2012 UAR 8282013Fiscal Year End:December-12December-12December-12December-12December-12December-12December-12June-12June-12December-12December-12December-12September-12December-12December-12December-12December-12September-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12June-12December-12December-12December-13December-13December-13December-13December-13December-12December-12December-12December-12June-12June-12June-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12December-12May-12December-12December-12December-12December-13December-12December-12December-12December-12March-12December-12December-12June-12December-12December-12December-12September-12December-12December-12December-12December-12December-12December-12December-13December-12December-12December-12December-12December-12December-12February-12December-12December-12December-12December-12December-12December-12December-12September-12December-12December-12December-12October-12December-12December-12December-12December-12December-12December-12September-12December-12December-12December-12December-13December-12December-12December-12December-12December-12December-12December-12September-12December-13December-12December-12December-12December-12December-12December-12June-12December-12Due Date:May-13May-13May-13May-13May-13May-13May-13Nov-12Nov-12May-13May-13May-13February-13May-13May-13May-13May-13February-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13Nov-12May-13May-1313-May13-May13-May13-May13-MayMay-13May-13May-13May-13Nov-12Nov-12Nov-12May-13May-13May-13May-13May-13December-12May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13Oct-12May-13May-13May-13May-13May-13May-13May-13May-13Aug-12May-13May-13Nov-12May-13May-13May-13November-12February-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13July-12May-13May-13May-13May-13May-13May-13May-13February-13May-13May-13May-13March-12May-13May-13May-13May-13May-13May-13February-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13May-13February-13May-13May-13May-13May-13May-13May-13May-13Nov-12May-13Date Received:REVISED 6/20/20135/9/135/9/135/9/135/16/135/31/135/31/13revised 8/14/2013revised 8/14/2013revised 7/29/20135/29/13revised 7/25/20133/26/13REVISED 7/2/2013CLOSE-OUTCLOSE-OUT5/31/132/20/13REVISED 7/2/2013revised 7/29/2013revised 7/29/20136/5/135/29/136/3/13REVISED 7/2/20135/23/135/29/135/14/135/30/13REVISED 7/2/20139/3/131/30/135/28/135/31/134/11/136/3/135/31/135/28/135/29/13reviseed 7/29/2013revised 7/29/2013revised 7/29/2013revised 7/29/2013revised 7/29/20135/29/13revised 5/28/2013revised 6/4/20135/30/135/23/135/23/135/23/135/23/135/23/134/11/135/29/13REVISED 7/2/20135/21/13REVISED 4/1/2013REVISED 8/26/2013revised 8/26/20135/29/135/31/135/30/134/11/135/31/136/3/135/29/135/29/135/29/135/29/135/29/135/29/13revised 8/26/20135/29/135/28/135/28/13REVISED 5/15/20135/31/135/16/136/28/136/19/135/31/135/29/135/31/135/31/137/23/125/30/13REVISED 7/2/20131/2/135/30/13REVISED 7/2/20134/11/134/23/13REVISED 6/27/20135/30/135/29/135/28/135/31/133/21/134/29/135/28/134/11/135/28/135/14/135/21/136/5/137/13/12REVISED 7/2/20136/10/135/14/135/31/135/31/135/31/135/31/13revised 7/30/2013revised 6/11/20134/29/136/5/135/14/136/5/135/3/135/31/135/29/135/31/135/31/13revised 3/27/20134/29/134/29/13REVISED 7/2/20135/3/134/11/134/11/137/8/135/28/135/28/135/31/135/28/13revised 7/29/20135/31/135/31/135/30/134/29/135/20/13REVISED 5/1/2013revised 6/18/201311/8/125/30/13Schedule 1: Nursing Facility InformationCLOSE OUTNEW ONWERCLOSURE NEW OWNERProvider Facility1.1Department of Health Services License Number: NCI-2694NCI-2687NCI-2663NCI-2657NCI-363NCI-390NCI-2656NCI-447NCI-212NCI-2641NCI-2643NCI-2677NCI-256NCI-345NCI-422NCI-424NCI-272NCI-2680NCI-2634NCI-2642NCI-2693NCI-322NCI-356NCI-412NCI-2637NCI-2696NCI-351NCI-2625NCI-306NCI-237NCI-318NCI-2652NCI-378NCI-2702NCI-421NCI-2658NCI-2630NCI-1979NCI-330NCI-339NCI-313NCI-1500NCI-321NCI-399NCI-2667NCI-2617NCI-235NCI-355NCI-2682NCI-2683NCI-2684NCI-2685NCI-2686NCI-419NCI-2650NCI-159NCI-066NCI-338NCI-323NCI-348NCI-408NCI-2672NCI-402NCI-369NCI-1718NCI-1209NCI-387NCI-381NCI-400NCI-395NCI-392NCI-1251NCI-396NCI-391NCI-382NCI-406NCI-2666NCI-2659NCI-046NCI-2670NCI-379NCI-2675NCI-372NCI-2674NCI-2638NCI-446NCI-358NCI-2647NCI-301NCI-2668NCI-2636NCI-2684NCI-2684NCI-253NCI-2639NCI-430NCI-2655NCI-2673NCI-2631NCI-336NCI-2661NCI-334NCI-343NCI-2688NCI-2690NCI-2690NCI-2668NCI-342NCI-279NCI-2649NCI - 2621NCI-2701NCI-2697NCI-2703NCI-2700NCI-312NCI-276NCI-068NCI-2691NCI-418NCI-2671NCI-2678NCI-2676NCI-359NCI-1468NCI-2654NCI-258NCI-2648NCI-050NCI-2689NCI-2679NCI-2645NCI-2644NCI-2646NCI-2664NCI - 2635NCI-2515NCI-2660NCI-232NCI-2681NCI-2616NCI-2695NCI-263NCI-2669NCI-327NCI-411NCI-2284NCI-3651.2Facility Name:Acacia Health Center Advanced Healthcare of GlendaleAHC of ScottsdaleAdvanced Healthcare of MesaFoothill Care Center, LLCArchstone Care CenterILHC of Phoenix, LLCARIZONA STATE VETERAN HOME-PHOENIXARIZONA STATE VETERANS HOME-TUCSONAvalon Care Center - ScottsdaleAvalon Care Center - Tuscan, LLCBanner Boswell Rehabilitation CenterThe Beatitudes CampusGlendale Healthcare Associates LLCBrighton Gardens of ScottsdaleBrighton Gardens of Sun CityCapri Care CenterCareMeridian-PhoenixPresidio Health Associates LLCAvalon Care Center - Chandler, LLCEmeriCare Inc.Christian Care Nursing Center, Inc.LIFE CARE CENTERS OF AMERICA, INC.Copper Mountain Inn, Inc.North Mountain Healthcare LLCWalnuts Holding, LLCCHANDLER UNITED MEDICAL INVESTORS LPDesert Haven Care CenterKingman #1, LLC24th Street Healthcare Associates LLCDevon Gables Health Care CetnerDevon Gables Rehabiliation CenterEstrella Care & RehabFoothills Rehabilitation Center, LLCThe Forum at Desert HarborFountain View VillageARC HDV, LLCHealthcare Management Professionals Inc.LIFE CARE CENTERS OF AMERCIA, INC.The Evangelical Lutheran Good Samartian SocietyThe Evangelical Lutheran Good Samaritan SocietyThe Evangelical Lutheran Good Samaritan SocietyThe Evangelical Lutheran Good Samaritan SocietyThe Evangelical Lutheran Good Samaritan SocietyPHOENIX HEALTHCARE, LLCHacienda Skilled Nursing FacilityHandmaker Services of the AgingHavasu Nursing Center #2, Inc.Red Rock Care and Rehab, IncLa Solana Care and Rehab, IncPonderosa Pines Care and Rehab, IncSunset Hills Care and Rehab, IncTall Pines Care and Rehab, IncThe Forum at TucsonGLOBE MEDICAL INVESTORS, LLCHighland Healthcare LLCImmanuel Campus of CareKindred Nursing and Rehabilitation-HaciendaKindred Nursing Centers West, LLCKindred Nursing Centers West, LLCLIFE CARE CENTERS OF AMERICA, INC.Pinnacle Health Facilities XXV, LPLa Posada at Park Centre, Inc.LaMesa Health Care CenterLa Rosa Healthcare CenterNasazi Health Care, Inc.LIFE CARE CENTERS OF AMERICA, INC.GLENDALE MEDICAL INVESTORS L.P.LIFE CARE CENTERS OF AMERICA, INC.COVE ASSOCIATES JOINT VENTURESIERRA VISTA MEDICAL INVESTORS L.P.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INCLIFE CARE CENTERS OF AMERCIA, INC.LIFESTREAM COMPLETE AT COOK HEALTH CARELIFESTREAM COMPLETE AT SUN RIDGEManor Care of Tucson AZ, LLCPinnacle Health Facilities XXI, LPSenior Living Options Maryland Gardens, LLCWindsor Maryland Gardens, LLCSouthwestern Medical Centers - AZ, Inc.Pinnacle Health Facilities XXVI, LPMESA UNITED MEDICAL INVESTORS L.P.Pinnacle Health Facilities XXVI, LPSunland Health Associates LLCMOUNTAIN VIEW C.C.Sandretto Hills Nursing Center #2, Inc.Radiant Hills Health Associates LLCNorthern Cochise Community HospitalOASIS PAVILION NURSING & REHABILITATIONRenewCare of Scosttsdale, Inc.Palm Valley Rehab & Care CenterSenior Living Options, LLCAFS of Yuma, IncPark Waverly Healthcare LLCPark Regency Care CenterPAYSON UNITED MEDICAL INVESTORS LTD.PHOENIX MOUNTAIN NURSING CENTERAmerican Retirement CorporationPlaza Health Care, Inc.Plaza HC Holding Co., LLCFriendship Retirement CorporationPueblo Norte Senior Living CenterQuince Holdings, LLCSLO RidgeCrest LLC dbaWindsor RidgeCrest LLCRIM COUNTRY REHAB, INC.People of Faith, Inc.Ensign Sabino LLCSanta Rita Nursing & Rehab CenterSRCV-Rosa LLCSant Chandler, LLCAsante of Mesa, LLCScottsdale Op Co, LLCAsante TRC of Surprise, LLCSCOTTSDALE HERITAGE COURTScottsdale Nursing & Rahab CenterScottsdale Residential Care InvestorsSIERRA BLANCA REHABILITATION CENTER LLCSierra WindsSplendidoSpringdale VillagePinnacle Health Facilities XXVI, LPLIFE CARE CENTERS OF AMERICA, INC.Sun Health Grandview Terrace, LLPSun Health La Loma Senior Living Services, Inc.SUN VALLEY LODGEAzore LLCSuncrest Healthcare CenterYoungtown Health, Inc.Symphony of MesaGardens of ScottsdaleGardens of Sun CityTempe Life Care Village, Inc.Silver Ridge Management IncThe Lingenfelter Center, LTDNorthern Arizona Senior Living Community, LLCRiver Gardens Rehab & Care CenterThe Terraces of PhoenixVerde Vista Care and Rehab, IncVi at Grayhawk, A Vi and Plaza Companies CommunityVi at Silverstone, A Vi and Plaza Companies CommunityVilla Maria Care CenterWellsprings of GilbertWestchester Care CenterWestminster VillageWinslow Campus of CareYuma Nursing Center #2, Inc.1.3DBA (if applicable):sameApache Junction Health CenterArizona Grand Senior Living CommunityAvalon Care Center - Shadow MountainSouthwest Health and Rehabilitation0Bella Vita Health and RehabilitationBrighton Gardens of ScottsdaleBrighton Gardens of Sun City0Catalina Care & RehabilitationChandler Health Care CenterChris Ridge Premier Care and RehabChristian Care Health CenterCITADEL CARE CTR.Copper Mountain Inn Coronado Care CenterDesert Blossom Health & Rehab CenterDESERT COVE NURSING CENTERDesert Highlands Care CenterDesert Terrace Nursing & RehabilitationFreedom Plaza Care CenterThe Gardens Rehab & Care CenterGLENDALE CARE CENTERGood Samaritan Society - Mesa Good ShepherdGood Samaritan Society - Peoria Good ShepherdGood Samaritan Society - Prescott ValleyGood Samaritan Society - Prescott VillageGood Samaritan Society - Quiburi MissionGRACE HEALTHCARE OF PHOENIXN/AHavasu Nursing Center00000HERITAGE HEALTH CARE CENTERHighland Manor Health & Rehabilitation Kindred Nursing Centers West, LLCKindred Transitional Care and Rehabilitation-NorthwestKindred Transitional Care and Rehabilitation-Kachina PointLA CANADA CARE CENTERLa Estancia Nursing and Rehabilitation CenterLa Hacienda at La PosadaLake Hills InnLAS FUENTES CARE CTR.LIFE CARE CENTER OF NORTH GLENDALELIFE CARE CENTER OF PARADISE VALLEYLIFE CARE CENTER OF SCOTTSDALELIFE CARE CENTER OF SIERRA VISTALIFE CARE CENTER AT SOUTH MOUNTAINLIFE CARE CENTER OF TUCSONLIFE CARE CENTER OF YUMAManorCare Health Services TucsonMaravilla Care CenterMaryland Gardens Care CenterMaryland Gardens Care CenterMeadow Park Care CenterMesa Christian Health and Rehabilitation CenterMI CASA NURSING CTR.Mission Palms of Mesa Health and Rehabilitation CenterMontecito Care0Mountain View ManorNorth Mountain Medical & Rehabilitationn/aOsborn Health and RehabilitationPalm Valley Rehab & Care CenterPalm View Rehabilitation & Care CenterPark