESS WOODS HOUSTON TX Government - Hospital district N 5676321 WINDSOR NURSING AND REHABILITATION CENTER OF CORPU CORPUS CHRISTI TX For profit - Corporation N 5675736 YOAKUM NURSING AND REHABILITATION CENTER YOAKUM TX Government - County N 5675888 REUNION PLAZA HEALTHCARE & REHABILITATION TYLER TX For profit - Corporation N 5675833 REGENT CARE CENTER OAKWELL FARMS SAN ANTONIO TX For profit - Corporation N 5675849 BAYTOWN NURSING & REHAB CENTER BAYTOWN TX For profit - Corporation N 5675962 SOUTHLAND REHABILITATION AND HEALTHCARE CENTER LUFKIN TX For profit - Individual N 5676388 THE PAVILION AT CREEKWOOD MANSFIELD TX For profit - Corporation N 5676355 FOCUSED CARE AT BRENHAM BRENHAM TX For profit - Individual N 5676397 PINE SHADOW RETREAT PORTER TX For profit - Corporation N 5676415 SHERIDAN MEDICAL LODGE BURKBURNETT TX For profit - Corporation N 5675256 TULIA HEALTH AND REHABILITATION CENTER TULIA TX For profit - Corporation N 5675076 LLANO NURSING AND REHABILITATION CENTER LLANO TX For profit - Corporation N 5675445 OAK MANOR NURSING CENTER FLATONIA TX For profit - Corporation N 5675229 WOODLAND MANOR NURSING AND REHABILITATION LP CONROE TX For profit - Corporation N 5675307 THE MANOR HEALTHCARE RESIDENCE MEXIA TX For profit - Corporation N 5675686 WINTERHAVEN HEALTHCARE RESIDENCE HOUSTON TX For profit - Corporation N 5675534 WHEELER NURSING AND REHABILITATION LP WHEELER TX For profit - Corporation N 5455497 CREEKSIDE TERRACE REHABILITATION BELTON TX For profit - Corporation N 545F414 MEMORIAL HEALTH CARE CENTER SEMINOLE TX Government - Hospital district N 5455872 ARLINGTON RESIDENCE AND REHABILITATION CENTER ARLINGTON TX For profit - Partnership N 5455900 FOCUSED CARE AT MOUNT PLEASANT MOUNT PLEASANT TX For profit - Corporation N 5455517 GARDENDALE REHABILITATION AND NURSING CENTER JACKSONVILLE TX For profit - Corporation N 5675202 LEXINGTON PLACE NURSING & REHABILITATION NACOGDOCHES TX For profit - Corporation N 5675095 HALLETTSVILLE REHABILITATION AND NURSING CENTER HALLETTSVILLE TX Government - Hospital district N 5675011 JACKSONVILLE HEALTHCARE CENTER JACKSONVILLE TX Government - Hospital district N 5675423 ASHFORD GARDENS HOUSTON TX For profit - Corporation N 5675453 COLLINWOOD CARE CENTER PLANO TX For profit - Corporation N 5675527 WHISPERWOOD NURSING & REHABILITATION CENTER LUBBOCK TX For profit - Corporation N 5676009 TREEMONT HEALTH CARE CENTER HOUSTON TX For profit - Corporation N 5

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 186: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

676337 WINDSOR HOUSTON HOUSTON TX For profit - Individual N 5455700 WILLOWBROOK NURSING CENTER NACOGDOCHES TX For profit - Individual N 5455834 SOUTH PLACE REHABILITATION AND SKILLED NURSING ATHENS TX Government - Hospital district N 5455712 GOLDEN AGE HEALTHCARE RESIDENCE DUBLIN TX For profit - Corporation N 5455528 RETAMA MANOR NURSING CENTER/LAREDO-WEST LAREDO TX For profit - Corporation N 5455544 STEVENS HEALTH CARE AND REHAB CENTER YOAKUM TX For profit - Corporation N 4455724 EDGEWATER CARE CENTER KERRVILLE TX For profit - Corporation N 4455835 INTERLOCHEN HEALTH AND REHABILITATION CENTER ARLINGTON TX For profit - Corporation N 4455726 RETAMA MANOR NURSING CENTER/VICTORIA SOUTH VICTORIA TX For profit - Corporation N 4455745 TIMBERWOOD NURSING AND REHABILITATION CENTER LIVINGSTON TX For profit - Individual N 4455917 DEER CREEK OF WIMBERLEY WIMBERLEY TX For profit - Corporation N 4455985 CLARKSVILLE NURSING CENTER CLARKSVILLE TX For profit - Corporation N 4676351 THE LANDING AT WATERMERE SOUTHLAKE TX For profit - Corporation N 4676218 JEFFERSON NURSING AND REHABILITATION CENTER BEAUMONT TX Government - Hospital district N 4676228 KENDALL HOUSE WELLNESS & REHABILITATION BOERNE TX Non profit - Corporation N 4676416 BRIGHTPOINTE AT LYTLE LAKE ABILENE TX For profit - Corporation N 4676368 TREVISO TRANSITIONAL CARE LONGVIEW TX Government - Hospital district N 4676005 PARK PLACE NURSING & REHABILITATION CENTER TYLER TX For profit - Corporation N 4675914 GRACY WOODS II LIVING CENTER AUSTIN TX Government - Hospital district N 4676123 FAIRFIELD NURSING & REHABILITATION CENTER FAIRFIELD TX For profit - Corporation N 4676043 HOUSTON COUNTY NURSING HOME CROCKETT TX For profit - Corporation N 4676177 GARRISON NURSING HOME & REHABILITATION CENTER GARRISON TX Government - Hospital district N 4675556 CYPRESS WOODS CARE CENTER ANGLETON TX For profit - Partnership N 4675522 MONAHANS MANAGED CARE CENTER MONAHANS TX For profit - Corporation N 4675602 FOCUSED CARE OF GILMER GILMER TX For profit - Corporation N 4675650 GARDEN TERRACE ALZHEIMERS CENTER OF EXCELLENCE FORT WORTH TX For profit - Corporation N 4675689 VILLAGE HEALTHCARE AND REHABILITATION MCALLEN TX For profit - Corporation N 4675883 SOUTHEAST NURSING & REHABILITATION CENTER SAN ANTONIO TX For profit - Corporation N 4675802 KEMP CARE CENTER KEMP TX For profit - Corporation N 4675806 THE LAURENWOOD NURSING AND REHABILITATION DUNCANVILLE TX For profit - Corporation N 4675768 MOUNTAIN VILLA NURSING CENTER EL PASO TX For profit - Corporation N 4675408 OVERTON HEALTHCARE CENTER OVERTON TX For profit - Corporation N 4675358 COLONIAL PINES HEALTHCARE CENTER SAN AUGUSTINE TX For profit - Partnership N 4675352 BRENTWOOD PLACE THREE DALLAS TX For profit - Corporation N 4675291 CROSBYTON NURSING AND REHABILITATION CENTER CROSBYTON TX Government - Hospital district N 4

