10:00A.M. AGENDA. 2. Happy Valley Assisted Living-Hot Spring Co., File #HSPA(l457) requesting

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1 ( Arkansas Health Services Permit Commission Permit Of Approval Meeting Freeway Medical Tower Building 5800 West Street Floor, Suite 801 Little Rock, AR June 15, :00A.M. AGENDA I. COMMISSION BUSINESS A. Call to Order B. Approval of Minutes C. Agency Report 1. Agency Application Decisions March 1, 2016 Cycle 2. Legal Updates 3. Other Business ( II. EXTENSION REQUESTS 1. United Methodist Children's Home, File #(1062) requesting their first sixth month extension to obtain a construction contract. Applicant states that they were asked by the Department of Family Service's Director at that time to free up space on their Fillmore Campus for special programming for children of human trafficking and contracted secure care. The DCFS Director has since resigned her position, as well as, the Department of Human Service's Director. Based on these two events, they have intentionally slowed their work toward moving beds until the new directors are in place and have time to assess if this effort is even needed. 2.) The applicant also states that The Methodist Children's Home Board of Directors are exploring to build a secure facility on the Fillmore Campus. If they give approval, this could result in not having to move any beds to an over bedded area. Also, they have made contact with three separate construction companies to answer pricing around the design and build that each of them offer for their Fillmore Campus. 2. Happy Valley Assisted Living-Hot Spring Co., File #HSPA(l457) requesting their first sixth month extension to obtain a construction contract. The applicant states that The opening of Happy Valley Health & Rehab 83 bed facility. Awaiting architect to provide final design for Happy Valley Assisted Living. Awaiting contractors to submit final bids for Happy Valley Assisted Living. Lighting strike to new facility causing electrical damage. 3. Happy Valley Assisted Living, Ouachita Co., File #HSPA(l458) requesting their first sixth month extension to obtain a construction contract. The applicant states that the opening of Happy Valley Health & Rehab 83 bed facility. Awaiting architect to provide final design for Happy Valley Assisted Living. Awaiting contractors to submit

2 c---- final bids for Happy Valley Assisted Living. Lighting strike to new facility causing electrical damage. 4. Ridgecrest Health & Rehabilitation, Craighead Co., File #HSPA(l426) requesting their second sixth month extension 1.) to obtain licensure and 2.) movement of beds. The applicant states that Ridgecrest has experienced some unforeseen delays with completing construction due to weather which have delayed issuance of the facility's Certificate of Occupancy and Life Safety Code Approval. Also, the applicant is requesting to move thirty-five (35) beds from Lexington Place Health and Rehabilitation to Ridgecrest an inter-county movement of beds. ( 5. Memory Lane, Inc., Crawford Co., File #HSPA(1413) requesting their third sixth month extension to obtain licensure for the remaining fifty-one ( 51) beds. The Applicant states that they have completed construction and opened their ALF 11 facility in January They received Medicaid Waiver Approval in November Their 1st 20-bed unit is now full. They opened their last 20-bed unit May 2, 2016, and are currently admitting several residents. As you may know, Van Buren First Assembly of God (VBF A) is the owner of Memory Lane. In August 2015, the Pastor, Reverend Bobby L. Johnson, passed away suddenly. He was the Pastor of this church for 35 years. As you can imagine, the magnitude of his loss has been tremendous for not only the church and the company, but for the community as well. In January 2016 VBFA elected a new Pastor, and this transition is still very much in process. In light of these events, the company Board is still evaluating the best course of action for Memory Lane in regard to the additional beds 6. Mt. Carmel Community@Bentonville, Benton Co., File #(1391) is requesting their fourth sixth month extension to complete the foundation. The applicant states that they have been working with their bank on the scheduling of their project in NW Arkansas. Applicant just opened Mt. Carmel Community in Rogers and the bank preferred the census at that location in Rogers be near 50% before they begin construction on their Bentonville project. With deposits and commitments, they are over that percentage, but until the garden home phase is completed they are not there yet, as several of their commitments are within that level of care. The dirt work has been completed at the owner's expense, but until the loan is finalized (which should be within the next couple of weeks) they will not be in a position to continue working on the foundation. L 7. Benton County Health & Rehab, Benton Co., File #HSP A(l 448) requesting their fifth sixth month extension to obtain a construction contract. Applicant states that the Permit Holder has been in discussion with a major area hospital system regarding initiating an arrangement for this nursing facility to be constructed on its Rogers campus, which has recently been approved by its leaders for an expansion costing nearly quarter of a billion dollars. This arrangement will serve to allow the respective providers to work together to assure better quality services are available to higher acuity patients within a transitional care facility. The Permit Holder agents have met with hospital system officials are working to coordinate a plan whereby this project owner will purchase