Avenue Health and RehabilitationPAYSON CARE CENTERPlaza Del Rio Care Center0Plaza Health CareProvidence Place at GlencroftPueblo Springs Rehab CenterRidgecrest HealthcareRidgecrest HealthcareRIM COUNTRY HEALTH & RETIREMENT COMMUNITYRoyal OaksSabino Canyon Rehab. & CareSanta Rita Nursing & Rehab CenterSanta Rosa Care CenterSant of ChandlerSant of MesaSante of North ScottsdaleSant of Surprise0Scottsdale Village SquareSonora at SplendidoSun City Health and Rehabilitation CenterSUN GROVE VILLAGE CARE CTR.Sun Health Grandview Care CenterSun Health La Loma Care CenterN/ASunwest Choice HealthcareSunview Health and Rehabilitation CenterFriendship Village of TempeThe Legacy Rehab & Care CenterThe Peaks, A Senior Living Community00Villa Maria Care Center LLCVolunteers of America Care Facilities0Yuma Nursing Center1.4Facility Phone Number:(305)-256-3509602-732-3400480-214-4200480-214-2400480-983-0700480.821.1268602-954-9178602-248-1550(520) 638-2150(480) 860-1766(520) 294-0005623-832-7000602-995-2611480-941-2222623-933-2222(602)944-1574(602)687-1100520-795-9574480-899-6717602-433-6300602-861-3241480-832-5555925.425.5721602-256-7500(480) 832-3903480-899-0641928-753-5580602-273-1347520-296-6181520-296-6181(623) -932-2282520-733-8700623-972-0995480.836.5000(623) 815-6100928-718-0718623-247-3949480-981-0098623-875-0100928-775-0045928-778-2450520-586-2372602-264-3824602-243-4231520-881-2323928-453-1500928-634-5548520-364-7937928-779-6931928-428-4910928-537-5333520-325-4800928-425-3118602-264-9039623-977-8373(520) 459-4900(520) 297-8311(928) 284-1000520-797-1191480-759-0358520-648-8380928-344-8541(520) 742-6242928.505.5552928-778-9603602-843-8433602-867-0212480-860-6396520-458-1050602-243-2780520-575-0900928-344-0425(623) 933-3333(623) 933-3333520-299-7088602-243-6121602-265-7484602-265-7484928/778-9667480-833-3988480-981-0687480-832-5160480-832-8333502-797-2600928-778-4837602-218-9483520-384-3541(520) 421-4960480-994-133313575 W. McDowell Road13575 W. McDowell Road928-783-8831520-882-6151480-345-8500928-474-6896602-996-5200623-933-7722(480) 990-1904(480) 990-1904623-939-9475480-948-3990(520) 296-2306(602)482-6671(602)482-6671(928) 474-1120623-933-2807520-722-5515520-795-1610480-361-6636480-699-9624480-588-5386623-594-5050480-949-5400480-947-7443480-946-6571(928) 368-2060623-298-0762520.878.2705480-981-8844623-933-0022623-566-0642623-975-8100623-537-7400623-933-0137623-584-6161602-305-7134603-977-6532480-941-2222623-933-2222480-831-3184928-763-1404928-718-4852928-774-7106928-763-8700602-944-4455928-567-5253408-361-3200480-478-6200520-323-9351480-729-6500480-831-8660480-451-2000928-289-4678928-726-67001.5Facility Physical Address:4555 East Mayo Blvd17001 N. 63rd Avenue9846 N. 95th Street5755 East Main Street2012 W Southern Ave1980 W Pecos Rd4602 North 24th Street4141 NORTH THIRD ST.555 E AJO WAY11150 N 92nd Street2900 E Milber Street10601 W. Santa Fe Drive1616 W. Glendale Avenue6001 East Thomas Road17225 Boswell Boulevard1501 E Orangewood5301 E Thomas Road2611 North Warren Avenue2121 West Elgin Street6246 N. 19th Avenue11812 N 19th Ave5121 E BROADWAY1100 Monroe Street11411 North 19th Avenue60 South 58th Street1750 W FRYE ROAD2645 East Thomas Road1081 Kathleen Ave2509 N 24th Street6150 E. Grant Rd.6150 E Grant Road350 East LaCanada2250 North Craycroft Road13840 N. Desert Harbor Dr.16455 East Ave of the Fountains13714 N. Plaza Del Rio Blvd.3131 Western Ave4704 W DIANA AVE5848 E. University Drive10323 W. Olive Avenue3380 N Windsong Drive1030 Scott Drive850 South Hwy 804202 N. 20TH AVE2401 E South Mountain Ave.2221 N. Rosemont Blvd3576 Kearsage Drive197 South Willard St.1400 San Antonio Avenue800 West University Ave1933 Peppertree Dr2401 East Hunt Street2500 Rosemont Blvd1300 SOUTH ST.4635 N 14th Street11301 N. 99th Ave.660 Coronado Drive1919 West Medical St.505 Jacks Canyon Road7970 N LA CANADA DR15810 South 42nd St.700 South La Posada Circle2470 S. Arizona St.7500 North Calle Sin Envidia2781 Osborn1045 SCOTT DRIVE13620 N 55TH AVE.4065 E BELL ROAD9494 E BECKER LANE2305 E WILCOX DRIVE8008 S JESSE OWENS PKWY6211 N LA CHOLLA BLVD2450 S 19TH AVE11527 W. PEORIA12215 W. BELL ROAD3705 N Swan Road8825 S 7th St31 W. Maryland Ave.31 W. Maryland Ave.864 Dougherty255 W. Brown Road330 S PINNULE CIRCLE6458 E. Broadway Road51 South 48th Street1313 W MAGEE ROAD1045 Sandretto Drive9155 N 3rd Street901 W Rex Allen Drive161 WEST RODEO ROAD3333 North Civic Center PlazaGoodyearGoodyear2222 S. Avenue A2001 N Park Avenue255 N Price Road107 E. LONE PINE DR.13232 N TATUM BLVD13215 N. 94th Drive1475 North Granite Reef Road1475 North Granite Reef Road8641 N 67th Ave7090 East Mescal St.5545 East Lee Street16640 North 38th Street16640 North 38th Street807 W. LONGHORN ROAD10025 W Royal Oak Rd5830 East Pima Street150 N. La Canada Drive1650 N. Santa Rosa Avenue825 S. 94th St 5358 E. Baseline Rd.17490 N. 93rd Street14775 West Yorkshire Dr. 3339 N DRINKWATER BLVD3293 Drinkwater Blvd.2620 N. 68th Street3401 N. LOCKWOOD DRIVE17300 N 88th Ave13500 N. Rancho Vistoso Blvd7255 East Broadway Road9940 Western Union Hills Dr.20625 N LAKE PLEASANT DR14505 W. Granite Valley Dr14260 Denny Blvd.12415 N. 103rd Ave.14002 W. Meeker Blvd2211 E Southern Ave12207 North 113th Avenue3130 East Broadway Road6001 E. Thomas Road17225 N. Boswell Blvd2525 E Southern Avenue2812 Silver Creek Road1099 Sunrise Ave3150 N. Winding Brook Rd.2150 Silver Creek Road7550 N 16th St15 East Highway 2607501 E Thompson Peak Pkwy22605 N 74th Street4310 E. Grant Road3319 S. Mercy Gilbert6100 South Rural Road12000 North 90th St.826 W. Desmond Street1850 West 25th Street1.6 City:PhoenixGlendaleScottsdaleMesaApache JunctionChandlerPhoenixPHOENIXTUCSONScottsdaleTucsonSun CityPhoenixGlendaleScottsdaleSun CityPhoenixPhoenixTucsonChandler PhoenixPhoenixMESAGlobePhoenixMesaCHANDLERPhoenixKingmanPhoenixTusconPhoenix AvondaleTucsonPeoriaFountain HillsPeoriaKingmanGLENDALEMesaPeoriaPrescott ValleyPrescottBensonPHOENIXPhoenixTucsonLake Havasu CityCottonwoodDouglasFlagstaffSaffordShow LowTucsonGLOBEPhoenixPeoriaSierra VistaTucsonSedonaTUCSONPhoenixGreen ValleyYumaTucsonLake Havasu CityPRESCOTTGLENDALEPHOENIXSCOTTSDALESIERRA VISTA PHOENIXTUCSONYUMAYOUNGTOWNSURPRISETucsonPhoenixPhoenixPhoenixPrescottMesaMESAMesaMesaTUCSONPrescottPhoenixWillcoxCASA GRANDEScottsdaleArizonaArizonaYumaTucsonChandlerPAYSONPHOENIXPeoriaScottsdaleScottsdaleGlendaleScottsdaleTucsonPhoenixPhoenixPAYSONSun CityTucsonGreen ValleyTucsonChandlerMesa ScottsdaleSurpriseSCOTTSDALEScottsdale ScottsdaleLAKESIDEPeoriaTucsonMesaSun CityPEORIASun City WestLitchfield ParkSun CitySun City WestPhoenixYoungtown MesaScottsdaleSun CityTempeBullhead CityKingmanFlagstaffBullhead CityPhoenixCamp VerdeScottsdaleScottsdaleTucsonGilbertTempeScottsdaleWinslow Yuma1.7 State:AZAZAZAZArizonaAZArizonaARIZONAARIZONAArizonaArizonaAZAZArizonaArizonaArizonaArizonaAZArizonaArizonaAZAZAZAZArizonaArizonaAZAZAZArizonaAZAZAZAZAZAZArizonaAZAZArizonaArizonaArizonaArizonaArizonaARIZONAAZAZAZAZAZAZAZAZAZAZArizonaAZAZAZAZAZAZArizonaAZAZAZAZAZAZAZAZAZAZAZARIZONAARIZONAAZArizonaAZAZAZArizonaAZArizonaArizonaAZAZArizonaAZARIZONAAZ8533885338AZArizonaAZAZARIZONAAZArizonaArizonaAZAZArizonaAZAZARIZONAAzArizonaArizonaArizonaArizonaArizonaAZArizonaAZArizonaArizonaARIZONAAZAZAZArizonaAZAZAZAZAZ AZArizonaAZAZAZAZArizonaAZArizonaArizonaAZAZArizonaArizonaArizonaAzArizonaAZAZAZ1.8 Zip Code:3806085308852588520585220852248501685012857138526085714-209785351850218530185251853738501885719-31608522485015-151185029852068550185029-3699852068522486401-391885008-1805857128571285353857128538185268-830785381864018530285205-744685345-734586314-226286301-179385602-698885015850428571286406-91158632685607860018554685901857128550185014-40168534585635857048635185704850488561485364857188640686301853048503285260856358504085741853648536285374857188504285013850138630585201852068520685206-12508570486305-371785020-241085643851228525113575 W. McDowell Road13575 W. McDowell Road85364857198522385541850328538185257852578530285254857128503285032855418535185712-5611856148571285224852068525585374852518525185257859298538285755852088537385382853758534085351853758504085363-1208852048525185373852828644286401860018644285020863228525585255857128529785283852608604785364-69041.9 County:MaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaPIMAMaricopaPimaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaPimaMaricopaMaricopaMaricopaMARICOPAGilaMaricopaMaricopaMARICOPAMaricopaMohaveMaricopaPimaPimaMaricopaPimaMaricopaMaricopaMaricopaMohaveMARICOPAMaricopaMaricopaYavapaiYavapaiCochiseMARICOPAMaricopaMaricopaMohaveYavapaiCochiseCoconinoGrahamNavajoPimaGILAMaricopaCochisePimaYavapaiPIMAMaricopaPimaYumaPimaMohaveYAVAPAIMARICOPAMARICOPAMARICOPACOCHISEMARICOPAPIMAYUMAMARICOPAMARICOPAPimaMaricopaMaricopaMaricopaYavapaiMaripcopaMARICOPAMaricopaMaricopaPIMAYavapaiMaricopaCochisePINALMaricopaGoodyearGoodyearPimaMaricopaGILAMARICOPAMaricopa0MaricopaMaricopaPimaMaricopaMaricopaGILAMaricopaPimaPimaPimaMaricopaMaricopaMaricopaMaricopaMARICOPAMaricopaMaricopaNAVAJOMaricopaPimaMaricopaMaricopaMARICOPAMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMaricopaMohaveMohaveCoconinoMohaveMaricopaYavapaiMaicopaMaricopaPimaMaricopaMaricopaMaricopaNavajoYuma1.10Mailing Address: (If different from above)same as aboveSAME005121 E BROADWAYSame1750 W FRYE ROADSAME4704 W DIANA AVE0000001300 SOUTH ST.07970 N LA CANADA DRSame1045 SCOTT DRIVE13620 N 55TH AVE.4065 E BELL ROAD9494 E BECKER LANE2305 E WILCOX DRIVE8008 S JESSE OWENS PKWY6211 N LA CHOLLA BLVD2450 S 19TH AVE0Same as aboveSame as abovesame330 S PINNULE CIRCLE00107 E. LONE PINE DR.NA0SameSameSameSame0same as above20625 N LAKE PLEASANT DRN/AN/AsameSame as Above00001.11 City:00MESACHANDLERGLENDALE000000GLOBE0TUCSONPRESCOTTGLENDALEPHOENIXSCOTTSDALESIERRA VISTA PHOENIXTUCSONYUMA0MESA00ArizonaArizonaPAYSONNA00PEORIAN/AN/Asame00001.12 State:00AZAZAZ000000AZ0AZAZAZAZAZAZAZAZAZ0AZ008539585395AZNA00AZN/AN/Asame00001.13 Zip Code:0085206852248530200000085501085704863018530485032852608563585040857418536408520600MaricopaMaricopa85541NA0085382N/AN/Asame00001.14 County:00MARICOPAMARICOPAMARICOPA000000GILA0PIMAYAVAPAIMARICOPAMARICOPAMARICOPACOCHISEMARICOPAPIMAYUMA0MARICOPA00623-536-9911623-536-9911GILANA00MARICOPAN/AN/Asame00001.15Administrator:Patrick KinneyForrest ArnettJona PaganoLisa HarrisonMichael CalderonAllen DunlapKim TeBruggeCOLLEEN RUNDELLJAMES ROSSRobert TunilaNani GrayDavid CheneyMeryl SalitDoug HaneyKelly F. BojorquezWade W. VestWilton SyckesLara BowlesRob EagarEric FaasKeitha ReedKathy Loschedier, CNHAMARK MUIRPaula MitchellNicole WilsonSteven JonesLINDSEY GAYAlan BealVicki PhillipsPat HobbsHeather FreibusHeather FriebusDiana NeiceVirginia LeacockSusan GoadMelanie SeamansMichael OliverKristen OttCHERYL WARTENBERGLynden R. HeimanLinda D. ExnerDavid SteeleTerry McGinnityArjun PurvisMICHAEL MORRISBill TimmonsArthur MartinKen KidderCourtney FischbeckLeilani