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 187: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675292 COTTONWOOD NURSING AND REHABILITATION LP DENTON TX For profit - Corporation N 4675293 FOCUSED CARE AT LINDEN LINDEN TX For profit - Corporation N 4675181 CARRIAGE HOUSE MANOR SULPHUR SPRINGS TX For profit - Corporation N 4675056 STANTON NURSING AND REHABILITATION LP STANTON TX For profit - Corporation N 4675057 BALCH SPRINGS NURSING HOME BALCH SPRINGS TX For profit - Corporation N 4675058 HOMEPLACE MANOR HAMLIN TX For profit - Corporation N 4455631 COLONIAL MANOR NURSING CENTER CLEBURNE TX For profit - Individual N 4455599 HERITAGE PARK REHABILITATION AND SKILLED NURSING C AUSTIN TX For profit - Corporation N 4455641 PALO DURO NURSING HOME CLAUDE TX For profit - Corporation N 4455806 THE TERRACE AT DENISON DENISON TX For profit - Corporation N 4455754 NORTHEAST REHABILITATION AND HEALTHCARE CENTER SAN ANTONIO TX For profit - Corporation N 4455333 SHARPVIEW RESIDENCE AND REHABILITATION CENTER HOUSTON TX For profit - Corporation N 4675295 LYTLE NURSING HOME LYTLE TX For profit - Corporation N 4675469 FLORESVILLE RESIDENCE AND REHABILITATION CENTER FLORESVILLE TX For profit - Corporation N 4675379 HAVENCARE NURSING AND REHABILITATION CENTER LLC LONGVIEW TX For profit - Corporation N 4675270 PECAN MANOR NURSING AND REHABILITATION KENNEDALE TX For profit - Corporation N 4676417 STERLING OAKS REHABILITATION KATY TX For profit - Individual N 4676393 LAS VENTANAS DE SOCORRO SOCORRO TX For profit - Individual N 4676394 WOODLANDS PLACE REHABILITATION SUITES DENISON TX For profit - Corporation N 4675952 JULIETTE FOWLER COMMUNITIES DALLAS TX Non profit - Corporation N 4675976 WINFIELD REHAB & NURSING CROCKETT TX For profit - Corporation N 4675858 PARAMOUNT SENIOR CARE CENTERS AT SAN ANTONIO SAN ANTONIO TX For profit - Corporation N 4676286 MEADOW LAKE HEALTH CENTER TYLER TX For profit - Corporation N 4676210 SUMMER PLACE NURSING & REHABILITATION BEAUMONT TX For profit - Corporation N 4676176 SENIOR CARE OF CROWLEY CROWLEY TX For profit - Corporation N 4676119 RIO GRANDE CITY NURSING AND REHABILITATION CENTER RIO GRANDE CITY TX For profit - Corporation N 4676030 SHADY OAK NURSING AND REHABILITATION MOULTON TX Government - City/county N 4676053 MERKEL NURSING CENTER MERKEL TX For profit - Corporation N 4676173 KENEDY HEALTH & REHABILITATION KENEDY TX For profit - Corporation N 3676147 SENIOR CARE OF STALLINGS COURT NACOGDOCHES TX For profit - Corporation N 3676275 RIDGECREST HEALTHCARE AND REHABILITATION CENTER FORNEY TX For profit - Corporation N 3676280 ESTRELLA OAKS REHABILITATION AND CARE CENTER GEORGETOWN TX For profit - Corporation N 3676251 LEGEND OAKS HEALTHCARE AND REHABILITATION - NORTH/ HOUSTON TX For profit - Corporation N 3676255 FORT WORTH CENTER OF REHABILITATION FORT WORTH TX For profit - Corporation N 3675840 LEXINGTON PLACE NURSING & REHABILITATION RICHLAND HILLS TX For profit - Partnership N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 188: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675801 GILMER NURSING AND REHABILITATION LP GILMER TX For profit - Corporation N 3675969 SETTLERS RIDGE CARE CENTER CELINA TX For profit - Corporation N 3675971 COLONIAL CARE CENTER SCHULENBURG TX Government - Hospital district N 3675938 SHINER NURSING AND REHABILITATION CENTER INC SHINER TX Non profit - Corporation N 3675964 MRC CREEKSIDE HUNTSVILLE TX Non profit - Corporation N 3675909 INDIAN OAKS LIVING CENTER HARKER HEIGHTS TX For profit - Corporation N 3675897 FRANKLIN NURSING HOME FRANKLIN TX For profit - Corporation N 3676333 SCC AT CLEAR BROOK CROSSING REHABILITATION AND HEA HOUSTON TX For profit - Corporation N 3675274 WILLIS NURSING AND REHABILITATION LP WILLIS TX For profit - Partnership N 3675185 LONGMEADOW HEALTHCARE CENTER JUSTIN TX For profit - Corporation N 3675201 HILLSIDE MEDICAL LODGE GATESVILLE TX For profit - Corporation N 3675067 GAINESVILLE CONVALESCENT CENTER GAINESVILLE TX For profit - Corporation N 3675106 GRACE POINTE WELLNESS CENTER EL PASO TX For profit - Corporation N 3675037 PITTSBURG NURSING CENTER PITTSBURG TX For profit - Corporation N 3675398 FOCUSED CARE OF CENTER CENTER TX For profit - Corporation N 3675459 WALNUT HILLS NURSING AND REHABILITATION AUSTIN TX For profit - Corporation N 3675519 LARKSPUR LUFKIN TX For profit - Corporation N 3675696 COUNTRY VILLAGE CARE ANGLETON TX For profit - Individual N 3675677 DEL RIO NURSING AND REHABILITATION CENTER DEL RIO TX Government - Hospital district N 3675668 WOOD MEMORIAL NURSING AND REHABILITATION CENTER MINEOLA TX For profit - Corporation N 3455493 VISTA HILLS HEALTH CARE CENTER EL PASO TX For profit - Corporation N 3455475 WHITE SETTLEMENT NURSING CENTER WHITE SETTLEMENT TX Government - Hospital district N 3455757 CLAIRMONT BEAUMONT BEAUMONT TX Government - Hospital district N 3455705 THE MONTEVISTA AT CORONADO EL PASO TX For profit - Corporation N 3455690 PARKS HEALTH CENTER ODESSA TX Government - Hospital district N 3455602 WESTERN HILLS HEALTHCARE RESIDENCE COMANCHE TX For profit - Corporation N 3455618 EDEN HOME INC NEW BRAUNFELS TX Non profit - Church related N 3455621 VALLEY GRANDE MANOR WESLACO TX For profit - Corporation N 3455929 GRANBURY REHAB & NURSING GRANBURY TX For profit - Corporation N 3455871 LYNWOOD NURSING AND REHABILITATION LP LEVELLAND TX For profit - Corporation N 3455946 SWEETWATER HEALTHCARE CENTER SWEETWATER TX For profit - Corporation N 345F603 EDWARD ABRAHAM MEMORIAL HOME CANADIAN TX Government - Hospital district N 3455986 HENDERSON HEALTH & REHABILITATION CENTER HENDERSON TX For profit - Corporation N 3675053 CHISOLM TRAIL NURSING AND REHABILITATION CENTER LOCKHART TX For profit - Corporation N 3675025 GOOD SAMARITAN SOCIETY--WHITE ACRES EL PASO TX Non profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 189: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675110 CUERO NURSING AND REHABILITATION CENTER CUERO TX Government - County N 3675356 BASTROP NURSING CENTER BASTROP TX For profit - Partnership N 3675452 ROSEWOOD REHABILITATION AND CARE CENTER CONVERSE TX For profit - Individual N 3675441 RENAISSANCE CARE CENTER GAINESVILLE TX For profit - Corporation N 3675615 MERIDIAN CARE AT GRAYSON SQUARE SAN ANTONIO TX For profit - Corporation N 3675717 SAN RAFAEL NURSING AND REHABILITATION CENTER CORPUS CHRISTI TX For profit - Corporation N 3675786 AFV II HEALTH CARE CENTER SAN ANTONIO TX Non profit - Corporation N 3675896 RIVER CITY CARE CENTER SAN ANTONIO TX For profit - Corporation N 3675651 SAN MARCOS REHABILITATION AND HEALTHCARE CENTER SAN MARCOS TX For profit - Corporation N 3675656 HACIENDA OAKS NURSING & REHAB SEGUIN TX For profit - Corporation N 3675563 COLONIAL NURSING & REHABILITATION CENTER LINDALE TX Government - Hospital district N 3675596 MONTE SIESTA NURSING AND REHABILITATION LP AUSTIN TX For profit - Corporation N 3676168 RAMBLING OAKS COURTYARD EXTENSIVE CARE COMMUNITY HIGHLAND VILLAGE TX For profit - Partnership N 3676074 TOWN HALL ESTATES WHITNEY INC WHITNEY TX Non profit - Church related N 3676104 KINDRED TRANSITIONAL CARE AND REHABILITATION-GRAPE GRAPEVINE TX For profit - Corporation N 3675939 VINTAGE HEALTH CARE CENTER DENTON TX For profit - Corporation N 3676424 FARMERSVILLE HEALTH AND REHABILITATION FARMERSVILLE TX For profit - Corporation N 3676382 FALCON RIDGE REHABILITATION HUTTO TX For profit - Corporation N 3676362 BRIDGECREST REHABILITATION SUITES HOUSTON TX For profit - Corporation N 3676247 SANDY LAKE REHABILITATION AND CARE CENTER COPPELL TX For profit - Corporation N 3676271 SENIOR CARE OF ONION CREEK AUSTIN TX For profit - Corporation N 3676342 ST. TERESA NURSING AND REHABILITATION CENTER EL PASO TX For profit - Corporation N 3676316 HIGH HOPE CARE CENTER OF BRENHAM BRENHAM TX For profit - Partnership N 3676314 LA HACIENDA NURSING & REHAB CENTER HOUSTON TX For profit - Corporation N 3676297 THE RIO AT MISSION TRAILS SAN ANTONIO TX For profit - Corporation N 3455989 BORGER HEALTHCARE CENTER BORGER TX For profit - Corporation N 3455960 HAYS NURSING & REHAB CENTER SAN MARCOS TX Non profit - Corporation N 3455972 LINDALE HEALTHCARE CENTER LINDALE TX For profit - Corporation N 3455944 REGENCY HEALTHCARE AND REHABILITATION CENTER AT RE CLARKSVILLE TX For profit - Corporation N 345F197 TWIN OAKS MANOR BOOKER TX Government - Hospital district N 3455823 TREEMONT HEALTHCARE AND REHABILITATION CENTER DALLAS TX For profit - Corporation N 3455467 ALAMO HEIGHTS HEALTH AND REHABILITATION CENTER SAN ANTONIO TX For profit - Corporation N 3455416 TRINITY HEALTHCARE RESIDENCE FORT WORTH TX For profit - Corporation N 2455538 MAGNOLIA MANOR GROVES TX For profit - Corporation N 2455532 PLEASANT SPRINGS HEALTHCARE CENTER MOUNT PLEASANT TX For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 190: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