3 hospital campus property and initiate construction on that new site. Negotiations of this sort are, by nature, slow and methodical, but they are optimistic that a site location change request can be presented to the Commission at the September 2016 regular meeting. 8. Belvedere Assisted Living, Garland Co., File #HSPA(1375) requesting their sixth, sixth month extension to complete the foundation. The applicant states that currently a million dollars worth of dirt work has been done to accommodate the skilled nursing and assisted living facilities. By the end of this week approximately half of the foundation for the skilled nursing portion of the campus will be complete. It is expected that ninety percent will be done by the June meeting. There is one corner of the building that will house a memory care unit which will take more time to complete. Another cause for delay is associated with a 150 foot hill that the Permit Holder will have to move off the property. ( 9. Methodist Health & Rehab, Inc., Sebastian Co., File #HSPA(l330) requesting their eighth sixth month extension to obtain a construction contract. The applicant states that in January 2016, after meeting with three different firms, they are pleased to inform you they have selected Plante Moran Living Forward to assist us with our master planning campus repositioning process as well as assist us with the development of our Phase I - Assisted Living Project. Since January 2016, they have been actively working with Plante Moran Living Forward TM to select an architectural firm. RDG Planning and Design with whom they had been working was not able to handle the work load of their project moving forward. During February/March Plante Moran Living Forward TM assisted them in sending out RPQ/RPF's to 14 senior living architectural firms. In March they reviewed all proposals and selected four finalist firms. In late March, after a detailed 2 day session reviewing proposals from all four firms, they are pleased to inform you they have selected Pope Architects from Minneapolis, Minnesota to design their 45 bed AL facility. Additionally, they are currently in negotiations with two General Contracting firms, The Weitz Company and Ryan Companies, to execute a final CMC Al for construction management services. They anticipate an executed contract with one of these firms in the next days. III. MOVEMENT OF BEDS 1. Ridgecrest Health and Rehab, Jonesboro, File #HSPA(l426) requesting to move thirty-five (35) beds from Lexington Place Health and Rehab, Jonesboro to Ridgecrest Health & Rehab. Both facilities are located in Craighead County. IV. DISCUSSION FOR COMMISSION 1. United Methodist Children's Home, to construct a new facility at the Fillmore Campus, Little Rock. 2. Rulebook ( '-

4 ARKANSAS HEAL TH SERVICES PERMIT COMMISSION MEETING FREEWAY MEDICAL TOWER BUILDING 9TH FLOOR, SUITE 906 BOARDROOM 5800 WEST 10 TH STREET LITTLE ROCK, AR March 16, :00 A.M. MINUTES ( Presiding: Member Present: Member Absent: Health Services Agency Staff: Legal Counsel: Hearing Officer: Guests: Mr. Kevin Hodges Mr. David Norsworthy Mr. Jim Petrus Dr. Jack Robertson Mr. David Laffoon Mr. Murry Reagor Ms. Janie Pugsley Keesa Smith Director Tracy Steele Ms. Roxann Walker Ms. Jennifer Cooper Ms. Latreasa Mullins Ms. Shemika Green Ms. Sara Farris Peggy Johnson Sign in Sheet is attached I. COMMISSION BUSINESS Kevin Hodges, Chair called the meeting to order at 10:02 AM. The Chair called for a motion to approve the minutes. MINUTES: A motion was made by Mr. Laffoon to approve the minutes of the March 2016 Commission meeting. The motion was seconded by Janie Pugsley. A voice vote was taken and the motion carried. Mr. Tracy Steele referred the Commissioners to the attached Agency Application Decisions of the December 1, 2015 Review Cycle and asked if there were any comments or questions. There were no questions or comments on Agency decisions.