EichmanRichard AndersonBret KingSandra LewisPaige RyanMATT HAM(RVP)Santiago,Nigel IJai LarmanDenise IwertzDennis GrafJoanne ReeseDAVID KAFORAHerb CookSteve KolnackiCatherine OliverRichard ParkJanet LumpkinSUSAN BENDERKATHLEEN CONNOLLYMICHAEL JOHNSONSHONNA BRIGGS (INTERIM)MICHAEL FLEMING (INTERIM)BRETT HOBBSBARBARA YOUNGJEFFREY PITTARDSCOTT MEDLINBOB FRECHETTEWilliam AmoureuxJeffrey BarrettSean MockbeeSean MockbeeMike Calderon, LNFATodd CorlessMISTI VALENTINOGary KotzForrest PetersonMARIA MONTIONKathleen LangfordEli RobbinsRoland Knox, CEOSCOTT MORINRick Aznar-BeaneTara MockbeeTara MockbeeAdam MerrellEllen CoteAndrew QuinnSAMUEL LOVELESSSANDY BESTICMichael OliverDavid StarrettDavid StarrettAntonia HortonRoss MonacoChris RomneyHolly GibsonHolly GibsonHARVEY PEVLOSKYKendra EberhartChristine JonesLinda PalmerKim ArndtAmi Mendez SelfSteve NawahineJana McDonaldMICHELLE MARTINEZShawn McAffeyKen GreenMATTHEW MEYERJennifer NealonGail RankinGary DavisELLA BARNEYCheryl KnuppNancy WilsonMichael L. FaheyTerry GrangerDavid DeRushiaSean HillBlake GilmanKelly BojorquezSara VetchJayne ChristensenAmy ElsburyKristen OttNancy EmerickSue McCarthyAdam UtanCourtney FischbeckKatherine SchulzBonnie HazelwoodCindy LeachRussell WagnerDan BelisleTimothy KerseyBarbara BrownMary Alka1.16 Phone:(305)-256-3509602-732-3400480-214-4200480-214-2400480-983-0700480-821-1268602-954-9178602-248-1591(520) 780-9943(480) 860-1766(520) 294-0005623-832-5356602-995-6110923-931-5800480-941-2222623-933-2222602-944-1574(602)687-1100520-795-9574480-899-6717602-433-6404602-443-5439480-832-5555928.425.5721602-256-9500(480) 832-3903480-899-0641602-956-8000928-753-5580602-273-1347520-296-6181 x 5011520 296-6181(623) 932-2282520 733-8700623-972-0995480.836.4802(623) 815-6106928-718-0718623-247-3949480-854-3240623-875-0115928-775-0045928-778-2450520-586-2372602-264-3824602-243-4231, X 103520-547-6008928-453-1500928-634-5548520-364-7937928-779-6931928-428-4910928-537-5333520-325-4800928-425-3118(602 )264-9039623-977-8373 ext. 636520-459-4900520-297-8311928-284-1000520-797-1191480-759-0358520-648-8380928-344-8541(520) 742-6242 Ext. 258928.505.1404928-778-9603602-843-8433602-867-0212480-860-6396520-458-1050602-243-2780520-575-0900928-344-0425520-299-7088602-243-6121602-265-7484602-265-7484928/778-9667480-833-3988480-981-0687480-832-5160480-832-8333502-797-2600928-778-4837602-218-9483520-384-3541(520) 421-4960480-990-1333623-536-9911623-536-9911928-783-8831520-882-5161480-345-8500928-474-6896602-996-5200(623) 815-6106(480) 990-1904(480) 990-1904623-847-3016480-948-3990(520) 296-2306602-482-6671602-482-6671(928) 474-1120623-815-4116520-722-5515520-625-0168520-795-1610 ext# 102480-361-6636480-699-9624480-588-5386623-594-5050480-949-5400480-947-7443480-946-6571(928) 368-2060623-972-0212520.878.2651623-933-0022623-566-0642623-975-8040623-975-7440623-933-0137623-584-6161602-305-7134603-977-6532480-941-2222623-933-2222480-831-3107928-763-1404928-718-4852928-774-7106928-763-8700602-944-4455928-567-5253408-361-3232480-478-6200520-323-9351480-831-8660480-451-2024928-289-4678928-726-67001.17 Email Address:kinneypatrick@sagewoodlcs.comfarnett@ahcfacilities.comahcscottsdale@yahoo.comlharrison@ahcfacilities.commcalderon@ajsnf.comadunlap@eschelon.comkim.tebrugge@arizonagrand.orgcrundell@azdvs.govjross@azdvs.govrtunila@avalonhci.comngray@avalonhci.comdavid.cheney@bannerhealth.commsalit@beatitudescampus.orgdhaney@ensigngroup.netscottsdale.ed@sunriseseniorliving.comsuncity.ed@sunriseseniorliving.comlbowles@caremeridian.comredgar@ensigngroup.netefaas@avalonhci.comChrisRidge-ED2@Emeritus.comkathy.loscheider@christiancare.orgmark_muir@lcca.comadmincmi@cybertrails.comnwilson@ensigngroup.netsjones@plumh.comlindsey_gay@lcca.comfxdl.02@cox.netdesertadmin@npgcable.comphobbs@ensigngroup.nethfriebus@devongables.comhfriebus@devongables.comdiana.neice@sunh.comadministrator@foothillsrehabcenter.comSgoad@5SQC.COMmseamans@seniorlifestyle.comMoliver@brookdaleliving.comkott@creativecare.cccheryl_wartenberg@lcca.comlheiman@good-sam.comlexner@good-sam.comdsteele1@good-sam.comtmcginni@good-sam.comapurvis@good-sam.comPHADMI@GRACEHC.COMBillTimmons@haciendainc.orgamartin@handmaker.orghavasuadmin@npgcable.comcafischbeck@havenhg.comleichman@havenhg.comrwanderson@havenhg.combcking@havenhg.comslewis@havenhg.comPryan@5sqc.commatthew_ham@lcca.comNsantiago@ensigngroup.netjlarman@watermarkcommunities.comDenise.Iwertz@kindred.comDennis.Graf@kindred.comJoanne.Reese@kindred.comdavid_kafora@lcca.comherb.cook@pcitexas.netsteven@laposadagv.comJdodd@5sqc.comripark@brookdaleliving.comlhiadmin@ctaz.comsusan_bender@lcca.comkathleen_connolly@lcca.commichael_johnson@lcca.comshonna_briggs@lcca.commichael_fleming@lcca.combrett_hobbs@lcca.combarbara_young@lcca.comjeffrey_pittard@lcca.comSMedlin@lifestreamliving.combfrechette@LifeStreamLiving.com498admin@hcr-manorcare.comJeffreys.Barrett@pcitexas.netsmockbee@marylandgardens.comsmockbee@windsorcares.comadministrator@meadowparkcare.comTodd.Corless@pcitexas.netmisti_valentino@lcca.comGary.Kotz@pcitexas.netfspeterson@ensigngroup.netmaria_montion@lcca.commountainadm@cable.neterobbins@ensigngroup.netrknox@ncch.comrabeane@ensigngroup.nettmockbee@palmvalleyrehab.comtmockbee@palmvalleyrehab.comAdam.Merrell@KissitoHealthcare.Orgecote@ensigngroup.netaquinn@brookdaleliving.comsamuel_loveless@lcca.comsandybestic@hotmail.comMoliver@brookdaleliving.com0toni@glencroft.comRmonaco@5sqc.comcromney@plumh.comhgibson@windsorcares.comhgibson@windsorcares.comkeberhart@royaloaks.comcjones@ensigngroup.netadministrator@santaritacare.comadmin@srccaz.comamendez@santemesa.comSteve.Nawahine@SanteNorth.comjmcdonald@santesurprise.commichelle_martinez@lcca.comsmcaffey@scottsdalenursing.comnealonjennifer@lcsnet.comgrankin@Splendidotucson.comgary.davis@pcitexas.netella_barney@lcca.comcheryl.knupp@sunhealthsl.orgnancy.wilson@sunhealthsl.orgmichael@sunvalleylodge.orgsuncrest@ahahealthcare.comsehill@ensignroup.netKbojorquez@5sqc.comSvetch@5sqc.comchristensenjayne@friendshipvillageaz.comaelsbury@thelegacyrehab.comkott@creativecare.ccnancy.emerick@thepeaks.orgsmccarthy@rivergardensrehab.comautan@abhow.comcafischbeck@havenhg.comkschulz@viliving.combhazelwood@viliving.comdbelisle@voa.orgtim.kersey@wmvaz.combbrown@winslowcc.comyumaadm@hotmail.com1.18Chief Financial Officer:David BennettMark EmmettMark EmmettMark EmmettN/AK. Robert Evenson, Jr.n/aNeeraj DeshpandeNEERAJ DESHPANDEBob WoltilBob Woltiljeremy williamsAllen BlochSuzanne SnapperMarc RichardsMarc RichardsMary Beth FormbySuzanne SnapperBob WoltilRobert BatemanDavid Klemm, CPAKATHY WOJCIKJoyce HumistonSuzanne SnapperWENDY VENRICKCliff ShirrellSuzanne SnapperA. Richard TischlerAvi RothnerGreg SanchezAvi RothnerPaul V. HoaglandTim AdamsSandy DangeloPatrick NugentTINA LLATARaye Nae NylanderRaye Nae NylanderRaye Nae NylanderRaye Nae NylanderRaye Nae NylanderALICE MARIE CLARK DANKSChristine McNamaraCliff ShirrellMatt BradyMatt BradyMatt BradyMatt BradyMatt BradyPaul V. HoaglandGINGER FAUCETTESuzanne SnapperRichard LechleiterRichard LechleiterRichard LechleiterKARENA HIGUERATom Patterson - Management CompanyPaul S. IdePaul V. HoaglandMark OhlendorfJoyce HumistonTERRI HARWOODREGINA CADENASUZANNE ZINDARSVERONICA PAJUYOCORRIE DUTTONSUE PRUDENCIODANIEL MEDEIROSLORA FLOWERSRONALD E. ESTESRONALD E. ESTESMatthew S. KangTom Patterson - Management CompanyLynnea Castillo, CPATom Patterson - Management CompanyAMANDA PETERSONTom Patterson - Management CompanySuzanne SnapperJUANITA SKIDMORECliff ShirrellSuzanne SnapperDarcy RobertsonJOSEPH A. MARTINSuzanne SnapperRoss RichardsonRoss RichardsonLori HuffmanSuzanne SnapperMark OhlendorfAMANDA SNOWBRUCE HARKINSSandy DangeloLee FormanLee FormanSusan M HornbostelPaul V. HoaglandDon McKeanDon McKeanJOSEPH A. MARTINDonald F. MaySuzanne SnapperPaul KoslokyAlan BealBrenda JensenLori WelchLori SmithSHELLY MARTINTeri StarkweatherNAJOSEPH A. MARTINSally WilliamsCarol SussenbachTom Patterson - Management CompanyDEBRA SCHULZEWilliam T. SellnerWilliam T. SellnerN/AMark GarberMichelle ZimbelmanSuzanne SnapperRichard A. DoyleRichard A. DoyleTerry BellesPatrick NugentPatrick Nugentn/aPatrick NugentPamela ClaassenMatt BradyMichelle GammageThomas HarperCarol BaumNancy GavinBud HartCathy WilliamsCliff Shirrell1.19 Phone:(480) 384-5600720-213-1776614.459.0445n/a602-234-8419(602) 234-8419(801) 596-8844(801) 596-8844623-832-4951602-995-6112949-487-9500703-854-0830703-854-0830(949) 263-6633949-487-9500801-596-8844206-378-4188602-443-5451480-832-5555970.516.1404949-487-9500480-899-0641573-471-1276949-487-9500248-642-2914847 905-4000(505) 468-4948847 905-4000617-796-8387312.673.4406(623) 876-2436928-718-4852623-247-3949605-362-3100605-362-3100605-362-3100605-362-3100605-362-3100423-308-1845520-322-3625573-471-1276801-296-5100801-296-5131801-296-5100801-296-5100801-296-5100617-796-8387928-425-3118(949) 487-9500502-596-7300502-596-7300502-596-7300520-797-1191972-930-8177520-648-7901617-796-8387(414) 918-5000970.516.1404928-778-9603602-843-8433602-867-0212480-860-6396520-458-1050602-243-2780520-575-0900928-344-0425(623) 933-3333(623) 933-3333419-254-7728972-930-8177210/828-5686 x5003972-930-8177480-981-0687972-930-8177949-487-9500502-797-2600573-471-1276949-487-9500520-384-8533(602) 265-1455949-487-9500540-265-0322949-487-9500414-918-5000928-474-6896816-734-0533(623) 876-24360623-847-3006617-796-8387602-482-6671602-482-6671(602) 265-1455623-815-4129949-487-9500925-631-9100602-956-8000480-699-9624480-588-5386623-594-5050480-949-5400949-240-2423(602) 265-1455623-972-0212847.492.6760972-930-8177623-566-0642623-832-6616623-832-6616N/A541-746-1020816-232-9573949-487-9500617-796-8387617-796-8387480-831-3225928-718-4852928-718-4852n/a928-718-4852925-924-7100801-296-5100408-361-3200480-478-6130602-368-8203952-983-4249480-451-2004623-256-02343573-471-12761.20 Email