455763 HUGULEY NURSING & REHAB CENTER BURLESON TX Non profit - Corporation N 2455789 OAK PARK NURSING AND REHABILITATION CENTER SAN ANTONIO TX For profit - Corporation N 2455753 OAK BROOK HEALTH CARE CENTER WHITEHOUSE TX For profit - Partnership N 2455891 RENAISSANCE PARK MULTI CARE CENTER FORT WORTH TX For profit - Corporation N 2455725 OAKMONT HEALTHCARE AND REHABILITATION CENTER OF HU HUMBLE TX For profit - Corporation N 2455672 GOLDEN PALMS RETIREMENT & HEALTH CENTER HARLINGEN TX For profit - Partnership N 2455674 WELLINGTON OAKS NURSING AND REHABILITATION LP FORT WORTH TX For profit - Corporation N 2455606 PARK VIEW CARE CENTER FORT WORTH TX Government - Hospital district N 2455952 CLEVELAND HEALTH CARE CENTER CLEVELAND TX Non profit - Corporation N 2455940 LUBBOCK HOSPITALITY NURSING AND REHABILITATION CEN LUBBOCK TX Government - Hospital district N 2455957 SANTA FE HEALTH & REHABILITATION CENTER WEATHERFORD TX For profit - Partnership N 2455959 WESTWARD TRAILS NURSING AND REHABILITATION NACOGDOCHES TX For profit - Corporation N 2676309 BAYWOOD CROSSING REHABILITATION & HEALTHCARE CENTE PASADENA TX For profit - Corporation N 2676313 LAREDO NURSING AND REHABILITATION CENTER LAREDO TX For profit - Corporation N 2676358 THE VILLAGES ON MACARTHUR IRVING TX For profit - Corporation N 2676233 BANDERA NURSING & REHAB CENTER BANDERA TX For profit - Corporation N 2676139 SENIOR CARE OF GREEN OAKS ARLINGTON TX For profit - Corporation N 2676373 PARK MANOR BEE CAVE BEE CAVE TX For profit - Corporation N 2676418 THE HEIGHTS OF BULVERDE SPRING BRANCH TX For profit - Corporation N 2676412 FALL CREEK REHABILITATION AND HEALTHCARE CENTER HUMBLE TX For profit - Partnership N 2675945 WELLINGTON CARE CENTER WELLINGTON TX For profit - Corporation N 2675954 SENIOR VILLAGE NURSING HOME PERRYTON TX Non profit - Corporation N 2675980 HILL COUNTRY CARE DRIPPING SPRINGS TX For profit - Corporation N 2675963 NORTH POINTE NURSING AND REHABILITATION LP WATAUGA TX For profit - Corporation N 2676004 THE HILLS NURSING & REHABILITATION DECATUR TX For profit - Corporation N 2676067 MIRA VISTA COURT FORT WORTH TX For profit - Corporation N 2676035 KINGSLAND HILLS CARE CENTER KINGSLAND TX For profit - Partnership N 2676039 WINTERS PARK NURSING AND REHABILITATION CENTER GARLAND TX For profit - Corporation N 2676113 LEGEND OAKS HEALTHCARE AND REHABILITATION CENTER - SAN ANTONIO TX For profit - Corporation N 2676148 PEACH TREE PLACE WEATHERFORD TX For profit - Corporation N 2676174 CAMERON NURSING AND REHAB CAMERON TX For profit - Corporation N 2676200 GOLDEN AGE NURSING HOME LUBBOCK TX For profit - Corporation N 2676206 WINDSOR ARBOR VIEW EDINBURG TX For profit - Corporation N 2675594 TERRACE WEST NURSING AND REHABILITATION LP MIDLAND TX For profit - Corporation N 2675667 UNIVERSITY PLACE NURSING CENTER HOUSTON TX Non profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 191: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675620 BEAUMONT NURSING AND REHABILITATION BEAUMONT TX For profit - Corporation N 2675622 CITYVIEW CARE CENTER FORT WORTH TX For profit - Corporation N 2675700 BROOKSHIRE RESIDENCE AND REHABILITATION CENTER BROOKSHIRE TX For profit - Corporation N 2675709 TIMBERIDGE NURSING AND REHABILITATION CENTER JASPER TX For profit - Corporation N 2675680 BRENTWOOD PLACE ONE DALLAS TX For profit - Corporation N 2675886 THE MEADOWS GATESVILLE TX Government - Hospital district N 2675887 ST JOSEPH MANOR BRYAN TX Government - Hospital district N 2675880 STERLING COUNTY NURSING HOME STERLING CITY TX Government - County N 2675846 TRINITY NURSING AND REHABILITATION SAN AUGUSTINE TX For profit - Corporation N 2675751 SEABURY NURSING & REHABILITATION ODESSA TX For profit - Corporation N 2675769 STAMFORD RESIDENCE AND REHABILITATION CENTER STAMFORD TX For profit - Corporation N 2675443 PRAIRIE ACRES FRIONA TX Government - Hospital district N 2675392 SAN JACINTO MANOR DEER PARK TX For profit - Corporation N 2675117 RUNNINGWATER DRAW CARE CENTER INC OLTON TX Non profit - Corporation N 2675128 MIDWESTERN HEALTHCARE CENTER WICHITA FALLS TX For profit - Corporation N 2675142 BRIARCLIFF HEALTH CENTER TYLER TX For profit - Partnership N 2675089 FOCUSED CARE AT SHERMAN SHERMAN TX For profit - Corporation N 2675169 FREDERICKSBURG NURSING AND REHABILITATION LP FREDERICKSBURG TX For profit - Partnership N 2675238 TRINITY TERRACE FORT WORTH TX Non profit - Corporation N 2675282 COUNTRY CLUB NURSING AND REHABILITATION LP AMARILLO TX For profit - Corporation N 2675267 GREENBRIER NURSING AND REHABILITATION CENTER OF TY TYLER TX For profit - Corporation N 2675046 ROSENBERG HEALTH & REHABILITATION CENTER ROSENBERG TX For profit - Corporation N 2675020 GREENVILLE HEALTH & REHABILITATION CENTER GREENVILLE TX For profit - Corporation N 2675009 COLEMAN HEALTHCARE CENTER COLEMAN TX For profit - Corporation N 2455941 WINDCREST NURSING AND REHABILITATION CENTER FREDERICKSBURG TX For profit - Corporation N 2455934 NORTHERN OAKS LIVING & REHABILITATION CENTER ABILENE TX For profit - Corporation N 2455699 AVALON PLACE WHARTON WHARTON TX For profit - Corporation N 2455715 MONUMENT REHABILITATION AND NURSING CENTER LA GRANGE TX For profit - Corporation N 2455748 ASHFORD HALL IRVING TX Government - Hospital district N 2455478 QUALITY CARE OF WACO WACO TX Government - Hospital district N 2675678 CARECHOICE OF BOERNE BOERNE TX For profit - Corporation N 2675593 WISTERIA PLACE ABILENE TX For profit - Corporation N 2675568 OASIS NURSING & REHABILITATION CENTER EL PASO TX For profit - Corporation N 2675536 HILL COUNTRY REHAB AND NURSING CENTER COPPERAS COVE TX For profit - Corporation N 2675424 GREEN OAKS REHAB & NURSING ATHENS TX For profit - Corporation N 2

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 192: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675251 COUNTRY MEADOWS NURSING & REHABILITATION CENTER CORSICANA TX For profit - Corporation N 2675350 WILLOW SPRINGS HEALTH & REHABILITATION CENTER ABILENE TX For profit - Corporation N 2675049 CORONADO HEALTHCARE CENTER PAMPA TX Government - Hospital district N 2675109 THE VILLAGE AT RICHARDSON RICHARDSON TX For profit - Corporation N 2675071 YORKTOWN NURSING AND REHABILITATION CENTER YORKTOWN TX For profit - Corporation N 2675134 WHISPERING OAKS REHAB & NURSING CUERO TX For profit - Corporation N 2675148 ORANGE VILLA NURSING AND REHABILITATION LP ORANGE TX For profit - Partnership N 2675177 PINE TREE LODGE NURSING CENTER LONGVIEW TX For profit - Individual N 2675226 STEVENS NURSING AND REHABILITATION CENTER OF HALLE HALLETTSVILLE TX Government - Hospital district N 2675233 MISSION CARE CENTERS-ALL SEASONS HOUSTON TX For profit - Partnership N 2676356 THE HEIGHTS OF NORTH HOUSTON HOUSTON TX For profit - Corporation N 2676339 REMARKABLE HEALTHCARE OF DALLAS, LP DALLAS TX For profit - Corporation N 2675925 THE MILDRED & SHIRLEY L GARRISON GERIATRIC EDUCATI LUBBOCK TX For profit - Corporation N 2676015 MABEE HEALTH CARE CENTER MIDLAND TX Non profit - Corporation N 2675908 AVANTE REHABILITATION CENTER IRVING TX For profit - Partnership N 2676257 TRUCARE LIVING CENTERS PALESTINE TX For profit - Corporation N 2676288 LAS PALMAS COTULLA TX Government - County N 2676300 CANTON OAKS CANTON TX For profit - Corporation N 2676305 THE STAYTON AT MUSEUM WAY FORT WORTH TX Non profit - Corporation N 2676193 THE WATERTON HEALTHCARE & REHABILITATION TYLER TX For profit - Corporation N 2676051 BRIARCLIFF SKILLED NURSING FACILITY CARTHAGE TX For profit - Corporation N 2676184 PROVIDENCE PARK REHABILITATION AND SKILLED NURSING TYLER TX For profit - Corporation N 1676158 SONTERRA HEALTH CENTER SAN ANTONIO TX For profit - Corporation N 1676145 PRAIRIE ESTATES FRISCO TX For profit - Corporation N 1676187 HERITAGE HOUSE OF MARSHALL HEALTH & REHABILITATION MARSHALL TX For profit - Corporation N 1676203 ROLLING MEADOWS WICHITA FALLS TX Non profit - Corporation N 1676216 POWERBACK REHABILITATION SAN ANTONIO SAN ANTONIO TX For profit - Corporation N 1676242 GANADO NURSING AND REHABILITATION CENTER GANADO TX Government - County N 1676306 HOLLY HALL HOUSTON TX Non profit - Other N 1676283 TRISUN CARE CENTER- NORTHEAST EL PASO EL PASO TX For profit - Corporation N 1676262 THE HEIGHTS OF TYLER TYLER TX Government - Hospital district N 1675815 KINGSVILLE NURSING AND REHABILITATION CENTER KINGSVILLE TX For profit - Corporation N 1675733 STONEBRIAR NURSING AND REHABILITATION CENTER AUSTIN TX For profit - Corporation N 1675712 HOMESTEAD NURSING AND REHABILITATION OF ITASCA ITASCA TX For profit - Corporation N 1675714 TOMBALL REHAB & NURSING TOMBALL TX For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 193: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