Address:bennettdavid@sagewoodlcs.commemmett@ahcfacilities.commemmett@ahcfacilities.commemmett@ahcfacilities.combevenson@rrohio.comn/andeshpande@azdvs.govndeshpande@azdvs.govN/AN/Ajeremy.williams@bannerhealth.comabloch@beatitudescampus.orgssnapper@ensigngroup.netmformby@caremeridian.comssnapper@ensigngroup.netN/ADavid.Klemm@ChristianCAre.orgkathy_wojcik@lcca.comJhumiston@cghealthinc.netssnapper@ensigngroup.netwendy_venrick@lcca.comcshirrell@nmassociates.netssnapper@ensigngroup.netmitchkantor@aol.comarothner@huntermgt.comgsanchez2@corp.genesishcc.comarothner@huntermgt.comPhoagland@5sqc.comtadams@seniorlifestyle.comSdangelo@brookdaleliving.compnugent@creativecare.cctina_llata@lcca.comN/AN/AN/AN/AN/AADANKS@GRACEHC.COMcmcnamara@handmaker.orgcshirrell@nmassociates.netmbrady@havenhg.commbrady@havenhg.commbrady@havenhg.commbrady@havenhg.commbrady@havenhg.comPhoagland@5sqc.comginger_faucette@lcca.comssnapper@ensigngroup.netrich.lechleiter@kindred.comrich.lechleiter@kindred.comrich.lechleiter@kindred.comkarena_higuera@lcca.compaul@laposadagv.comPhoagland@5sqc.comohlendorf@yahoo.comJhumiston@cghealthinc.netterri_harwood@lcca.comregina_cadena@lcca.comsuzanne_zindars@lcca.comveronica_pajuyo@lcca.comcorrie_dutton@lcca.comsue_prudencio@lcca.comdaniel_medeiros@lcca.comlora_flowers@lcca.comRestes@lifestreamliving.comrestes@LifeStreamLiving.commkang@hcr-manorcare.comlcastillo@touchstone-communities.comamanda_peterson@lcca.comssnapper@ensigngroup.netjuanita_skidmore@lcca.comcshirrell@nmassociates.netssnapper@ensigngroup.netdrobertson@ncch.commartinjcpa@aol.comssnapper@ensigngroup.netLori.Huffman@KissitoHealthcare.Orgssnapper@ensigngroup.netmohlendorf@brookdalelinving.comamanda_snow@lcca.combruce-harkins@kc.rr.comSdangelo@brookdaleliving.com0susan@glencroft.comPhoagland@5sqc.comdmckean@windsorcares.comdmckean@windsorcares.commartinjcpa@aol.comdmay@royaloaks.comssnapper@ensigngroup.netPaul@mpfi.comfxdl.02@cox.netbjensen@santemesa.comLWelch@santenorth.comlsmith@santesurprise.comshelly_martin@lcca.comtstarkweather@nahci.commartinjcpa@aol.comswilliams@sierrawinds.comdebra_schulze@lcca.combill.sellner@sunhealthsl.orgbill.sellner@sunhealthsl.orgN/Amichellez@ahahealthcare.comssnapper@ensigngroup.netRdoyle@snhreit.comRdoyle@snhreit.combellesterry@friendshipvillageaz.compnugent@creativecare.ccpnugent@creativecare.ccn/apnugent@creativecare.cc0mbrady@havenhg.commgammage@viliving.comtharper@viliving.comcbaum@coppersandinc.comngavin@voa.orgbud.hart@wmvaz.comcwilliams@qwest.netcshirrell@nmassociates.net1.21Person Providing Information:David BennettMark EmmettMark EmmettMark EmmettCarol ArieteBrandy LuhmanNancy WeimerJoseph A. Martin, CPAJOSEPH A. MARTIN, CPAJeff MooreJeff MooreEric HofflanderCammy ClevengerMarc GlogowskyTony J. HarrisTony J. HarrisLarry LitmanBernard BarnuevoMarc GlogowskyJeff MooreJeff MooreJenna MeyerJOHN BINDERUPKimberly K. McKayMarc GlogowskyEllen SubiaJOHN BINDERUPLarry LitmanCliff ShirrellMarc GlogowskyStephen David - ABRShaindy KompelSid IngramShaindy KompelLori NelsonLeticia U GonzalezSandy DangeloLarry LitmanJOHN BINDERUPKim KouriKim KouriKim KouriKim KouriKim KouriJANAN MITCHELLJoseph O'MalleyLarry LitmanCliff ShirrellRyan CorneliusRyan CorneliusRyan CorneliusRyan CorneliusRyan CorneliusLori NelsonJOHN BINDERUPMarc GlogowskyBrian BurdetteJohn MeriwetherJohn MeriwetherJohn MeriwetherJOHN BINDERUPJamie Collier - Management CompanyKelly King-McDonaldLori NelsonKimberly K. McKayJOHN BINDERUPJOHN BINDERUPJOHN BINDERUPJOHN BINDERUPJOHN BINDERUPJOHN BINDERUPJOHN BINDERUPJOHN BINDERUPJOSEPH A. MARTINJOSEPH A. MARTINTori AbramsJamie Collier - Management CompanyAlison BestAlison BestSandra KincaidJamie Collier - Management CompanyJOHN BINDERUPJamie Collier - Management CompanyMarc GlogowskyJOHN BINDERUPCliff ShirrellMarc GlogowskyDarcy RobertsonMarc GlogowskyLarry LitmanLarry LitmanYun ZhangMarc GlogowskyDouglas C. Walters, CPAJOHN BINDERUPCHRIS HALESandy DangeloWilma BelardoWilma BelardoSusan M HornbostelLori NelsonEllen SubiaLarry LitmanLarry LitmanRhonda GrandonMarc GlogowskyLarry LitmanMichael R. HarrisLarry LitmanLarry LitmanLarry LitmanLarry LitmanJOHN BINDERUPTeri StarkweatherLarry LitmanBill Pray, Polaris GroupAnna D'SouzaLarry LitmanJamie Collier - Management CompanyJOHN BINDERUPJane SwansonJane SwansonJoyce LloydLarry LitmanAndrea KeppleMarc GlogowskyLarry LitmanLori NelsonLori NelsonBill PrayPolaris GroupLarry LitmanLarry LitmanMichael SluisLarry LitmanZhen ZhangRyan CorneliusMatthew LongMatthew LongLarry LitmanLarry LitmanErica LeiterBill PrayPolaris GroupLarry LitmanCliff Shirrell1.22 Phone:(305)-256-3509720-213-1776720-213-1776720-213-1776480-983-0700480-821-1268952-361-8062602-265-1455(602) 265-1455(503) 244-2134(503) 244-2134602-747-4730602-433-6179(949) 487-9500703-854-0830703-854-0830602-789-8104949-494-0785(949)487-9500503-244-2134503-244-2134602-443-5412402-934-9682719.471.7290(949) 487-9500(760) 473-0388 ext 117402-934-9682602-789-8104573-471-1276(949) 487-9500562-624-9819847 905-3290(505) 468-6846847 905-3290303-973-9430312.673.4360(623) 876-2436602-789-8104402-934-9682605-362-3100605-362-3100605-362-3100605-362-3100605-362-3100423-308-1845602-243-4231, X 107602-300-8519573-471-1276801-296-5100801-296-5118801-296-5100801-296-5100801-296-5100303-973-9430402-934-9682(949)487-9500856-833-1700(502) 596-7510(502) 596-7510(502) 596-7510402-934-9682972-930-8122520-648-7905303-973-9430719.471.7290402-934-9682402-934-9682402-934-9682402-934-9682402-934-9682402-934-9682402-934-9682402-934-9682(602) 265-1455(602) 265-1455419-252-5540972-930-8122602-265-7484602-265-7484210/828-5686 x5044972-930-8122402-934-9682972-930-8122(949) 487-9500402-934-9682573-471-1276(949) 487-9500520-384-8533(949) 487-9500602-300-8519602-300-8519540-265-0322(949) 487-9500727-244-5978402-934-9682903-454-0261(623) 876-2436(818) 905-8000 ext 110(818) 905-8000 ext 110623-847-3006303-973-9430(760) 471-0388 ext 117602-789-8104602-789-8104623-815-4124(949) 487-9500602-789-8104520-795-1610 ext# 115602-300-8519602-300-8519602-300-8519602-300-8519402-934-9682949-240-2423602-789-8104800-275-6252847.492.5036602-789-8104972-930-8122402-934-9682623-832-4332623-832-4332623-933-0137602-789-8104515-963-1125(949) 487-9500602-789-8104303-973-9430303-973-9430800-275-6252602-789-8104602-789-8104952-361-8046602-789-8104925-924-7156801-296-5100904-923-1400904-923-1400602-300-8519602-300-8519952-983-4264800-275-6252602-789-8104573-471-12761.23 Email Address:bennettdavid@sagewoodlcs.commemmett@ahcfacilities.commemmett@ahcfacilities.commemmett@ahcfacilities.comajhc.billing@ajsnf.com bluhman@eschelon.comnweimer@thegoodmangroup.commartinjcpa@aol.commartinjcpa@aol.comjmoore@hhc-cpa.comjmoore@hhc-cpa.comeric.hofflander@bannerhealth.comcclevenger@beatitudescampus.orgmglogowsky@ensigngroup.nettony.harris@sunriseseniorliving.comtony.harris@sunriseseniorliving.comllitman@healthcaresystemsandservicesbbarnuevo@caremeridian.commglogowsky@ensigngroup.netjmoore@hhc-cpa.comjmoore@hhc-cpa.comjenna.meyer@christiancare.orgjohn_binderup@lcca.comkmckay@bkd.commglogowsky@ensigngroup.netellen@plumh.comjohn_binderup@lcca.comhealthcaresystems@earthlink.netcshirrell@nmassociates.netmglogowsky@ensigngroup.netsdavid@accure.bizskompel@altitudehs.comsid.ingram@sunh.comskompel@altitudehs.comLnelson@5Sqc.comlgonzalez@seniorlifestyle.comSdangelo@brookdaleliving.comllitman@healthcaresystemsandservices.comjohn_binderup@lcca.comkkouri@good-sam.comkkouri@good-sam.comkkouri@good-sam.comkkouri@good-sam.comkkouri@good-sam.comJANANM@GRACEHC.COMjomalley@haciendainc.orgllitman@healthcaresystemsandservices.comcshirrell@nmassociates.netrycornelius@havenhg.comrycornelius@havenhg.comrycornelius@havenhg.comrycornelius@havenhg.comrycornelius@havenhg.comLnelson@5Sqc.comjohn_binderup@lcca.commglogowsky@ensigngroup.netbburdette@knaupassociates.comJohn.Meriwether@kindred.comJohn.Meriwether@kindred.comJohn.Meriwether@kindred.comjohn_binderup@lcca.comjamie.collier@pcpmg.netkelly@laposadagv.comLnelson@5Sqc.comkmckay@bkd.comjohn_binderup@lcca.comjohn_binderup@lcca.comjohn_binderup@lcca.comjohn_binderup@lcca.comjohn_binderup@lcca.comjohn_binderup@lcca.comjohn_binderup@lcca.comjohn_binderup@lcca.commartinjcpa@aol.commartinjcpa@aol.comtabrams@hcr-manorcare.comjamie.collier@pcpmg.netabest@marylandgardens.comabest@windsorcares.comskincaid@touchstone-communities.comjamie.collier@pcpmg.netjohn_binderup@lcca.comjamie.collier@pcpmg.netmglogowsky@ensigngroup.netjohn_binderup@lcca.comcshirrell@nmassociates.netmglogowsky@ensigngroup.netdrobertson@ncch.commglogowsky@ensigngroup.netllitman@healthcaresystemsandservices.comllitman@healthcaresystemsandservices.comYun.Zhang@KissitoHealthcare.Orgmglogowsky@ensigngroup.netsnopes@yahoo.comjohn_binderup@lcca.comchris.chco@att.netSdangelo@brookdaleliving.comwbelardo@hqmg.comwbelardo@hqmg.comsusan@glencroft.comLnelson@5Sqc.comellen@plumh.comllitman@healthcaresystemsandservices.comllitman@healthcaresystemsandservices.comrgrandon@royaloaks.commglogowsky@ensigngroup.nethealthcaresystems@earthlink.netllitman@healthcaresystemsandservices.comllitman@healthcaresystemsandservices.comllitman@healthcaresystemsandservices.comllitman@healthcaresystemsandservices.comjohn_binderup@lcca.comtstarkweather@nahci.comhealthcaresystems@earthlink.netadsouza@matherlifeways.comllitman@healthcaresystemsandservices.comjamie.collier@pcpmg.netjohn_binderup@lcca.comjane.swanson@sunhealthsl.orgjane.swanson@sunhealthsl.orgjoyce@sunvalleylodge.orgllitman@healthcaresystemsandservices.comakepple@ahahealthcare.commglogowsky@ensigngroup.netllitman@healthcaresystemsandservices.comLnelson@5sqc.comLnelson@5sqc.combill.pray@polaris-group.comllitma@healthcaresystemsandservices.comllitman@healthcaresystemsandservices.commsluis@thegoodmangroup.comllitman@healthcaresystemsandservices.comzzhang@abhow.comrycornelius@havenhg.compriconsultants@cs.compriconsultants@cs.comllitman@healthcaresystemsandservices.comllitman@healthcaresystemsandservices.comeleiter@voa.orgbill.pray@polaris-group.comhealthcaresystems@earthlink.netcshirrell@nmassociates.net

1.24Type of Control: (Select One)Proprietary - PartnershipProprietary - PartnershipProprietary - PartnershipProprietary - PartnershipProprietary - PartnershipProprietary-CorporationNon-Profit-OtherGovernment OperatedGovernment OperatedProprietary - PartnershipProprietary - PartnershipNon-Profit-OtherNon-Profit-OtherProprietary - CorporationProprietary-CorporationProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary - CorporationProprietary - PartnershipProprietary - CorporationNon Profit-OtherProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary-CorporationProprietary - PartnershipProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary - CorporationNon-Profit-ChurchNon-Profit-ChurchNon-Profit-ChurchNon-Profit-ChurchNon-Profit-ChurchProprietary-CorporationNon-Profit-OtherNon-Profit-OtherProprietary-CorporationProprietary-CorporationProprietary-CorporationProprietary-CorporationProprietary-CorporationProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary-CorporationNon Profit-OtherProprietary - CorporationProprietary - CorporationProprietary - CorporationProprietary - CorporationProprietary - PartnershipNon-Profit-OtherProprietary - CorporationProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary - PartnershipProprietary - CorporationProprietary - PartnershipProprietary - PartnershipProprietary - CorporationProprietary - CorporationProprietary - CorporationNonProfit-ChurchNonProfit-ChurchProprietary - CorporationProprietary - PartnershipProprietary-PartnershipProprietary-CorporationProprietary - PartnershipProprietary - PartnershipProprietary - PartnershipProprietary - CorporationProprietary - CorporationProprietary-CorporationProprietary - CorporationNon-Profit-OtherProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary - CorporationNon-Profit-OtherProprietary - CorporationProprietary - CorporationProprietary - PartnershipProprietary-Corporation0NonProfit-ChurchProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary-CorporationNon-Profit-OtherProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary - PartnershipProprietary - PartnershipProprietary - PartnershipProprietary - PartnershipProprietary - CorporationProprietary - CorporationProprietary - PartnershipProprietary-CorporationProprietary - CorporationProprietary - PartnershipProprietary-CorporationProprietary - PartnershipProprietary - CorporationProprietary-PartnershipNon-Profit-OtherNon-Profit-OtherProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary - CorporationProprietary - CorporationNon-Profit-OtherNon-Profit-ChurchProprietary-CorporationProprietary - CorporationProprietary - CorporationProprietary - Corporation0Non-Profit-OtherProprietary - CorporationProprietary-CorporationProvider Numbers01.25NPI:106372511714474988521366594632129576862019523825251376616235190298326510130097451336444181133613337017705777101770505448150885660891174518013136649585515381140121740277136139697266716492622391619961653135665619313563356321316993793185139033013765356741326349093131698678918110967381184656175176047754115684627411334615066139678691916495483061528023033198265849816190739131457351967152800550116593524741205826922121591861018513815781467436121127571200217109769561255329991183112181314575906141366681520199294415112656714241437398690145730440411543681321811989866126543988915089432831336232867147763009313462814331649440751110482796319826598191689632770106341198114977930791376580357165932424217503843761124066188127557026915381074381144271818144725646619321059621295772127140793070413261341071942550645147763541519525723311528006012150803798716492719661487691465123516123310533068111295992345106374983614877310221295084440109378595810038948411629079975119478328210331773081780858522143718026210634106521114273778102300751512351858361811220270127552162713162970131578568267116463761712159379171922094044120584840513768345801407152812181127834419929610112351778741326023631114421209317607012211518940550160906187810131666021376714758170082360612554812221477603363151826305219321060851578526927146766370817909356251366495855153811401213866351341437270634126543277716795154491417900606161905812019020451641235334541109301977019029538133528517908468551669467098109383841916290066631.26AHCCCS:NANANA154708382713497804344432691486834748835118F01176401636880700402204845827884828351005921434027004-189855847182148059881404-033777648763318268806213-1714748841340547686402N/AN/ANo44656904-19130404520404443998170411870412363400125440324083241682461306449535461315461234461225N/A06-8305514209447591633489041773-0168859104-2010348222None559841N/A37189904-107004-502719-3524none04-114537-755804-087404-11614031139092236449419368423473178738277648735224404-056935195182039132-8288417078822344117956578619349478730937410881542546183004-0121447228807779355752355752404010N/A4860149247717865589305545587024198979249169032368771678981969028904-067642635551304539262835221704-1583N/AN/AN/A896441497661538322392675360199791873504698162614182569436136ALTC0194618324N/A040775488181416901.27Medicare Certified: (Select One)YesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesyesYesyesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYESYesYesYesYesYesYesYesYes0YesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYESYesYesYesYesYesYesYesYesYesYesYesyesYesYesYesYesYesNoYesYesyesyesYesYesYesYesYesYesYESYesYesYesYesYesYesYesNoyesYesYesYesYesYesYesyesYesYesYesYesYesYesYesYesYesYesYesyesYes1.28CCN (Previously Medicare Number): 03-527903-526803-526803-52663511203513003-520903-523403-52840351050350993517603-509203-5259352613516003-527403-519003510103-511603-510303-5233118052503516403-509503-506203-516903-501403-514503-514503-5166Yes0352010325603524903-515903517103518303524403515803521403-510703-525803501603-5093-518303-50910003-514103-508803-525003508603507003509403-518903527003-515303519703-524003-513103-512603-514603-514303-513603-524103-514003-513303-513703-524303-516503517503-524703-524703-512703519603-512003507103-513503-523203-511403-50873130203-527603-50763525503-509603-517403525103-511703-507203-514403-5084Mar-843515403509003-50683512503-5134N/A03-515103-50733500435283352800352863528203-50830350593521703-5277 03-52313527303-520703522503-5111N/AN/AN/A03-51103520503-524503-5193035259035261 03-5074YesYes03-525703-526703-500303-5118352723528103-5014703-5285117102803-519203-525403-51521.29Tax ID20-380895426-401020320-228162620-2271232086-074535331-112856441-219377386-600479186-600479120-021276020-021280886-019284602-055041052-146849352146849301-066376726-322120157-115963820-0212787127304309762-096386286-101471432-008549327389239462-136378037143922343-189377004-360544686-072771048-482642685-045778545-357935927-056349920-404478686-091461062-096386245022805545022805545022805545022805545022805526-117150314-190623386-062607743-176256326-422219526-421862826-422191326-422290626-422332827-056353820-172683206-163921020-891040052-208555852-208555852-208555862-096386226-140124986-082816004-349486784-128430262-096386262-134313462-096386286-056751162-124447462-096386262-096386262-096386223-745826786-071252926-062250020-558228520-200485580-083240574-286331426-140127762-136378226-140127732-008549262-096386243-176256757-120762386-020845126-290762384-171746690-086715920-097329504-354145232-008549462-174949062-121929186-069163186-066159956-231351086-026521852-723711480047838820-194860390-086764020-454043286-041080733-092128220150868337-143922130-053749227-039566227-403063327-183994962096386288-049412395-311715020-876907386-052106187-068872626-333272326-140127762-096386286-079547786-102834886-019988720137134086098324827-125430426-333264045-167550545-167550586-033541720-190940805-055717186-090662120-190894086-017644626-422396334-409961303-057447141197431945521068841-096582986-042402086032003943-176256901.30Reporting Period Start Date:1/1/121/1/121/1/121/1/121/1/121/1/121/1/127/1/112/23/121/1/121/1/121/1/1210/1/111/1/121/1/121/1/121/1/1210/31/111/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/129/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/127/1/111/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/127/1/117/1/117/1/111/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/121/1/126/1/111/1/1201/01/201212/1/121/1/121/1/121/1/121/1/121/1/124/1/111/1/121/1/127/1/111/1/121/1/1212/1/121/1/1210/1/111/1/121/1/121/1/121/1/121/1/121/1/1211/1/121/1/121/1/121/1/121/1/1212/1/121/1/123/1/111/1/121/1/121/1/121/1/121/1/123/20/121/1/1210/1/1112/31/121/1/121/1/1211/1/111/1/121/1/121/1/121/1/121/1/121/1/1210/1/111/1/121/1/121/1/121/1/129/1/129/1/121/1/121/1/121/1/121/1/121/1/1210/1/111/1/121/1/121/1/121/1/125/1/127/1/111/1/127/1/111/1/121/1/00Reporting Period End Date:12/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/126/30/126/30/1212/31/1212/31/1212/31/129/30/1212/31/128/31/128/31/1212/31/129/30/1212/31/1212/31/1212/31/1212/31/20112/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/128/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/126/30/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/126/30/126/30/126/30/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/125/31/1212/31/1211/30/201212/31/1212/13/1212/31/1212/31/1212/31/1212/31/123/31/1212/31/1212/31/126/30/1212/31/1212/31/1212/31/1211/30/129/30/1212/31/1212/31/1212/31/1212/31/1212/31/1210/31/1212/31/1212/31/1212/31/1212/31/1211/30/1212/31/1212/31/122/28/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/129/30/1212/31/1212/31/1210/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/129/30/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/1212/31/129/30/1212/31/1212/31/1212/31/1212/31/1212/31/126/30/1212/31/126/30/1212/31/121.32New Nursing Care Institution start date of operation (if applicable):n/a6/11/09n/aN/An/a01/1/12n/aN/A0n/a000n/aN/AN/An/an/an/an/an/an/an/an/a0N/A12/01/2012N/An/aN/A00N/An/aNA0n/a3/20/12N/An/aNANAN/A9/1/129/1/12n/a03/8/12N/A01.33Date of Submission:5/25/125/30/132/28/135/31/122/15/135/31/125/10/135/29/135/31/125/3/135/29/135/29/135/31/1205/31/125/31/125/29/1311/30/125/29/135/31/135/31/135/31/135/31/135/31/1305/29/135/31/1211/19/1211/19/1211/19/125/29/135/31/135/29/135/31/125/29/135/29/135/29/135/29/135/29/135/29/135/29/135/29/1312/31/995/31/136/19/135/31/135/29/135/31/135/31/127/31/125/29/135/31/1205/31/124/23/135/31/125/31/125/29/135/20/125/31/1205/3/20135/31/1212/31/125/31/135/31/135/29/135/31/125/31/132/20/135/31/125/30/1305/31/135/1/1312/31/995/29/13Home Office (If Applicable)1.34Home Office Name:Lifecare ServicesAdvanced Health Care CorporationAdvanced Health Care CorporationAdvanced Health Care CorporationAmerican Medical Financial Corpn/aAvalon Healthh Care, Inc.Avalon Health Care, Inc.Banner Health0Ensign Services, Inc.Sunrise Senior LivingSunrise Senior LivingCareMeridian, LLCEnsign Services, Inc.Avalon Health Care, Inc.Emeritus Senior Living, Inc.LIFE CARE CENTERS OF AMERICA, INC.C&G Health Care Mgmt, Inc.Esign Services, Inc.Plum Healthcare Group, LLCLIFE CARE CENTERS OF AMERICA, INC.Ensign Services, Inc.Lodge Realty, LLPn/aSunBridge Healthcare CorporationN/AFive Star Quality Care, IncSenior Lifestyle Management LLCBrookdale Senior Living, Inc.LIFE CARE CENTERS OF AMERCIA, INC.The Evangelical Lutheran Good Samaritan SocietyThe Evangelical Lutheran Good Samaritan SocietyThe Evangelical Lutheran Good Samaritan SocietyThe Evangelical Lutheran Good Samaritan SocietyThe Evangelical Lutheran Good Samaritan SocietyGRACE HEALTHCARE, LLC00000Five Star Quality Care, IncLIFE CARE CENTERS OF AMERICA, INC.The Ensign Group, Inc.Kindred Healthcare, Inc.Kindred Healthcare, Inc.Kindred Healthcare, Inc.LIFE CARE CENTERS OF AMERICA, INC.Preferred Care, Inc.Five Star Quality Care, IncBrookdale Senior Living, Inc.C&G Health Care Mgmt, Inc.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERCIA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERCIA, INC.LIFESTREAM COMPLETE SENIOR LIVINGLIFESTREAM COMPLETE SENIOR LIVINGHCR Manor Care Services, LLCPreferred Care, Inc.Touchstone Communities, Inc.Preferred Care, Inc.LIFE CARE CENTERS OF AMERICA, INC.Preferred Care, Inc.Ensign Services, Inc.LIFE CARE CENTERS OF AMERICAEnsign Services, Inc.0Ensign Services, Inc.Kissito Healthcare, Inc.Ensign Services, Inc.Brookdale Senior Living, Inc.LIFE CARE CENTERS OF AMERICA, INC.WESTCARE, INC.Brookdale Senior Living, Inc.0Five Star Quality Care, IncPlum Healthcare Group, LLCWindsor HealthCareEnsign Services, Inc.N/AN/AN/ALIFE CARE CENTERS OF AMERICANorth AmericanHealth Care Inc.N/AMather LifeWaysPreferred Care, Inc.LIFE CARE CENTERS OF AMERICA, INC.Sun Health Senior Living, LLCSun Health Senior Living, LLCN/AAmerican Healthcare Management ServicesEnsign Services, Inc.SNH SE Tenant TRS, IncSNH SE Tenant TRS, Incn/aABHOW0ViViVolunteers of America National Services01.35Street Address:400 Locust St. Suite 8201800 S. Potomac1800 S. Potomac1800 S. Potomac1661 Old Henderson Roadn/a206 N 2100 West206 North 2100 West1441 N. 12th Steet027101 Puerta Real, Suite 4507900 Westpark Drive Suite T-9007900 Westpark Drive Suite T-90018A Journey Ste 20027101 Puerta Real, Suite 450206 N 2100 West3131 Elliott Avenue3570 KEITH ST NW1004 East Main Street27101 Puerta Real, Suite 450100 E. San Marcos Blvd.Ste 2003570 KEITH ST NW27101 Puerta Real, Suite 450260 E. Brown St., Ste 315101 Sun Avenue NE400 Centre St.111 East Wacker Drive111 Westwood Place, Suite 4003570 KEITH ST NW4800 West 57th Street4800 West 57th Street4800 West 57th Street4800 West 57th Street4800 West 57th Street7201 SHALLOWFORD RD00000400 Centre St.3570 KEITH ST NW27101 Puerta Real, Suite 450680 South Fourth Street680 South Fourth Street680 South Fourth Street3570 KEITH ST NW5500 W. Plano Parkway400 Centre St.111 Westwood Place1004 East Main Street3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW11315 W. PEORIA AVE.11315 W. PEORIA AVE.333 N Summit Street5500 W. Plano Parkway1020 NE Loop 410, Suite 6405500 W. Plano Parkway3570 KEITH ST NW5500 W. Plano Parkway27101 Puerta Real, Suite 4503570 KEITH ST NW27101 Puerta Real, Suite 450027101 Puerta Real, Suite 4505228 Valleypointe Pkwy, Building B Suite 127101 Puerta Real, Suite 450111 Westwood Place3570 KEITH ST NW13232 N TATUM BLVD111 Westwood Place, Suite 4000400 Centre St.100 E. San Marcos Blvd. Ste 2009200 West Sunset Blvd, 7th Floor27101 Puerta Real, Suite 4503570 KEITH ST NW3 Monarch Bay Plaza Suite 2031603 Orrington Ave., Suite 18005500 W. Plano Parkway3570 KEITH ST NW14719 W. Grand Ave.14719 W. Grand Ave.0121 SE Shurfine Dr Ste 927101 Puerta Real, Suite 450255 Washington255 Washingtonn/a6120 Stoneridge Mall Rd, 3rd Floor071 S Wacker Dr. , Suite 90071 S Wacker Dr., Suite 9007530 Market Place Drive01.36 City:Des Moines, IAAurora, COAurora, COAurora, COColumbusn/aSalt Lake City, UtahSalt Lake City, UtahPhoenix0Mission ViejoMcLeanMcLeanAliso ViejoMission ViejoSalt Lake City, UtahSeattleCLEVELAND, TENNESSEECortezMission ViejoSan Marcos, CACLEVELAND, TENNESSEEMission ViejoBirminghamAlbuquerque, NMNewton, MAChicagoBrentwoodCLEVELAND, TENNESSEESioux Falls, South DakotaSioux Falls, South DakotaSioux Falls, South DakotaSioux Falls, South DakotaSioux Falls, South DakotaCHATTANOOGA, TN00000Newton, MACLEVELAND, TENNESSEEMission ViejoLouisvilleLouisvilleLouisvilleCLEVELAND, TENNESSEEPlano, TXNewton, MABrentwood, TNCortezCLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEEYOUNGTOWNYOUNGTOWNToledoPlano, TXSan Antonio, TexasPlano, TXCLEVELAND, TENNESSEEPlano, TXMission ViejoCLEVELAND, TNMission Viejo0Mission ViejoMission ViejoBrentwood, TNCLEVELAND, TENNESSEEPHOENIXBrentwood, TN0Newton, MASan Marcos, CAWest Hollywood, CAMission ViejoCLEVELAND, TNDana PointEvanstonPlano, TXCLEVELAND, TENNESSEESurpriseSurprise0AnkenyMission ViejoNewton, MANewton, MAn/aPleasonton0Chicago, ILChicago, ILEden Prairie01.37 Zip Code:50309-233480012-543080012-543080012-543043220n/a84116841168500609269122102221029265692691841169812137312813219269192069373129269148009871090245860601370273731257117-503857177-503857117-503857117-503857117-5038374210000002458373129269140202402024020237312750930245837027813213731237312373123731237312373123731237312853628536243699-0086750937820975093373127509392691373209269109269124019926913702737312850323702700245892069900699269137320926296020175093373128537485374050021926910245802458n/a94588060606606065534401.38 County:Polk CountyArapahoeArapahoeArapahoeFranklinn/aMaricopa0OrangeFairfaxFairfaxOrange CountyOrangeBRADLEY (TENNESSEE)MontezumaOrangeSan Diego CountyBRADLEY (TENNESSEE)OrangeOaklandBernallioMiddlesexCookWilliamsonBRADLEY (TENNESSEE)HAMILTON00000MiddlesexBRADLEY (TENNESSEE)OrangeJefferson CountyJefferson CountyJefferson CountyBRADLEY (TENNESSEE)CollinMiddlesexWilliamsonMontezumaBRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)MARICOPAMARICOPALucasCollinBexarCollinBRADLEY (TENNESSEE)CollinOrangeBRADLEY, TENNESSEEOrange0OrangeRoanokeOrangeWilliamsonBRADLEY (TENNESSEE)MARICOPAWilliamson0MiddlesexSan DiegoOrangeBRADLEY, TENNESSEEOrangeCookCollinBRADLEY (TENNESSEE)MaricopaMaricopa0PolkOrangeMiddlesexMiddlesexn/aAlameda0CookCookHennepin01.39Mailing Address:Same as aboven/a00P.O. BOX 3480SameP.O. BOX 34800P.O. BOX 3480000000P.O. BOX 3480000P.O. BOX 3480SameP.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 34800sameP.O. BOX 348000P.O. BOX 3480NA00same as aboveP.O. BOX 3480P.O.Box 6030P.O.Box 60300n/a00001.40 City:n/a00CLEVELANDCLEVELAND0CLEVELAND000000CLEVELAND000CLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELAND0CLEVELAND00CLEVELANDNA00CLEVELANDSun City WestSun City West0n/a00001.41 State:n/a00TENNESSEETENNESSEE0TENNESSEE000000TENNESSEE000TENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEE0TENNESSEE00VATENNESSEENA00TENNESSEEAZAZ0n/a00001.42 Zip Code:n/a003732037320037320000000373200003732037320373203732037320373203732037320373200373200037320NA003732085376853760n/a00001.43 County:n/a00BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)0BRADLEY (TENNESSEE)000000BRADLEY (TENNESSEE)000BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)0BRADLEY (TENNESSEE)00BRADLEY (TENNESSEE)NA00BRADLEY (TENNESSEE)MaricopaMaricopa0n/a00001.44Contact Person:David Bennett, DOAMark EmmettMark EmmettMark EmmettScott Haren/aDavid SlawsonDavid Slawson0Marc GlogowskyTony J. HarrisTony J. Harris949-494-0785Marc GlogowskyDavid SlawsonKEITH GOSSJoyce HumistonMarc GlogowskyEllen SubiaKEITH GOSSMarc GlogowskySonja M. MartinezSid IngramLori NelsonLeticia U GonzalezRuss BelloraKEITH GOSSKim KouriKim KouriKim KouriALICE MARIE CLARK DANKS00000Lori NelsonKEITH GOSSMarc GlogowskyDavid SimpsonDavid SimpsonDavid SimpsonKEITH GOSSRobert RiekLori NelsonDouglas C. Walters, CPAJoyce HumistonKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSA. Dean ShipmanRobert RiekCarl FellbaumRobert RiekKEITH GOSSRobert RiekMarc GlogowskyKEITH GOSSMarc Glogowsky0Marc GlogowskyLori HuffmanMarc GlogowskyDouglas C. Walters, CPAKEITH GOSSBRUCE HARKINSRuss Bellora0Lori NelsonEllen SubiaMarc GlogowskyKEITH GOSSTeri StarkweatherAnna D'SouzaRobert RiekKEITH GOSSJane SwansonJane Swanson0Andrea KeppleMarc GlogowskyLori NelsonLori Nelsonn/aZhen Zhang0Jerrun MuldrowJerrun MuldrowErica Leiter01.45 E-mail address:bennettdavid@sagewoodlcs.com720-213-1776720-213-1776720-213-1776share@rrohio.comn/adslawson@avalonhci.comdslawson@avalonhci.com0mglogowsky@ensigngroup.nettony.harris@sunriseseniorliving.comtony.harris@sunriseseniorliving.combbarnuevo@caremeridian.commglogowsky@ensigngroup.netdslawson@avalonhci.comkeith_goss@lcca.comJhumiston@cghealthinc.netmglogowsky@ensigngroup.netellen@plumh.comkeith_goss@lcca.commglogowsky@ensigngroup.net284-642-2914sid.ingram@sunh.comLnelson@5sqc.comlgonzalez@seniorlifestyle.comRbellora@brookdaleliving.comkeith_goss@lcca.comkkouri@good-sam.comkkouri@good-sam.comkkouri@good-sam.comADANKS@GRACEHC.COM00000Lnelson@5sqc.comkeith_goss@lcca.commglogowsky@ensigngroup.netDavid.Simpson@kindred.comDavid.Simpson@kindred.comDavid.Simpson@kindred.comkeith_goss@lcca.combob@rwtx.comLnelson@5sqc.comsnopes@yahoo.comJhumiston@cghealthinc.netkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comdeshipman@hcr-manorcare.combob@rwtx.comcfellbaum@touchstone-communities.combob@rwtx.comkeith_goss@lcca.combob@rwtx.commglogowsky@ensigngroup.netKEITH_GOSS@LCCA.COMmglogowsky@ensigngroup.net0mglogowsky@ensigngroup.netLori.Huffman@KissitoHealthcare.Orgmglogowsky@ensigngroup.netDwalterscpa@gmail.comkeith_goss@lcca.combruce-harkins@kc.rr.comRbellora@brookdaleliving.com0Lnelson@5sqc.comellen@plumh.commglogowsky@ensigngroup.netKEITH_GOSS@LCCA.COMtstarkweather@nahci.comadsouza@matherlifeways.combob@rwtx.comkeith_goss@lcca.comjane.swanson@sunhealthsl.orgjane.swanson@sunhealthsl.org0akepple@ahahealthcare.commglogowsky@ensigngroup.netLnelson@5sqc.comLnelson@5sqc.comn/azzhang@abhow.com0jmuldrow@viliving.comjmuldrow@viliving.comeleiter@voa.org01.46 Phone:(305) 256-3509memmett@ahcfacilities.commemmett@ahcfacilities.commemmett@ahcfacilities.com614.459.0445n/a(801) 596-8844(801) 896-88440(949) 487-9500703-854-0830703-854-0830949-784-0785(949) 487-9500801-896-8844423-473-5763970.516.1404(949) 487-9500(760) 471-0388 ext. 117423-473-5763(949) 487-9500michigansonja@aol.com(505) 468-6846303-973-9430312.673.4360(312) 731-3326423-473-5763605-362-3100605-362-3100605-362-3100423-308-184500000303-973-9430423-473-5763(949) 487-9500502-596-7945502-596-7945502-596-7945423-473-5763972-930-8135303-973-9430727-244-5978970.516.1404423-473-5763423-473-5763423-473-5763423-473-5763423-473-5763423-473-5763423-473-5763423-473-5763419-254-7841972-930-8135210/828-5686 x5002972-930-8135423-473-5763972-930-8135(949) 487-9500423-473-5763(949) 487-95000(949) 487-9500540-265-0322(949) 487-9500727-244-5978423-473-5763816-735-0533(312)731-33260303-973-9430(760) 471-0388 ext. 117(949) 487-9500423-473-5763949-240-2423847.492.5036972-930-8135423-473-5763623-832-4332623-832-43320515-963-1125(949) 487-9500303-973-9430303-973-9430n/a925-924-71560312-803-8557312-803-8557952-983-42640Management Company (If Applicable)N/A 1.47Mgt. Co. Name:Lifecare ServicesThe Goodman Group, LLCN/AN/A0National Mentor Healthcare, LLCN/ALIFE CARE CENTERS OF AMERICA, INC.N/AHome Office is Mgt. CompanyLIFE CARE CENTERS OF AMERICA, INC.0Altitude Health Services Inc.Altitude Health Services, Inc.LIFE CARE CENTERS OF AMERCIA, INC.N/AN/AN/AN/AN/AN/A24-7 Care and Rehab, Inc24-7 Care and Rehab24-7 Care and Rehab, Inc24-7 Care and Rehab, Inc24-7 Care and Rehab, Inc0LIFE CARE CENTERS OF AMERICA, INC.Watermark Retirement Communities000LIFE CARE CENTERS OF AMERICA, INC.Preferred Care Partners Management Group, L.P.N/ALIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERCIA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERICA, INC.LIFE CARE CENTERS OF AMERCIA, INC.0Preferred Care Partners Management Group, L.P.SLO Maryland Gardens, LLCSnF ManagementTouchstone Communities, Inc.Preferred Care Partners Management Group, L.P.LIFE CARE CENTERS OF AMERICA, INC.Preferred Care Partners Management Group, L.P.LIFE CARE CENTERS OF AMERICAWIT2, LLCDIAMOND CARE HEALTH NETWORKSenior Living Options, LLCKissito Healthcare, Inc.LIFE CARE CENTERS OF AMERICA, INC.NAHQMG of Arizona-Plaza, IncHQMG of Arizona-Plaza, IncHome Office is Mgt. CompanyDIAMOND CARE HEALTH NETWORK, LLCPioneer Health Group, Inc.Sant Operations, LLCSant Operations, LLCSant Operations, LLCSant Operations, LLCLIFE CARE CENTERS OF AMERICALife Care Services, Inc.Preferred Care Partners Management Group, L.P.LIFE CARE CENTERS OF AMERICA, INC.N/AN/AN/AAZORE LLCAmerican Healthcare Management ServicesFive Star Quality Care, IncFive Star Quality Care, IncLife Care Services, Inc.The Goodman Group, LLC024-7 Care and Rehab, IncCopperSand, IncN/AACWIN1.48Street Address:400 Locust St. Suite 8201107 Hazeltine Blvd., #200003570 KEITH ST NW3570 KEITH ST NW02201 