675774 LEGEND HEALTHCARE AND REHABILITATION - GREENVILLE GREENVILLE TX For profit - Corporation N 1675783 THE VILLA AT MOUNTAIN VIEW DALLAS TX For profit - Corporation N 1676019 LAMPSTAND NURSING AND REHABILITATION LP BRYAN TX For profit - Corporation N 1676012 MYSTIC PARK NURSING & REHAB CENTER SAN ANTONIO TX For profit - Corporation N 1676025 AUTUMN LEAVES NURSING AND REHAB INC HENDERSON TX For profit - Corporation N 1675974 MEDINA VALLEY HEALTH & REHABILITATION CENTER CASTROVILLE TX For profit - Partnership N 1675970 MEMPHIS CONVALESCENT CENTER MEMPHIS TX For profit - Corporation N 1675981 MINEOLA HEALTHCARE RESIDENCE MINEOLA TX For profit - Corporation N 1675991 PARK MANOR OF HUMBLE HUMBLE TX For profit - Corporation N 1676002 THE PLAZA AT EDGEMERE HEALTH CARE DALLAS TX Non profit - Corporation N 1675927 CRANE NURSING & REHABILITATION CENTER CRANE TX For profit - Corporation N 1675934 LA DORA NURSING AND REHABILITATION CENTER BEDFORD TX For profit - Corporation N 1675899 MATAGORDA NURSING & REHABILITATION CENTER BAY CITY TX For profit - Partnership N 1675946 SENIOR CARE OF MARLANDWOOD EAST TEMPLE TX For profit - Corporation N 1676376 SILVER SPRING ABILENE TX For profit - Corporation N 1676332 THE MEDICAL RESORT AT BAY AREA PASADENA TX For profit - Corporation N 1676421 LEGEND OAKS HEALTHCARE AND REHABILITATION -WAXAHAC WAXAHACHIE TX For profit - Corporation N 1675214 THE RESORT AT TEXAS CITY TEXAS CITY TX For profit - Corporation N 1675153 HERITAGE HOUSE AT KELLER REHAB & NURSING KELLER TX For profit - Corporation N 1675118 BRUSH COUNTRY NURSING AND REHABILITATION AUSTIN TX For profit - Partnership N 1675119 WEST LAKE HEALTHCARE RESIDENCE MESQUITE TX For profit - Individual N 1675360 WOODLAND SPRINGS NURSING CENTER WACO TX For profit - Corporation N 1675309 RETAMA MANOR NURSING CENTER/ALICE ALICE TX Government - Hospital district N 1675489 DEVINE HEALTH & REHABILITATION DEVINE TX For profit - Corporation N 1675409 WINDSOR MISSION OAKS SAN ANTONIO TX Government - Hospital district N 1675513 DECATUR NURSING AND REHABILITATION LP DECATUR TX For profit - Corporation N 1675614 BALLINGER HEALTHCARE AND REHABILITATION CENTER BALLINGER TX For profit - Corporation N 1455471 MOUNTAIN VIEW HEALTH & REHABILITATION EL PASO TX For profit - Corporation N 1455574 WEATHERFORD HEALTH CARE CENTER WEATHERFORD TX For profit - Corporation N 1455513 LAMPASAS NURSING AND REHABILITATION CENTER LAMPASAS TX For profit - Corporation N 1455450 MERIDIAN CARE MONTE VISTA SAN ANTONIO TX For profit - Partnership N 1455069 BAYLOR SCOTT & WHITE CONTINUING CARE HOSPITAL SKIL TEMPLE TX Non profit - Corporation Y 1455822 RETAMA MANOR NURSING CENTER/HARLINGEN HARLINGEN TX For profit - Corporation N 1455824 SENIOR CARE OF WURZBACH SAN ANTONIO TX For profit - Corporation N 1455832 WINDSOR GARDENS LANCASTER TX For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 194: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

455800 WESTCHASE HEALTH AND REHABILITATION CENTER HOUSTON TX For profit - Corporation N 1455652 SILVER CREEK MANOR SAN ANTONIO TX For profit - Corporation N 1455638 GREENVIEW MANOR WACO TX For profit - Corporation N 1455965 TEXHOMA CHRISTIAN CARE CENTER INC WICHITA FALLS TX Government - Hospital district N 145F411 GOODALL WITCHER NURSING FACILITY CLIFTON TX Government - City Y 1675028 ESTATES HEALTHCARE AND REHABILITATION CENTER FORT WORTH TX For profit - Corporation N 1675268 LAREDO MEDICAL CENTER LAREDO TX For profit - Corporation Y 1675289 PINECREST NURSING & REHABILITATION CENTER TYLER TX For profit - Corporation N 1675212 THE HOMESTEAD OF DENISON DENISON TX For profit - Corporation N 1675394 OAKWOOD MANOR NURSING HOME VIDOR TX For profit - Corporation N 1675396 RETAMA MANOR/LAREDO SOUTH LAREDO TX For profit - Corporation N 1675428 RETAMA MANOR NURSING CENTER/PLEASANTON SOUTH PLEASANTON TX For profit - Limited Liability company N 1675437 STONEBROOK MANOR AT BROADWAY SAN ANTONIO TX For profit - Partnership N 1675458 PARKVIEW NURSING AND REHABILITATION CENTER LOCKHART TX For profit - Partnership N 1675305 PLEASANT VALLEY HEALTHCARE AND REHABILITATION CENT GARLAND TX For profit - Corporation N 1675373 CARRIZO SPRINGS NURSING AND REHABILITATION LP CARRIZO SPRINGS TX For profit - Corporation N 1675380 WINDSOR NURSING AND REHABILITATION CENTER OF SEGUI SEGUIN TX For profit - Corporation N 1675386 WHISPERING PINES LODGE LONGVIEW TX For profit - Corporation N 1675388 HILLVIEW MANOR GOLDTHWAITE TX For profit - Corporation N 1675777 PARKWAY PLACE HOUSTON TX Non profit - Corporation N 1675739 REGENT CARE CENTER OF THE WOODLANDS LIMITED PARTNE THE WOODLANDS TX For profit - Corporation N 1675808 WINDSOR CARE CENTER TERRELL TX For profit - Corporation N 1675838 BIRCHWOOD NURSING AND REHABILITATION LP COOPER TX For profit - Corporation N 1675913 PFLUGERVILLE CARE CENTER PFLUGERVILLE TX Government - County N 1675648 CONROE HEALTH CARE CENTER CONROE TX Non profit - Corporation N 1675690 GOLDEN ESTATES REHABILITATION CENTER SAN ANTONIO TX For profit - Corporation N 1675611 GRACE PRESBYTERIAN VILLAGE DALLAS TX Non profit - Other N 1675496 SLATON CARE CENTER SLATON TX For profit - Corporation N 1676209 SENIOR CARE HEALTH & REHABILITATION CENTER - DECAT DECATUR TX For profit - Corporation N 1676217 ROYSE CITY HEALTH AND REHABILITATION CENTER ROYSE CITY TX For profit - Partnership N 1676185 SENIOR CARE OF HARBOR LAKES GRANBURY TX For profit - Corporation N 1676178 DUNCANVILLE HEALTHCARE AND REHABILITATION CENTER DUNCANVILLE TX For profit - Corporation N 1676180 ELGIN NURSING AND REHABILITATION CENTER ELGIN TX Government - Hospital district N 1676181 THE HEIGHTS PLEASANTON TX For profit - Corporation N 1676111 THE BUCKINGHAM HOUSTON TX Non profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 195: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

676127 EMERALD HILLS REHABILITATION AND HEALTHCARE CENTER NORTH RICHLAND HILLS TX Government - Hospital district N 1676136 HUEBNER CREEK HEALTH & REHABILITATION CENTER SAN ANTONIO TX For profit - Partnership N 1676138 THE HEIGHTS OF GONZALES GONZALES TX For profit - Corporation N 1676081 LEGEND OAKS HEALTHCARE AND REHABILITATION CENTER HOUSTON TX For profit - Corporation N 1676084 WARM SPRINGS REHABILITATION HOSPITAL OF SAN ANTONI SAN ANTONIO TX For profit - Corporation Y 1676090 WESLEY COURT HEALTH CENTER ABILENE TX For profit - Corporation N 1676101 KINDRED TRANSITIONAL CARE AND REHABILITATION-RIDGM FORT WORTH TX For profit - Corporation N 1676041 THE MISSION AT AIR FORCE VILLAGE SAN ANTONIO TX Non profit - Corporation N 1676010 LEGACY REHABILITATION AND LIVING AMARILLO TX For profit - Corporation N 1675968 STONE OAK CARE CENTER SAN ANTONIO TX For profit - Corporation N 1675933 LA HACIENDA HEALTHCARE HARLINGEN TX For profit - Partnership N 1675935 LIFE CARE CENTER OF HALTOM FORT WORTH TX For profit - Corporation N 1676374 MIDLOTHIAN HEALTHCARE CENTER MIDLOTHIAN TX For profit - Corporation N 1676398 THE RIO AT FOX HOLLOW BROWNSVILLE TX For profit - Corporation N 1676221 HERITAGE PARK OF KATY NURSING AND REHABILITATION KATY TX For profit - Corporation N 1676223 BAYOU PINES CARE CENTER LA MARQUE TX For profit - Corporation N 1676240 CIBOLO CREEK BOERNE TX For profit - Partnership N 1676267 BRODIE RANCH NURSING & REHAB CENTER AUSTIN TX For profit - Corporation N 1676263 DEERBROOK SKILLED NURSING AND REHAB CENTER HUMBLE TX For profit - Corporation N 1676325 TRISUN CARE CENTER - LAKESIDE SAN ANTONIO TX For profit - Corporation N 1676315 THE HILLCREST OF NORTH DALLAS DALLAS TX For profit - Corporation N 145E393 KENT COUNTY NURSING HOME JAYTON TX Government - County N 1455942 LUBBOCK HEALTH CARE CENTER LUBBOCK TX For profit - Partnership N 1455915 GRANBURY CARE CENTER GRANBURY TX For profit - Corporation N 145F402 WARE MEMORIAL CARE CENTER AMARILLO TX Non profit - Corporation N 145F470 TRUMAN W SMITH CHILDRENS CARE CENTER GLADEWATER TX For profit - Corporation N 1455617 CHRISTIAN CARE CENTER MESQUITE TX Non profit - Corporation N 1455628 HILLTOP VILLAGE NURSING AND REHABILITATION CENTER KERRVILLE TX For profit - Corporation N 1455591 FOCUSED CARE OF WAXAHACHIE WAXAHACHIE TX For profit - Individual N 1455684 CLAIRMONT LONGVIEW LONGVIEW TX For profit - Corporation N 1455651 DOWNTOWN HEALTH AND REHABILITATION CENTER FORT WORTH TX For profit - Corporation N 1455908 SCHULENBURG REGENCY NURSING CENTER SCHULENBURG TX For profit - Corporation N 1455551 PLAINVIEW HEALTHCARE CENTER PLAINVIEW TX Government - Hospital district N 1455560 MCALLEN NURSING CENTER MCALLEN TX For profit - Corporation N 1455455 MERIDIAN CARE OF ALICE ALICE TX For profit - Partnership N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 196: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

455485 THE CLAIRMONT TYLER TYLER TX For profit - Corporation N 1455390 BUENA VIDA NURSING AND REHAB-SAN ANTONIO SAN ANTONIO TX For profit - Individual N 1455020 COLONIAL MANOR CARE CENTER NEW BRAUNFELS TX For profit - Corporation N 1465088 MISSION AT ALPINE REHABILITATION CENTER PLEASANT GROVE UT Non profit - Other N 2446A058 FAIRVIEW CARE CENTER EAST SALT LAKE CITY UT For profit - Corporation N 17465084 UINTAH BASIN REHABILITATION AND SENIOR VILLA ROOSEVELT UT Non profit - Corporation Y 16465102 PARKDALE HEALTH AND REHAB PRICE UT For profit - Corporation N 15465162 ASPEN PARK REHABILITATION SALT LAKE CITY UT For profit - Corporation N 15465183 SPANISH FORK REHABILITATION AND NURSING SPANISH FORK UT For profit - Partnership N 1446A064 PINE CREEK REHABILITATION AND NURSING SALT LAKE CITY UT Non profit - Corporation N 1046A069 ALPINE MEADOW REHABILITATION AND NURSING WEST VALLEY CITY UT For profit - Corporation N 10465186 MAPLE SPRINGS SENIOR LIVING NORTH LOGAN UT For profit - Partnership N 8465059 RICHFIELD REHABILITATION AND CARE CENTER RICHFIELD UT For profit - Corporation N 8465104 OREM REHABILITATION AND NURSING CENTER OREM UT Government - Hospital district N 6465165 MISSION AT BEAR RIVER REHABILITATION CENTER TREMONTON UT Non profit - Other N 646A071 LOMOND PEAK NURSING AND REHABILITATION, LLC OGDEN UT For profit - Corporation N 6465125 ROCKY MOUNTAIN CARE - COTTAGE ON VINE MURRAY UT Non profit - Corporation N 5465091 DRAPER REHABILITATION AND CARE CENTER DRAPER UT For profit - Corporation N 4465175 MISSION AT COMMUNITY LIVING REHABILITATION CENTER CENTERFIELD UT Government - County N 4465078 HIGHLAND CARE CENTER HOLLADAY UT For profit - Corporation N 4465057 FOUR CORNERS REGIONAL CARE CENTER BLANDING UT For profit - Corporation N 4465101 HURRICANE HEALTH AND REHABILITATION HURRICANE UT Government - Hospital district N 3465158 MEADOW BROOK REHABILITATION AND NURSING SALT LAKE CITY UT Government - County N 3465116 ROCKY MOUNTAIN CARE - LOGAN LOGAN UT Non profit - Corporation N 2465093 WILLOW GLEN HEALTH AND REHAB BRIGHAM CITY UT For profit - Corporation N 2465167 STONEHENGE OF OREM OREM UT For profit - Corporation N 2465085 EMERY COUNTY CARE AND REHABILITATION CENTER FERRON UT Non profit - Corporation N 2465086 MOUNTAIN VIEW HEALTH SERVICES OGDEN UT For profit - Corporation N 1465098 PINNACLE NURSING AND REHABILITATION CENTER PRICE UT Government - Hospital district N 1465130 STONEHENGE OF SPRINGVILLE SPRINGVILLE UT For profit - Corporation N 1465144 SEASONS HEALTH AND REHABILITATION ST GEORGE UT For profit - Corporation N 1465107 HERITAGE HILLS REHABILITATION AND CARE CENTER NEPHI UT For profit - Corporation N 1465115 WASHINGTON TERRACE CENTER OGDEN UT For profit - Corporation N 1465169 THATCHER BROOK REHABILITATION & CARE CENTER CLEARFIELD UT For profit - Partnership N 1465170 ASPEN RIDGE OF UTAH VALLEY OREM UT For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 197: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

465064 ST GEORGE REHABILITATION ST GEORGE UT For profit - Corporation N 1465020 PIONEER CARE CENTER BRIGHAM CITY UT For profit - Corporation N 1495311 OUR LADY OF HOPE HEALTH CENTER RICHMOND VA Non profit - Church related N 31495264 BAYSIDE OF POQUOSON HEALTH AND REHAB POQUOSON VA For profit - Corporation N 27495324 SEASIDE HHC @ ATLANTIC SHORE VIRGINIA BEACH VA For profit - Corporation N 26495149 PORTSMOUTH HEALTH AND REHAB PORTSMOUTH VA For profit - Corporation N 25495187 HILLSVILLE REHABILITATION & HEALTHCARE CENTER LLC HILLSVILLE VA For profit - Corporation N 25495189 REGENCY HEALTH AND REHABILITATION CENTER GRAFTON VA For profit - Corporation N 25495249 FARMVILLE REHABILITATION & HEALTH CARE CENTER LLC FARMVILLE VA For profit - Corporation N 24495109 THE LAURELS OF UNIVERSITY PARK RICHMOND VA For profit - Corporation N 22495268 WESTMORELAND REHABILITATION & HEALTHCARE CENTER COLONIAL BEACH VA For profit - Corporation N 18495357 OUR LADY OF THE VALLEY ROANOKE VA Non profit - Corporation N 17495184 WOODHAVEN HALL AT WILLIAMSBURG LANDING WILLIAMSBURG VA Non profit - Corporation N 16495150 BEACON SHORES NURSING & REHABILITATION VIRGINIA BEACH VA For profit - Corporation N 15495152 HERITAGE HALL TAZEWELL TAZEWELL VA For profit - Corporation N 14495345 LANCASHIRE CONVALESCENT AND REHABILITATION CENTER KILMARNOCK VA For profit - Corporation N 13495333 HIGHLAND RIDGE REHAB CENTER DUBLIN VA For profit - Corporation N 12495331 GRAYSON REHABILITATION AND HEALTH CARE CENTER INDEPENDENCE VA For profit - Corporation N 11495240 FREDERICKSBURG HEALTH AND REHAB FREDERICKSBURG VA For profit - Corporation N 10495338 GRACE HEALTHCARE OF ABINGDON ABINGDON VA For profit - Corporation N 10495317 HERITAGE HALL DILLWYN DILLWYN VA For profit - Corporation N 10495151 AVANTE AT LYNCHBURG LYNCHBURG VA For profit - Corporation N 10495257 THE LAURELS OF WILLOW CREEK MIDLOTHIAN VA For profit - Corporation N 10495192 ENVOY OF LAWRENCEVILLE, LLC LAWRENCEVILLE VA For profit - Partnership N 10495194 AUTUMN CARE OF PORTSMOUTH PORTSMOUTH VA For profit - Corporation N 9495404 THE GLEBE DALEVILLE VA Non profit - Corporation N 9495353 HERITAGE HALL BLACKSTONE BLACKSTONE VA For profit - Corporation N 9495140 ROSE HILL HEALTH AND REHAB BERRYVILLE VA For profit - Corporation N 8495230 ENVOY AT THE VILLAGE FORK UNION VA For profit - Corporation N 8495185 WAVERLY HEALTH AND REHABILITATION CENTER WAVERLY VA For profit - Partnership N 8495190 CONSULATE HEALTHCARE OF WILLIAMSBURG WILLIAMSBURG VA For profit - Corporation N 7495235 ENVOY OF WILLIAMSBURG, LLC WILLIAMSBURG VA For profit - Corporation N 7495244 AUTUMN CARE OF MADISON MADISON VA For profit - Corporation N 7495283 MANORCARE HEALTH SERVICES-IMPERIAL RICHMOND VA For profit - Corporation N 7495362 ASHLAND NURSING AND REHABILITATION ASHLAND VA For profit - Corporation N 7

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 198: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

495381 SUMMIT HEALTH & REHABILITATION CENTER LYNCHBURG VA Non profit - Corporation N 7495375 EMPORIA MANOR LLC EMPORIA VA For profit - Corporation N 6495371 HERITAGE HALL-RICH CREEK RICH CREEK VA For profit - Corporation N 6495288 THE FOUNTAINS AT WASHINGTON HOUSE ALEXANDRIA VA For profit - Corporation N 6495250 GALAX HEALTH AND REHAB GALAX VA For profit - Corporation N 6495183 THE HAVEN AT BRANDERMILL WOODS MIDLOTHIAN VA For profit - Corporation N 6495211 MOUNT VERNON HEALTHCARE CENTER ALEXANDRIA VA For profit - Partnership N 6495046 OAKWOOD MANOR BEDFORD MEM BEDFORD VA Non profit - Corporation Y 6495398 DINWIDDIE HEALTH AND REHAB CENTER PETERSBURG VA For profit - Corporation N 6495309 THORNTON HALL NURSING AND REHABILITATION CENTER NORFOLK VA For profit - Corporation N 6495281 BLUE RIDGE REHAB CENTER MARTINSVILLE VA For profit - Corporation N 6495286 JAMES RIVER CONVALESCENT CENTE NEWPORT NEWS VA For profit - Corporation N 5495300 HERITAGE HALL KING GEORGE KING GEORGE VA For profit - Corporation N 5495221 THE BRIAN CENTER LOW MOOR VA Non profit - Corporation N 5495372 SENTARA WOODVIEW SOUTH BOSTON VA Non profit - Corporation N 5495423 BONVIEW REHABILITATION AND HEALTHCARE RICHMOND VA For profit - Corporation N 549E075 SKYLINE TERRACE CONV HOME WOODSTOCK VA For profit - Corporation N 5495214 AUGUSTA MEDICAL CTR SKILLED CA FISHERSVILLE VA Non profit - Corporation Y 5495201 SENTARA NURSING CENTER PORTSMOUTH PORTSMOUTH VA Non profit - Corporation N 5495325 PHEASANT RIDGE NURSING & REHAB CENTER ROANOKE VA For profit - Corporation N 5495282 LOUISA HEALTH & REHABILITATION CENTER LOUISA VA For profit - Corporation N 5495358 AMELIA NURSING CENTER AMELIA VA For profit - Partnership N 549E151 LITTLE SISTERS OF THE POOR IN RICHMOND RICHMOND VA Non profit - Corporation N 5495343 GRACE HEALTH AND REHAB CENTER OF GREENE COUNTY STANARDSVILLE VA For profit - Corporation N 4495327 ENVOY OF WESTOVER HILLS RICHMOND VA For profit - Corporation N 4495260 BEAUFONT HEALTH AND REHABILITATION CENTER RICHMOND VA For profit - Corporation N 4495242 HERITAGE HALL - BROOKNEAL BROOKNEAL VA For profit - Limited Liability company N 4495210 NORFOLK HEALTH AND REHABILITATION CENTER NORFOLK VA For profit - Partnership N 4495366 LAKE PRINCE WOODS, INC SUFFOLK VA Non profit - Corporation N 4495350 HERITAGE HALL WISE WISE VA For profit - Corporation N 3495356 HERITAGE HALL BLACKSBURG BLACKSBURG VA For profit - Corporation N 349E004 BEDFORD CO NURSING HOME BEDFORD VA Government - County N 3495302 THE CARRINGTON LYNCHBURG VA For profit - Corporation N 3495419 COVENANT WOODS NURSING HOME MECHANICSVILLE VA Non profit - Corporation N 3495226 WAYLAND NURSING AND REHABILITATION CENTER KEYSVILLE VA For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 199: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