Main Street2201 Main Street3570 KEITH ST NW2498 S Redwood Rd2948 S Redwood Rd2948 S. Redwood Rd.2948 S Redwood Rd.2948 S Redwood Rd03570 KEITH ST NW2020 W. Rudasill Road0003570 KEITH ST NW5420 W. Plano Parkway3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW3570 KEITH ST NW05420 W. Plano Parkway16601 N. 40th St., Ste. 2029200 West Sunset Blvd 7th Floor1020 NE Loop 410, Suite 6405420 W. Plano Parkway3570 KEITH ST NW5420 W. Plano Parkway3570 KEITH ST NW6774 N Calle Sin Nombre5134 N. CENTRAL AVE., STE 20416601 N. 40th Street, Suite 1105228 Valleypointe Pkwy, Building B Suite 13570 KEITH ST NWNA1475 N Granite Reef Road1475 N Granite Reef Road5134 N. CENTRAL AVE., STE 2041640 School Street17207 N. Perimeter Dr STE 21017207 N. Perimeter Dr STE 21017207 N. Perimeter Dr STE 21017207 N. Perimeter Dr STE 2103570 KEITH ST NW400 Locust St., Suite 8205420 W. Plano Parkway3570 KEITH ST NWN/AN/A014002 W. Meeker Blvd.121 SE Shurfine Dr Ste 9400 Centre St.400 Centre St.400 Locust St. Suite 8201107 Hazeltine Blvd., #20002948 S Redwood Rd3602 E. Greenway Rd, Ste 104001.49 City:Des Moines, IAChaska00CLEVELAND, TENNESSEECLEVELAND, TENNESSEE0Evanston, ILEvanston, ILCLEVELAND, TENNESSEEWest ValleyWest ValleyWest ValleyWest ValleyWest Valley0CLEVELAND, TENNESSEETucson, AZ000CLEVELAND, TENNESSEEPlano, TXCLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEECLEVELAND, TENNESSEE0Plano, TXPhoenixWest HollywoodSan Antonio, TexasPlano, TXCLEVELAND, TENNESSEEPlano, TXCLEVELAND, TNTucson PHOENIXPhoenixCLEVELAND, TENNESSEENAScottsdaleScottsdalePHOENIXMoragaScottsdale, AZScottsdale, AZScottsdale, AZScottsdale, AZCLEVELAND, TNDes Moines, IAPlano, TXCLEVELAND, TENNESSEEN/AN/A0Sun City West AnkenyNewton, MANewton, MADes Moines, IAChaska0West ValleyPhoenix001.50 Zip Code:50309-233455318003731237312060202602023731284119841198411984119841190373128570400037312750933731237312373123731237312373123731237312075093850329006978209750933731275093373208571885012850322401937312NA85257852578501294556852558525585255852553732050309-23347509337312N/AN/A08537550021024580245850309-23345531808411985032001.51 County:Polk CountyCarver00BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)0CookCookBRADLEY (TENNESSEE)Salt LakeSalt LakeSalt LakeSalt LakeSalt Lake0BRADLEY (TENNESSEE)Pima000BRADLEY (TENNESSEE)CollinBRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)0CollinMaricopaLos AngelesBexarCollinBRADLEY (TENNESSEE)CollinBRADLEY, TENNESSEEPimaMARICOPAMaricopaRoanokeBRADLEY (TENNESSEE)NAMaricopaMaricopaMARICOPAMaricopaMaricopaMaricopaMaricopaBRADLEY, TENNESSEEPolk CountyCollinBRADLEY (TENNESSEE)N/AN/A0PolkMiddlesexMiddlesexPolk CountyCarver0Salt LakeMaricopa001.52Mailing Address:Same as abovesame00P.O. BOX 3480P.O. BOX 34800P.O. BOX 3480000000P.O. BOX 3480000P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 3480P.O. BOX 34800sameP.O. BOX 34800016601 N. 40th Street, Suite 110P.O. BOX 3480NA18757 Burbank Blvd. #13015760 Ventura Blvd. Suite 9201640 School Street0P.O. BOX 3480N/AN/A014002 W. Meeker Blvd.same00001.53 City:same00CLEVELANDCLEVELAND0CLEVELAND000000CLEVELAND000CLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELANDCLEVELAND0CLEVELAND00PhoenixCLEVELANDNATarzanaEncinoMoraga0CLEVELANDN/AN/A0Sun City Westsame00001.54 State:same00TENNESSEETENNESSEE0TENNESSEE000000TENNESSEE000TENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEETENNESSEE0TENNESSEE00ArizonaVATENNESSEENACACACalifornia0TENNESSEEN/AN/A0AZsame00001.55 Zip Code:same00373203732003732000000037320000373203732037320373203732037320373203732037320037320008503237320NA913569143694556037320N/AN/A085375same00001.56 County:same00BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)0BRADLEY (TENNESSEE)000000BRADLEY (TENNESSEE)000BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)BRADLEY (TENNESSEE)0BRADLEY (TENNESSEE)00Ross RichardsonBRADLEY (TENNESSEE)NALos AngelesLos Angeles0BRADLEY (TENNESSEE)N/AN/A0same00001.57Contact Person:David Bennett, DOANancy Weimer00KEITH GOSSKEITH GOSS0Shaindy KompelShaindy KompelKEITH GOSSRyan CorneliusRyan CorneliusRyan CorneliusRyan CorneliusRyan Cornelius0KEITH GOSSJeff Jarnigan000KEITH GOSSMary TaylorKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSSKEITH GOSS0Mary TaylorRoss RichardsonAsh ChawlaCarl FellbaumMary TaylorKEITH GOSSMary TaylorKEITH GOSSJoe CiminoLori HuffmanKEITH GOSSNAMichael SchwartzMichael SchwartzJeri BluthGreg FicekGreg FicekGreg FicekGreg FicekKEITH GOSSSally WilliamsMary TaylorKEITH GOSSN/AN/A0Phil FriedlanAndrea KeppleLori NelsonLori NelsonMarvin Cole E.D.Michael Sluis0Ryan CorneliusCarol Baum001.58 E-mail address:(305) 256-3509nweimer@thegoodmangroup.com00keith_goss@lcca.comkeith_goss@lcca.com0skompel@altitudehs.comskompel@altitudehs.comkeith_goss@lcca.com801-296-5100801-296-5118rycornelius@havenhg.comrycornelius@havenhg.comrycornelius@havenhg.com0keith_goss@lcca.comjjarnigan@watermarkcommunities.com000keith_goss@lcca.commary.taylor@pcpmg.netkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.comkeith_goss@lcca.com0mary.taylor@pcpmg.netrrichardson42@gmail.comachawla@snfmgmt.com210/828-5686 x5002mary.taylor@pcpmg.netkeith_goss@lcca.commary.taylor@pcpmg.net423-473-57630540-265-0322keith_goss@lcca.comNAmschwartz@hqmg.conmschwartz@hqmg.conjeri@mpfi.comficek@santepartners.comficek@santepartners.comficek@santepartners.comficek@santepartners.com423-473-5763swilliams@sierrawinds.commary.taylor@pcpmg.netkeith_goss@lcca.comN/AN/A0philfriedlan@sunwestchoice.comakepple@ahahealthcare.com303-973-9430303-973-9430marvincole@lcsnet.commsluis@thegoodmangroup.com0rycornelius@havenhg.comcbaum@coppersandsinc.com001.59 Phone:bennettdavid@sagewoodlcs.com952-361-806200423-473-5763423-473-57630847 905-3290847 905-3290423-473-5763rycornelius@havenhg.comrycornelius@havenhg.com801-296-5100801-296-5100801-296-51000423-473-5763520-241-9119000423-473-5763972-930-8147423-473-5763423-473-5763423-473-5763423-473-5763423-473-5763423-473-5763423-473-5763423-473-57630972-930-8147602-264-0995310-385-1078cfellbaum@touchstone-communities.com972-930-8147423-473-5763972-930-8147KEITH_GOSS@LCCA.COM520-444-4109Lori.Huffman@KissitoHealthcare.Org423-473-5763NA(818) 905-8000(818) 905-8000925-235-1010480-626-2272480-626-2272480-626-2272480-626-2272KEITH_GOSS@LCCA.COM623-972-0212972-930-8147423-473-5763N/AN/A0623-584-6161515-963-1125Lnelson@5sqc.comLnelson@5sqc.com480-831-4500952-361-80460801-296-5100520-323-935100Other InformationLicensed bed capacity01.60Beginning of Period:32543838190120362001201202407172186485613331102120606812810419110612011512010831231216114957641111281968015080806010074741188064801289967961072281002301121281925812542104128223210132152124162128128581181946060641911801002061201161552413413017217014320066163130128221221225841292002001091221121151447070727010890132112706012211812817996581401151272044856128120885888649936248332111601191201.61End of Period:3254383819012036200120120240717218648561333110212060681281041911061201151201083123121611495764111128196801508080581007474118806480128996796107228100230112128192581254210412822321013215212416212812858118194606064191180100206120116155241341301721701432006616313012822122122584129200200109125112115144707072701089013211270601221181281799658140115127204485612812088588864993624833211160119120Operational Beds in Service01.62Beginning of Period:325438381901163620012012024071721624856109311021206068128104187106120115120933123121541495764111128196801508080601007474116806480128996796100228100230112128192581254210412822321013215212416212812858118194606064191180100192120114155241341201721701432006616313012822122118384129200200109122102115144707072705990132112704912211812812882451401091272044856128120885888649936247932111601191141.63End of Period:32543838190116362001201202407172162485610931102120606812810418710612011512093312312154149576411112819680150808058100747411680648012899679610022810023011212819240125421041282232101321521241621281285811819460606419118010019212011415524134120172170143200661631301282212211838412920020010912510211514470707270599013211270461221181281288248140109127204485612812088588864993624793211160119114Skilled Medicare Lic. Beds (if distinct)01.64Beginning of Period:54380190116n/a2002200721864856413110201281041911061201150108031201495764111128196000001007408064801289967961072281002301121281920125010412822321013215212416212811819460606419118010020612001550130172170143200163130128179179338450500112115144707072701089013210121221181289496N/A140012790485612812088n/a88649983321116011901.65End of Period:54380190116n/a200220072186485641311020128104191106120115010803120149576411112819600000100710806480128996796107228100230112128192012510412822321013215212416212811819460606419118010020612001550130172170143200163130128179179338450500112115144707072701089013210121221181289496N/A140012790485612812088n/a8864998332111601190

1.66Registered with the Arizona Department of Insurance as a Continuing Care Retirement CenterYes000NNoNNYesyes00NONoNN0NONoNONONNNoNONoYNNONNNNN0NNNoNoNoNoNo0NONoNo0NONoXNOYesNoNONONONONONONONONO0NONoNoNoNONONONoNNoNoNONoNNNONoNONOY00yesnoNNNOyesNoNNNoNNNNONNOYesNONOYesYesNoNNNoNYesNNNoN0NoN/ANNoYesNoN1.67Licensed Nursing Facility Beds:3854383819012036200120120240721864856133311021206068128104191106120115120108031216114957641111281968015080805810074741188064801289967961072281002301121281925812542104128223210132152124162128128581181946060641911801002221201161552413413017217014320066163130128179179225841292002001091251121151447070727010890132112703612211812817996581401151272044856128120885888649936248332111601191201.68Facililty's Licensed Assisted Living Beds10000079000071121000005600None0000002500801258500280000009300000013000113000113085None0000000050004040060000000000004500424210833000590000000007924820000730000868391009208005436650240001.69Facility's Independent Living Beds278000011200004600000024300None191000000220015590008872286620014000000149001560004660155None000000001610000000000000000119003440047016700037300000000051246119002881292400005760039036902602700090000