495326 CHARLOTTESVILLE POINTE REHABILITATION AND HEALTHCA CHARLOTTESVILLE VA For profit - Corporation N 3495321 HERITAGE HALL LEXINGTON EAST LEXINGTON VA For profit - Corporation N 3495323 HERITAGE HALL - LAUREL MEADOWS LAUREL FORK VA For profit - Corporation N 3495344 KINGS DAUGHTERS COMMUNITY HEALTH & REHAB STAUNTON VA For profit - Corporation N 3495167 WYTHE CNTY COMMUNITY HOSP ECU WYTHEVILLE VA For profit - Corporation Y 3495168 SHENANDOAH VALLEY HEALTH AND REHAB BUENA VISTA VA For profit - Corporation N 3495178 CHARLOTTESVILLE HEALTH & REHABILITATION CENTER CHARLOTTESVILLE VA For profit - Partnership N 3495144 PETERSBURG HEALTHCARE CENTER PETERSBURG VA For profit - Corporation N 3495406 THE WYBE AND MARIETJE KROONTJE HEALTH CARE CENTER BLACKSBURG VA For profit - Corporation N 3495417 CARRINGTON PLACE AT RURAL RETREAT RURAL RETREAT VA For profit - Corporation N 349E050 MOUNTAIN VIEW NURSING HOME ARODA VA Non profit - Church related N 3495086 CONCORDIA TRANSITIONAL CARE AND REHAB-BAY POINTE VIRGINIA BEACH VA For profit - Corporation N 2495188 APPOMATTOX HEALTH AND REHABILITATON CENTER APPOMATTOX VA For profit - Partnership N 2495199 GREENSVILLE HEALTH AND REHABILITATION CENTER EMPORIA VA For profit - Corporation N 2495118 ROCKY MOUNT REHABILITATION & HEALTHCARE CENTER LLC ROCKY MOUNT VA For profit - Corporation N 2495347 CONSULATE HEALTH CARE OF WINDSOR WINDSOR VA For profit - Corporation N 2495336 AUGUSTA NURSING & REHAB CENTER FISHERSVILLE VA For profit - Corporation N 2495380 CHASE CITY HEALTH AND REHAB CENTER CHASE CITY VA For profit - Corporation N 2495301 HERITAGE HALL FRONT ROYAL FRONT ROYAL VA For profit - Corporation N 2495296 COURTLAND HEALTH & REHABILITATION CENTER COURTLAND VA For profit - Partnership N 2495297 BOWLING GREEN HEALTH & REHABILITATION CENTER BOWLING GREEN VA For profit - Corporation N 2495318 BERRY HILL NURSING HOME SOUTH BOSTON VA For profit - Corporation N 2495405 SUMMIT SQUARE WAYNESBORO VA Non profit - Corporation N 2495359 DOGWOOD VILLAGE OF ORANGE COUNTY HEALTH AND REHAB ORANGE VA For profit - Corporation N 2495209 RALEIGH COURT HEALTH AND REHABILITATION CENTER ROANOKE VA For profit - Corporation N 2495197 BELVOIR WOODS HEALTH CARE CENTER AT THE FAIRFAX FORT BELVOIR VA For profit - Partnership N 2495202 GRETNA HEALTH AND REHABILITATION CENTER GRETNA VA For profit - Corporation N 1495193 HENRICO HEALTH & REHABILITATION CENTER HIGHLAND SPRINGS VA For profit - Corporation N 1495220 THE SPRINGS NURSING CENTER HOT SPRINGS VA Non profit - Corporation N 1495254 COLONNADES HEALTH CARE CENTER CHARLOTTESVILLE VA For profit - Corporation N 1495267 BROOKSIDE REHAB & NURSING CENTER WARRENTON VA For profit - Partnership N 1495272 LEXINGTON COURT REHABILITATION & HEALTH CARE CTR RICHMOND VA For profit - Corporation N 1495277 HERITAGE HALL NURSING HOME /NA NASSAWADOX VA For profit - Corporation N 1495087 SALEM HEALTH & REHABILITATION SALEM VA For profit - Corporation N 1495165 SHENANDOAH VLY WESTMINSTER-CANTERBURY WINCHESTER VA Non profit - Church related N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 200: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

495173 SENTARA NURSING CENTER NORFOLK NORFOLK VA Non profit - Corporation N 1495186 BETH SHOLOM HOME OF EASTERN VI VIRGINIA BEACH VA Non profit - Corporation N 1495363 FAIRMONT CROSSING AMHERST VA Non profit - Corporation N 1495367 NORTHAMPTON CONVALESCENT AND REHABILITATION CENTER HAMPTON VA For profit - Corporation N 1495369 THE CONVALESCENT CENTER AT PATRIOTS COLONY WILLIAMSBURG VA Non profit - Other N 1495349 CARRINGTON PLACE AT WYTHEVILLE - BIRDMONT CENTER WYTHEVILLE VA For profit - Corporation N 1495412 NOVA HEALTH AND REHAB WEBER CITY VA For profit - Corporation N 1495377 THE LAURELS OF CHARLOTTESVILLE CHARLOTTESVILLE VA For profit - Corporation N 1495400 THE CULPEPER CULPEPER VA Non profit - Corporation N 1495319 THE VIRGINIAN FAIRFAX VA Non profit - Corporation N 1495328 CARRINGTON PLACE OF TAPPAHANNOCK TAPPAHANNOCK VA For profit - Corporation N 1495330 GREENBRIAR REGIONAL MEDICAL CENTER CHESAPEAKE VA For profit - Corporation N 1495340 NEWPORT NEWS NURSING & REHAB NEWPORT NEWS VA For profit - Corporation N 1495308 RIVERSIDE REHABILITATION CENTER AT HAMPTON HAMPTON VA Non profit - Corporation N 1495395 HARBOR'S EDGE NORFOLK VA Non profit - Corporation N 1495374 MOUNTAIN VIEW REGIONAL MEDICAL CENTER NORTON VA Non profit - Corporation N 1495364 THE ORCHARD WARSAW VA Non profit - Corporation N 1495365 MAPLE GROVE HEALTH CARE CENTER LEBANON VA Non profit - Corporation N 1495306 BLUE RIDGE NURSING THERAPY CONNECTION STUART VA For profit - Corporation N 1495269 THE JEFFERSON ARLINGTON VA For profit - Corporation N 1495236 ENVOY AT THE MEADOWS GOOCHLAND VA For profit - Partnership N 1495237 VA BEACH HEALTHCARE AND REHAB VIRGINIA BEACH VA For profit - Corporation N 1495123 HOPEWELL HEALTH CARE CENTER HOPEWELL VA For profit - Corporation N 1495133 VALLEY HEALTH CARE CENTER CHILHOWIE VA For profit - Corporation N 1495204 ST FRANCIS NURSING CTR NEWPORT NEWS VA Non profit - Church related N 1495153 CEDARS HEALTHCARE CENTER CHARLOTTESVILLE VA For profit - Corporation N 1495408 KING'S GRANT RETIREMENT COMMUN MARTINSVILLE VA For profit - Corporation N 1495415 THE VILLAGE AT ORCHARD RIDGE WINCHESTER VA Non profit - Church related N 149E256 OUR LADY OF PERPETUAL HELP VIRGINIA BEACH VA Non profit - Church related N 1475036 UNION HOUSE NURSING HOME GLOVER VT For profit - Partnership N 7475042 MAPLE LANE NURSING HOME BARTON VT For profit - Partnership N 6475049 BEL AIRE CENTER NEWPORT VT For profit - Corporation N 4475058 MENIG NURSING HOME RANDOLPH CENTER VT Non profit - Corporation N 4475048 DERBY GREEN NURSING HOME DERBY VT Non profit - Corporation N 3475046 CEDAR HILL HEALTH CARE CENTER WINDSOR VT For profit - Corporation N 3

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 201: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

475043 GREENSBORO NURSING HOME GREENSBORO VT Non profit - Corporation N 2475037 BARRE GARDENS NURSING AND REHAB LLC BARRE VT For profit - Corporation N 2475053 MAYO HEALTHCARE INC. NORTHFIELD VT Non profit - Corporation N 1475020 BERLIN HEALTH & REHAB CTR BARRE VT For profit - Corporation N 1475055 THE VILLA REHAB ST ALBANS VT For profit - Corporation N 1505367 WILLOW SPRINGS CARE AND REHABILITATION YAKIMA WA For profit - Corporation N 17505439 BAYVIEW MANOR SEATTLE WA Non profit - Corporation N 11505412 COLVILLE TRIBAL CONVALESCENT C NESPELEM WA Government - Federal N 1050A181 COLUMBIA BASIN HOSPITAL EPHRATA WA Government - Hospital district Y 6505272 LIFE CARE CENTER OF MOUNT VERNON MOUNT VERNON WA For profit - Corporation N 6505033 ROCKWOOD SOUTH HILL SPOKANE WA Non profit - Church related N 5505265 EMERALD CARE WAPATO WA Non profit - Other N 4505070 LIFE CARE CENTER OF RICHLAND RICHLAND WA For profit - Corporation N 3505526 LIFE CARE CENTER OF SOUTH HILL PUYALLUP WA For profit - Corporation N 3505378 PRESTIGE CARE & REHABILITATION - BURLINGTON BURLINGTON WA For profit - Corporation N 3505429 SHARON CARE CENTER CENTRALIA WA For profit - Corporation N 2505529 AVAMERE TRANSITIONAL CARE OF PUGET SOUND TACOMA WA For profit - Corporation N 2505324 LIFE CARE CENTER OF PUYALLUP PUYALLUP WA For profit - Corporation N 2505358 RIVERSIDE NURSING & REHAB CTR CENTRALIA WA For profit - Corporation N 2505309 CAREAGE OF WHIDBEY COUPEVILLE WA For profit - Individual N 2505355 ADVANCED POST ACUTE AUBURN WA For profit - Corporation N 2505417 SAINT ANNE NURSING AND REHABILITATION CENTER SEATTLE WA For profit - Corporation N 2505459 NISQUALLY VALLEY CARE CENTER MCKENNA WA For profit - Corporation N 1505313 HALLMARK MANOR FEDERAL WAY WA For profit - Corporation N 1505214 THE OAKS AT FOREST BAY SHORELINE WA For profit - Individual N 1505255 AVALON CARE CENTER - OTHELLO LLC OTHELLO WA For profit - Corporation N 1505347 THE OAKS AT LAKEWOOD TACOMA WA For profit - Corporation N 1505086 LANDMARK CARE AND REHABILITATION YAKIMA WA For profit - Corporation N 1505195 NORTH AUBURN REHAB & HEALTH CENTER AUBURN WA For profit - Corporation N 1505507 SHELTON HEALTH & REHAB CENTER SHELTON WA For profit - Corporation N 1505376 MT BAKER CARE CENTER BELLINGHAM WA For profit - Corporation N 1525536 OREGON MANOR OREGON WI For profit - Corporation N 35525544 HERITAGE OF ELMWOOD NH ELMWOOD WI Non profit - Corporation N 23525497 PINE MANOR HEALTH AND REHABILITATION CLINTONVILLE WI For profit - Corporation N 22525685 ATRIUM POST ACUTE CARE OF PLYMOUTH PLYMOUTH WI For profit - Partnership N 21

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 202: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

52A251 NORWOOD HEALTH CTR-CENTRAL MARSHFIELD WI Government - County N 17525580 ATRIUM POST ACUTE CARE OF BLOOMER BLOOMER WI For profit - Partnership N 11525481 ATRIUM POST ACUTE CARE OF NEENAH NEENAH WI For profit - Corporation N 10525440 PLUM CITY CARE CTR PLUM CITY WI For profit - Corporation N 10525279 TUDOR OAKS HEALTH CENTER MUSKEGO WI Non profit - Church related N 9525343 ATRIUM POST ACUTE CARE OF SHAWANO AT EVERGREEN SHAWANO WI For profit - Corporation N 9525363 WOODLAND VILLAGE NURSING HOME SURING WI For profit - Partnership N 9525364 CLEARWATER CARE CENTER EAU CLAIRE WI Non profit - Corporation N 9525383 AMERICAN LUTHERAN HOME-MONDOVI MONDOVI WI Non profit - Corporation N 8525616 CROSSROADS CARE CENTER OF MAYVILLE MAYVILLE WI For profit - Individual N 8525348 GREENTREE HEALTH AND REHAB CTR CLINTONVILLE WI For profit - Corporation N 7525477 ST FRANCIS HEALTH SERVICES SAINT FRANCIS WI For profit - Corporation N 7525529 BRIDGES OF MILWAUKEE REHAB AND CARE CENTER (THE) MILWAUKEE WI For profit - Individual N 7525713 NEIGHBORS - EAST NEIGHBORHOOD (THE) MENOMONIE WI Government - County N 6525639 ST ELIZABETH NURSING HOME JANESVILLE WI Non profit - Church related N 6525398 PRESCOTT NURSING AND REHAB COMMUNITY PRESCOTT WI For profit - Corporation N 6525125 KENOSHA ESTATES REHAB AND CARE CENTER KENOSHA WI For profit - Corporation N 5525241 EDGERTON CARE CENTER, INC EDGERTON WI Non profit - Corporation N 5525705 BIRCHWOOD HEALTHCARE AND REHAB CENTER MILWAUKEE WI For profit - Individual N 5525630 NEW GLARUS HOME NEW GLARUS WI Non profit - Corporation N 5525546 ATRIUM POST ACUTE CARE OF NEW HOLSTEIN NEW HOLSTEIN WI For profit - Corporation N 5525357 ATRIUM POST ACUTE CARE OF KEWAUNEE KEWAUNEE WI For profit - Partnership N 5525415 MENOMONEE FALLS HEALTH SERVICES MENOMONEE FALLS WI For profit - Corporation N 4525525 PRAIRIE MAISON PRAIRIE DU CHIEN WI Non profit - Other N 3525673 MAPLE RIDGE CARE CENTER SPOONER WI Non profit - Corporation N 3525493 SUNRISE HEALTH SERVICES MILWAUKEE WI For profit - Corporation N 3525710 LADYSMITH LIVING CENTER, INC LADYSMITH WI For profit - Corporation N 2525522 GRANCARE NURSING AND REHAB CTR FOND DU LAC WI For profit - Individual N 2525432 MARY JUDE NURSING HOME WEST ALLIS WI For profit - Corporation N 2525600 MITCHELL MANOR WEST ALLIS WI For profit - Corporation N 2525547 SYMPHONY OF GLENDALE GLENDALE WI For profit - Corporation N 2525411 WILLOWDALE HEALTH SERVICES NEW HOLSTEIN WI For profit - Corporation N 2525397 SUPERIOR REHABILITATION CENTER LLC SUPERIOR WI For profit - Corporation N 1525407 ATRIUM POST ACUTE CARE OF APPLETON APPLETON WI For profit - Partnership N 1525362 LAFAYETTE MANOR DARLINGTON WI Government - County N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 203: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

525371 DYCORA TRANSITIONAL HEALTH - GLENDALE GLENDALE WI For profit - Corporation N 1525351 VILLA PINES LIVING CENTER FRIENDSHIP WI For profit - Corporation N 1525353 ATRIUM POST ACUTE CARE OF STEVENS POINT STEVENS POINT WI For profit - Corporation N 1525085 EASTCASTLE PL BRADFORD TER CONV CTR MILWAUKEE WI Non profit - Corporation N 1525321 DYCORA TRANSITIONAL HEALTH - RIVERDALE MUSCODA WI For profit - Individual N 1525561 EAST TROY MANOR EAST TROY WI Non profit - Corporation N 1525562 VERNON MANOR VIROQUA WI Government - County N 1525579 ATRIUM POST ACUTE CARE OF LITTLE CHUTE LITTLE CHUTE WI For profit - Corporation N 1525442 TOMAH NURSING AND REHAB TOMAH WI For profit - Corporation N 1525502 BALDWIN CARE CENTER BALDWIN WI Non profit - Corporation N 1525622 SOLDIERS GROVE HEALTH SERVICES SOLDIERS GROVE WI Non profit - Corporation N 1525628 MARINUKA MANOR GALESVILLE WI Government - City N 1525632 WATER'S EDGE HAYWARD WI Non profit - Corporation Y 1525592 LADYSMITH NURSING HOME LADYSMITH WI For profit - Corporation N 1525598 SHEBOYGAN SENIOR COMMUNITY INC SHEBOYGAN WI Non profit - Corporation N 1525678 AVANTI HEALTH AND REHABILITATION CENTER, LLC MINOCQUA WI For profit - Partnership N 1525680 UNITED PIONEER HOME LUCK WI Non profit - Corporation N 1525683 WOODS CROSSING AT WOODS POINT BRODHEAD WI For profit - Corporation N 1525648 BARRON CARE AND REHABILITATION BARRON WI For profit - Corporation N 1525412 ATRIUM POST ACUTE CARE OF SHAWANO AT BIRCH HILL SHAWANO WI For profit - Corporation N 1525369 WAUSAU MANOR HEALTH SERVICES WAUSAU WI For profit - Partnership N 1525350 COLONIAL CENTER COLBY WI Non profit - Other N 1525270 CROSSROADS CARE CENTER OF FOND DU LAC FOND DU LAC WI For profit - Corporation N 1525532 GOOD SAMARITAN SOCIETY-ST CROIX VALLEY ST CROIX FALLS WI Non profit - Corporation N 1525550 MARKESAN RESIDENT HOME MARKESAN WI Non profit - Corporation N 1525687 PIGEON FALLS HCC PIGEON FALLS WI Government - County N 1525456 SHEBOYGAN HEALTH SERVICES SHEBOYGAN WI For profit - Corporation N 1515021 MADISON PARK HEALTHCARE HUNTINGTON WV For profit - Corporation N 2951E154 MAIN STREET CARE HINTON WV Non profit - Other N 27515123 WELLSBURG CENTER WELLSBURG WV For profit - Corporation N 17515075 JOHN MANCHIN SR HEALTH CARE CENTER FAIRMONT WV Government - State N 16515045 GRANT MEMORIAL HOSPITAL PETERSBURG WV For profit - Corporation Y 12515141 MEADOWVIEW MANOR BRIDGEPORT WV For profit - Corporation N 1151E124 LAKIN HOSPITAL WEST COLUMBIA WV Government - State N 1051E148 HOPEMONT HOSPITAL TERRA ALTA WV Government - State N 9

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 204: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