1.70Total Facility Beds:32654383819012022720012012024071653186405613331102120359681281040106120115120108312359161149292279196128196196222108146601007418111880648012899346961074971002301121281926371252821041282232101321521241621283395811819410010064251180100222120116155241341301721701432002301631304722212218032841292002001095571121151447070727010890262112703063231181284672251551401151272041341391281208818988513993503301483222560119120472513225Schedule 2: Patient Days Population Patient Days (A)2.01 Mercy Care Level I ALTCS Patient Days2484,31810,1263277,030431603,34010,0231676635,0934,2774,0191,516011,8682,5601,65289604,08603,26215,752183004,7833,8485,282004212,72790797100610700003,99712,056814503,9432,62900007,9804,322006,1561,57806,6791,44811633,7920006,8361,4491,6906,67535502,2314,9425815,75801,1493,45103,7428,9811,8694259,35003,0972,8832792,9381,6971,75701,6641205,1567,6472,7760004,8756,8404,5383,8410000Patient Days(A)00002,5916,08902.02 Mercy Care Level II ALTCS Patient Days2,3674,6474,063536,224679502,3295,4926872,4376,1501,1623,2811,680010,0475,4601,6422,39204,38904,0067,7721,295007,5992,3169,2080008047,5401,3330014903380005,1729,878549105,2411,51800008,8206,329003,1043,17205,1291,09045133,5150005,6632,8001,7278,42199206,5766,5102797,642010,2701,57407,15610,3163,35461214,47906,2097,4767132,3055,030090208854,7322,9360003,0592,5322,4526,190000000004,7374,59802.03 Mercy Care Level III ALTCS Patient Days6586031744921032601094561,6341,3411,0344451,03925601,07241021366039401,1491,0847220025501,0660005606756100580100001,4561,184880063640300009141,3000046438101,2542606541,2910002,8811065788579204,210689932,33008781,93403,2151,6381,4613052,1730596942931517711,131042801,1041,21900001,26201,291804000000004191,60902.04 Mercy Care Acute Care Patient Days (Levels I, II and III)159017644201,147102385333702040001749243028013520000025738700000000000009773690001700000000000000004204417703206840040360032600111077662200003600003534415154500000000130902.05 Mercy Care Specialty Population ALTCS Patient Days923201,41200001,5235,5421,4340001809,76207810,688040903,3305,04919,0960013204,837000001210000000028310,97986230130000072800506,169023,58713,2461,20906,191003,1863283011,6901,7301,3915,9230311003495,3991,1664,828005,6804305211,4960013,089013801130003,9971,3992,3086,67500000000002.06 Evercare Level I ALTCS Patient Days3012,2871,4962,145742609823,357432,5975246599772,48101,0389091,6981,3279,39662802,1431,31007,8561,8761,2192,5825,3555,01404,4485437292,5961,95202,29403,177001,1072,52691495,0522,588984010,14407,9823,1971,764001,8671,7788,7342,0851,8751971559004,0031,2971,2937653,87272210,0791,0436253681,88411,9632,7834671,3132,3281,3671,12618997403,3001,7051241,5002,2361,9372,60701593802,46709801,8561,0640001,1153,3927601,3330010,5439,007005,95101,701282965,6642.07 Evercare Level II ALTCS Patient Days1,0981,9861,3841,597879603663,6183582,7131,72909183,07001,8988022,2171,5048,55088803,7561,24489206,9802,5755292,5087,6365,144003781,8497,2477,40103,7860113002,0483,114107574,6757,711850011,400010,6275,0093,493001,5564,5178,0951,6011,41151231,913004,2302,8214,0177591,5267317,2428401,2821243,0487,4866,7103842,2552,2261,5741,2952472,01905,4561,9642241,5463,9127,6997,63506985282,93701,4232783,0030008202,0202,035913009,2207,6033,444004,72003,5072,6063,2586,3992.08 Evercare Level III ALTCS Patient Days4380293387001,2922405399202911904361961533723,12830601,1823664,07601,250151065824960000591198790000009376426622,547021403,05801,360783460001,093923923361251516002,64707682452841835341,313751,6762,2571,2550582527200123370983961623541,1262,1562,147009710328374000041,029440005186142,3200017102,8095321,7682.09 Evercare Acute Care Patient Days (Levels I, II and III)6900438000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000018000007402.10 Evercare Specialty Population ALTCS Patient Days722354000030131596383100000480004506095032926181633502754001184,7980000000000000188020723,39700000016500000019260449237584203282142800320142190233496059937145133025082,943874580003340310614201811712002767140204900000500852968156200336063690000015,3132.11 Bridgeway Level I ALTCS Patient Days4,7736,6092,8611,30694903602,08224601,4804691,6823,08701,3271,0543,09480202,0970244932001,8102,059618006,5632,98175007,152011,766005,0791,7941,548656427810047300006,5036,328015,2171,41219802,3434,54620852,2200004851,9969841,433366082112,0278739359408549693,8852,2311,28430515,40407039761554,1503661631,5100161101,8781,2362,0280001,3768239741,5090000000092,53502.12 Bridgeway Level II ALTCS Patient Days4,1571,5721,7572,25485501,1923,7898152303,2115921,7834,52301,4211,9962,745319065906101,543001,9041,1553,682004,6110388007,91603,699004,7531,0175,09622487510891100005,5625,07206,0194,095001,7993,42242201,9130007366,8165592,493401,4845,8241,190931,48101133,1512,3161,5636501224,5710875676622,34061,3950156205001,2484,4940003,4689231,3603,0120000000080002.13 Bridgeway Level III ALTCS Patient Days5,8811,24633717393001522310254473287101,983416134434000122245001,3065857730091603420067703,049001,418336367503710092000067199609409150044081512378660001,0491,2693941,10802,0814,444441312600128606548437311,53246846600492311,75706620263732002,7870001,0973067351,208000000005902.14 Bridgeway Acute Care Patient Days (Levels I, II and III)21000003900000000002300000000000003510000000160000000000000000000000410233070000000000000000800000000000000185095502.15 Bridgeway Specialty Population ALTCS Patient Days2,5111,0750008261,7752,75017000103050294,5510002840003701,235003,818000000000002,956249428200000001910000002,16407,9951,575124087255088801,7471,3220155610001,70603213,5527581,594003,1263722,25104,579006,65600240002,0053,0854262,43800000000002.16 Scan Level I ALTCS Patient Days7168241,512628000283012127301,0950514472604940249006800920058913000000002422980011800003671,959001,09600001210008123632408005103290021108663250000012100720200483302000303660500000000002.17 Scan Level II ALTCS Patient Days3297261,8601,1340001,07212106329001,44006633331,34803950505001,3430001000000000003134820025400003,3601,181002,03800001210006191,7942378801218121,1060036301,79984128900002330012102427242,20100065148384031400000000002.18 Scan Level III ALTCS Patient Days311,1590000070021202420000010700137000000000000001211210012100002424930014500001210002571212420001425510002418148000000000121018468000237089112100000000002.19 Scan Acute Care Patient Days (Levels I, II and III)0000006211000000000000000000000000000000000000000000000000000000000000000000000000000000000000000002.20 Scan Specialty Population ALTCS Patient Days1211,4240007381270000001510024203700006700000000000000084700000062000220000689000506002420362012100002093100001210001,163000000796173039400000000002.21 AHCCCS Level I FFS Patient Days37283952662000146001712,67027319127014812,3651050030000370020791421432006,84173513,28004,5420432,4894431,261985096,741030336400185000000070125094901901,2431048046313,953011180077501,8772473203073667225,8150481,12799000003662001101820077008,09602.22 AHCCCS Level II FFS Patient Days159236659200705930006,946768270264012017,6741700316274000001,6771,5673327707,03211843801,41340481907086132,02601156,092402531100530000003434156842243223410458336136895783,232026198505102,724067101,3033662843,47601,1060000001623540000008790012,49302.23 AHCCCS Level III FFS Patient Days900112001101661470400003,20838369034404504,872750011004000001,31533417701,1957058104921,109227307522291285002,122615000057000000004600594334360425133539356521,116000005803,83001,922096301764,39101,06300000015000000039006,80602.24 AHCCCS Acute Care Patient Days (Levels I, II and III)00000054862000000001,50310265513,9242,2220000000000000000013574890000145000000000010013600000000559512000003,940579000045102800076600000002062593641000000001769022.25 AHCCCS Specialty Populations Patient Days0001729032149000926409700041846444500000000000000004020001484000000290000000000164876460154710223261080210000006530000000000910473000684000002.26 Skilled Medicare Patient Days4700170081293012882545326983,86236264652,018227648993,581267347623103391332573751377220664,6041989315160274,492303227611,4908062,11878037495370830468872,569206419474,6464,816171020725363602374557758144409305537856,1176,569295018965,6832,8576,5884,370671121835260742686617,1539,1757,2754,9308,0975,0324,11510,31012836174,5459400196642646,803549524606750261337246680358937948256820343928658,290396417692,2864362673649349281927228396058476035761385316730701415856392357714383510017572710854528992,83769978791030781662015645001405359842488889,49748216,93635723093279517874207196293141821,9612.27 Private Patient Days391713339230160136233,36868891,0321048172328,09770023003057130968149886440792,802301310908713,8622322239221,81789849421430733230165141803593279523902,5864,6621529705554589425701588465118938696612,2882,022119125133512653,3617181148104242022675540891,7491,7431,1801,8553,3414162493,14340008362,03651900366816571,6411230169120205001228148297819317481786159035432,555551617041,30550573583374741540123259637723123124813995411916113135812196341841301455941523907773232041098810,70446401173556121719501302136256143631,212013,68126717556173811323382182154711,9562.28Part C/Advantage/Medicare Replacement Days0000629725172,7202941,26626465215471215305884310749240447410056851806781779222146510958066010245011136391985012701862989434025146181784143782152012639797,099344342121491,4945,29099150654956018402191332118631047655907531820625146665010100025385891339294159,4371567867637184853516540482832815810332349211,2671233946500139278136234665251635020365313111525528492391911752610384647573171544133350452617739941950163813914497371571,0827955691299130951218587641,0052.29 Other Patient Days13417876742324259191352421,406193431423666669248351632002291551144636122524446218129,07031956726022930101525071479251126337290823147425237510309619231546672313515773274053313037014922194188431634741950911481857684830658627915194237963154340211142511153103440829163263951021457130152983389282888079739204552513221078113161054300093110609650931962653452488027688395130221001983851455364514626314725862111912392.30Total Patient Days861718482137561378636825375791020961313108729371600432246223196516677062616028415496529275327241797522156337122885259156258273427930646297942955561,85629884483364425392171310124818304073451717828387822764321498199253070917411193431931119637181132726628042230141587927662289746150127665604901229136979265351314035428141812940831228684995509114259375303517926619321473901517518372815442519237181520930424184148819639517924109923305539543765833145520552,444457914633319058339664080539509498399904593072421037646441544120360713772328018328435043114188175027274171371443617104355183127215641830433026348683210336094236021070440399268372873355600368830444369731850298281856558792133319564106494533225874258291101923335685362072.31Occupancy Rate73.78%93.77%99.18%99.39%53.10%88.51%77.48%83.76%2.47%ERROR:#DIV/0!68.35%86.68%88.26%87.38%28.94%25.25%71.42%43.88%86.24%74.51%81.85%89.00%71.96%75.80%86.67%66.57%78.05%73.01%67.84%79.38%54.32%26.24%85.76%81.37%44.18%55.93%61.26%65.08%48.12%60.89%70.64%94.41%73.42%93.86%83.90%64.46%71.61%43.97%67.07%77.33%93.12%59.86%63.51%64.75%78.73%73.98%73.70%75.79%71.86%74.50%78.93%37.76%218300.00%77.44%92.50%77.26%66.66%83.93%71.68%29.51%67.46%77.51%60.77%68.62%83.28%82.52%86.56%76.65%95.71%97.58%5718.58%60.68%62.98%53.66%75.48%93.83%53.06%95.37%76.78%75.67%97.62%92.36%87.49%63.47%79.11%56.93%85.76%84.57%74.18%74.69%88.55%78.75%79.73%66.10%66.45%90.42%82.68%68.35%78.24%95.95%55.53%68.50%35.20%67.07%67.04%52.07%73.72%76.29%61.22%49.46%74.17%80.74%68.53%77.26%78.86%61.10%79.06%67.46%61.98%74.67%62.98%44.56%93.53%72.72%92.86%87.46%18.30%91.07%53.99%81.04%51.75%78.33%54.31%71.85%87.82%81.93%82.44%02.32Total Admissions during the report