515120 RIVER OAKS CLARKSBURG WV For profit - Corporation N 7515077 WEIRTON MEDICAL CENTER WEIRTON WV Non profit - Corporation Y 7515099 ROANE GENERAL HOSPITAL SPENCER WV For profit - Corporation Y 6515049 MORGANTOWN HEALTH AND REHABILITATION CENTER MORGANTOWN WV For profit - Corporation N 6515051 ST. JOSEPH'S HOSPITAL BUCKHANNON WV Non profit - Church related Y 5515186 MAPLES NURSING HOME BLUEFIELD WV For profit - Corporation N 5515188 SPRINGFIELD CENTER LINDSIDE WV For profit - Corporation N 4515160 CRESTVIEW MANOR NURSING AND REHABILITATION JANE LEW WV For profit - Corporation N 4515152 MONTGOMERY GENERAL ELDERLY CARE MONTGOMERY WV Non profit - Corporation N 451E034 NELLA'S NURSING HOME ELKINS WV For profit - Corporation N 451E150 WAR MEMORIAL HOSPITAL BERKELEY SPRINGS WV Non profit - Corporation Y 3515178 CARE HAVEN CENTER MARTINSBURG WV For profit - Corporation N 3515128 BRIGHTWOOD CENTER FOLLANSBEE WV For profit - Corporation N 3515007 HUNTINGTON HEALTH AND REHABILITATION CENTER HUNTINGTON WV For profit - Corporation N 3515087 CEDAR RIDGE CENTER SISSONVILLE WV For profit - Corporation N 3515191 CAREHAVEN OF PLEASANTS BELMONT WV For profit - Corporation N 3515130 STONE PEAR PAVILION CHESTER WV For profit - Corporation N 3515071 SALEM CENTER SALEM WV For profit - Corporation N 3515080 HAMPSHIRE MEMORIAL HOSPITAL ROMNEY WV Non profit - Corporation Y 3515142 CLAY HEALTH CARE CENTER IVYDALE WV For profit - Partnership N 251E109 JACKIE WITHROW HOSPITAL BECKLEY WV Government - State N 2515028 PRINCETON CENTER PRINCETON WV For profit - Corporation N 2515168 WAYNE NURSING AND REHABILITATION CENTER WAYNE WV For profit - Corporation N 2515116 GOOD SAMARITAN SOCIETY OF BARBOUR COUNTY BELINGTON WV Non profit - Corporation N 2515029 SUMMERSVILLE REGIONAL MEDICAL CENTER SUMMERSVILLE WV Government - City Y 2515053 TYGART CENTER AT FAIRMONT CAMPUS FAIRMONT WV For profit - Corporation N 2515058 MAPLESHIRE NURSING AND REHABILITATION CENTER MORGANTOWN WV For profit - Partnership N 2515061 HILLTOP CENTER HILLTOP WV For profit - Partnership N 2515121 MEADOW GARDEN RAINELLE WV For profit - Individual N 2515183 POCAHONTAS CENTER MARLINTON WV For profit - Corporation N 2515193 ARTHUR B HODGES CENTER, THE CHARLESTON WV Non profit - Corporation N 2515134 MEADOWBROOK ACRES CHARLESTON WV For profit - Corporation N 251A010 NELLA'S INC ELKINS WV For profit - Corporation N 2515194 BRIDGEPORT HEALTH CARE CENTER BRIDGEPORT WV For profit - Corporation N 1515133 ANSTED CENTER ANSTED WV For profit - Corporation N 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 205: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Provnum SNF Name City State Ownership In HospitalDays during 2018Q1

with less than 8 hours RN Staffing

515182 MILETREE CENTER SPENCER WV For profit - Partnership N 1515159 EAGLE POINTE PARKERSBURG WV For profit - Partnership N 1515001 PINE LODGE BECKLEY WV For profit - Corporation N 1515179 CANTERBURY CENTER SHEPHERDSTOWN WV For profit - Corporation N 1515153 FAYETTE NURSING AND REHABILITATION CENTER FAYETTEVILLE WV For profit - Corporation N 1515088 RALEIGH CENTER DANIELS WV For profit - Partnership N 1515072 PINE RIDGE KINGWOOD WV For profit - Corporation N 1515103 GLENVILLE CENTER GLENVILLE WV For profit - Corporation N 1515106 TEAYS VALLEY CENTER HURRICANE WV For profit - Corporation N 1535053 PLATTE COUNTY LEGACY HOME WHEATLAND WY Government - Hospital district N 1353A051 SOUTH LINCOLN NURSING CENTER KEMMERER WY Government - Hospital district N 12535056 SAGE VIEW CARE CENTER ROCK SPRINGS WY For profit - Corporation N 353A050 STAR VALLEY CARE CENTER AFTON WY Government - Hospital district Y 2535029 CROOK COUNTY MEDICAL SERVICES DISTRICT LTC SUNDANCE WY Government - Hospital district Y 2535051 THERMOPOLIS REHABILITATION AND WELLNESS THERMOPOLIS WY For profit - Corporation N 2535030 NEW HORIZONS CARE CENTER LOVELL WY Government - State Y 2535038 ROCKY MOUNTAIN CARE - EVANSTON EVANSTON WY Non profit - Corporation N 2535043 LARAMIE CARE CENTER LARAMIE WY For profit - Corporation N 1535044 CHEYENNE REG MEDICAL CTR TRANSITIONAL CARE UNIT CHEYENNE WY Government - City/county Y 1

© 2018 LeadingAge New York Technology Solutions LLC, All Rights Reserved

Page 206: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard, Mail Stop C2-21-16

Baltimore, Maryland 21244-1850

Center for Clinical Standards and Quality/Quality, Safety & Oversight Group

19-02-NH

DATE: November 30, 2018

TO: State Survey Agency Directors

FROM: Director

Quality, Safety & Oversight Group

SUBJECT: Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and

New Minimum Data Set (MDS) Census Reports

Background

Staffing in long-term care nursing facilities significantly affects the care delivered to residents.

Since July 2016, nursing homes have been submitting data electronically through the PBJ system

as required under section 1128I(g) of the Social Security Act (the Act) and 42 CFR §483.70(q).

The data submitted by facilities are the number of hours direct care staff are paid to work each

day. All data submitted is auditable back to payroll and other verifiable sources.

In April 2018, CMS began using PBJ data to calculate staffing levels and star ratings on the

Nursing Home Compare website and in the Five Star Quality Rating System. For more

information on this change, please see memorandum QSO-18-17-NH

(https://www.cms.gov/Medicare/Provider-Enrollment-and-

Certification/SurveyCertificationGenInfo/Downloads/QSO18-17-NH.pdf). At this time, over 97

percent of facilities have been able to report staff hours through the PBJ system. We sincerely

appreciate their efforts to support public reporting and improve quality.

Memorandum Summary

• Notification to States – The Centers for Medicare & Medicaid Services (CMS) will

provide CMS Regional Offices (ROs) and State Survey Agencies with a list of facilities

with potential staffing issues to support survey activities for evaluating sufficient staffing

and improving resident health and safety.

• Updates in the PBJ Policy Manual and Frequently Asked Questions (FAQs) – We

are expanding the guidance on the meal breaks policy to ensure consistency. In addition,

we are adding guidance regarding reporting hours for “Universal Care Workers.”

Additional Technical Support for Facilities – New MDS-based census reports in the

Certification and Survey Provider Enhanced Reporting (CASPER) system.

Page 207: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Page 2 – State Survey Agency Directors

Notification to States and CMS Regional Offices

While CMS is encouraged by facilities’ efforts to improve staffing, we are also concerned about

some of the findings from the new PBJ data. For example, some facilities are reporting several

days in a quarter without a registered nurse (RN) onsite and/or significantly low nurse staffing

levels on weekends (see QSO-18-17-NH). Since nurse staffing is directly related to the quality of

care that residents’ experience, CMS is very concerned about the risk to resident health and

safety that these situations may present. Therefore, CMS will begin informing state survey

agencies of facilities with potential staffing issues: facilities with significantly low nurse staffing

levels on weekends; and facilities with several days in a quarter without an RN onsite.

Facilities identified as having low staffing on weekends:

The State Operations Manual, Chapter 7, section 7207.2.2, requires states to conduct at least 10

percent of the standard health surveys on the weekend or before 8:00 a.m. or after 6:00 p.m. (i.e.,

“off-hours”). States shall [now be required to] conduct at least fifty percent of the required off-

hours surveys on weekends using the list of facilities provided by CMS.

Facilities identified as having reported days with no RN onsite:

We are aiding surveyors’ investigations by identifying facilities who have higher risk of

noncompliance with the RN staffing requirement. When conducting a scheduled standard or

complaint survey (regardless of the type of complaint), surveyors should investigate compliance

with 42 CFR 483. 35(b)(1), which is the requirement for a facility to provide the services of an

RN seven days a week, eight hours a day. If a surveyor confirms that this requirement has not

been met, the facility shall be cited for noncompliance under deficiency F-tag 727.

PBJ Policy Manual and FAQ Updates

CMS is making the following updates to the PBJ Policy Manual and FAQ document. These

documents can be found in the downloads section of the PBJ website at

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html

Meal Break Policy:

We are expanding the guidance in the PBJ Policy Manual related to deducting time for meal

breaks. Note: This is not a change in policy, but that we are only providing additional details.

The guidance includes information for deducting meal times for specific shifts (e.g., eight-hour

shifts, twelve-hour shifts, etc.). We have also added a Q&A to the PBJ Policy FAQs that explains

the rationale for the meal break policy.

Universal Care Workers

Some facilities employ “Universal Care Workers,” who are typically certified nurse aides

(CNAs) who perform additional duties outside of the nurse aide role, such as food preparation or

light housekeeping services. CMS has added language to both the PBJ Policy Manual and the

PBJ Policy FAQ to instruct facilities that they must use a reasonable methodology to allocate the

hours that these employees are providing CNA services and report these hours accordingly.

Hours spent on other duties (i.e. housekeeping, cooking etc.) must not be reported as CNA hours.

Page 208: The action removes obsolete references to state schools ... FAB 2019-01-09 Final Handouts.pdfdisrespectful. This proposal replaces the aforementioned term with “Individuals with

Page 3 – State Survey Agency Directors

These hours can be reported under housekeeping or other services; however, reporting of these

hours is not required.

MDS Census Reports

CMS has created two reports for providers to help ensure data is submitted accurately and in a

timely manner. These reports use the same methodology CMS uses to calculate each facility’s

census, which is then used to calculate the number of staff hours per resident per day posted on

the Nursing Home Compare website. The reports are:

The MDS Census Summary Report: Allows users to retrieve the daily MDS-based resident

census (i.e., count of residents) for each day in a quarter.

MDS Census Detail Report: Allows users to retrieve a list of the residents that the MDS-based

census is comprised of on a given date or dates.

More information on these reports can be found at the following links:

For State Survey Agencies: https://web.qiesnet.org/qiestosuccess/training.html

o Look for the section called CASPER Reporting User’s Guide.

o From the dropdown list highlight Section 49 Payroll Based Journal (PBJ) Reports

and click on Select.

o Find the specific report you would like to run and go to the page number cited.

o Follow the steps to pull the report.

For facilities: https://qtso.cms.gov/reference-and-manuals/casper-reporting-users-guide-

pbj-providers

o Select Section 12 - Payroll Based Journal (PBJ) Reports from the right side in the

blue box.

o Find the specific report you would like to run and go to the page number cited.

o Follow the steps to pull the report.

Point of Contact: For questions related to this information, please contact

[email protected].

Effective Date: Immediately. This policy should be communicated with all survey and

certification staff, their managers and the State/Regional Office training coordinators within 30

days of this memorandum.

/s/

Karen Tritz

Acting Director

cc: Survey and Certification Regional Office Management