5 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 LEGAL UPDATE Sara Farris, Attorney, provided the following report on pending court actions and the legal updates were addressed as the following: (1) Twin Rivers Health and Rehab LLC v. Health Services Permit Comm 'n, et al. Pulaski County Circuit Court No. 60CV Twin Rivers filed a complaint for judicial review and declaratory judgment challenging the decision to grant a POA to Gracewood Nursing. Sara Farris filed the administrative record on March 4th and filed the Response on March 6th. Gracewood has been named as a defendant and has filed a Motion to Dismiss. Twin Rivers filed a Motion to Transfer the case to the same judge assigned to Twin River's lawsuit against the Office of Long Term Care, and this Motion has been granted. The Court held a hearing on the Motion to Dismiss and then set a briefing schedule for briefs on the merits. Update: The parties submitted briefs on the merits and a hearing was held on March 4th, All agreed that the parties will submit additional briefs on a procedural issue before the Court hears oral arguments on the merits. ( (2) Genesis Pediatric Home Health v. Health Services Permit Comm 'n Miller County Circuit Court No. 46CV-l Genesis filed a judicial appeal challenging the decision to deny it a POA to operate as a pediatric home health agency in Miller County. Sara Farris filed the Response and administrative record with the Court on March 4th. Opposing counsel filed discovery requests on the Commission and Ms. Farris filed a Motion to Quash, which the Court has not yet ruled on. NO CHANGE: The Court has issued a briefing schedule, and oral arguments will be heard in Texarkana on April ih (3) RCR Health Care d/b/a Premiere Homecare v. Health Services Permit Commission Miller County Circuit Court No. CIV Premiere filed a petition for judicial review challenging the decision to deny a permit of approval for a home health agency in Miller County. I filed the administrative record on May 21, Heritage Home Health's motion to intervene was denied on 12/31/09. Premiere Homecare filed a brief in support of its petition on 2/16/10. Counsel filed the Commission's brief on 3/09/10. We are waiting for a hearing to be scheduled or a decision. Update: Sara filed a Motion to Dismiss. l ( 4) RCR Health Care d/b/a Premier Homecare v. Health Services Permit Commission Lafayette County Circuit Court No. CIV

6 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 Premiere filed a petition for judicial review challenging the decision to deny a permit of approval for a home health agency in Lafayette County. Counsel filed the administrative record on 5/21/08. Heritage Home Health's motion to intervene was denied on 12/31/09. Premiere Homecare filed a brief in support of its petition on 2/16/10. Counsel filed the Commission's brief on 3/09/10. We are waiting for a hearing to be scheduled or a decision. Update: Sara filed a Motion to Dismiss. (5) Clifford Flowers d/b/a Jefferson County Southeast Arkansas Hospice - Pulaski County v. Arkansas Health Services Permit Commission Pulaski County Circuit Court No. 60-CV Clifford Flowers d/b/a Jefferson County Southeast Arkansas Hospice - Pulaski County filed a petition for judicial review challenging the denial of its permit of approval application. The petition for judicial review was filed on 11/15/13. Counsel filed a response to the petition on 12/05/13 and filed the administrative record on 12/12/13. We are waiting for a briefing schedule. NO CHANGE Other Business: ( II. New Business: Kevin Hodges, Chair, publicly recognized Mr. Jim Petrus and David Laffoon for their outstand services in on the Health Services Permit Agency Committee. EXTENSION REQUESTS 1. Lincoln County Assisted Living, Lincoln Co., File #HSP A (1434) requested their first sixth month extension to complete the foundation. The applicant states they had informed AHSP A that an extension would not be necessary, inclement weather forced a delay in construction and it is necessary to ask for an extension in order to complete the foundation. The architectural and mechanical plans are complete; they have closed _on the property and will proceed with the foundation as soon as the extension is granted. Todd Hightower was present and gave an update. Motion: A motion was made by Mr. Norsworthy and seconded by Mr. Petrus to grant the first sixth month extension to complete the foundation. A voice vote was taken. The motion carried. 2. St. Bernards Village ALF I, Craighead Co., File #HSPA (1435) requesting their first sixth month extension to obtain licensure. The applicant states that they have applied for licensure to the Office of Long-Term Care, and are waiting for their reply.withdrawn 3. Country Place Senior Living of Harrison, Boone Co., File #HSPA (1440) requested their first sixth month extension to obtain a construction contract. Applicant states 3

7 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 that the extension is needed due to stalled negotiations in extending feasibility and closing for the previous property under contract. Extra time is needed to locate a new, desirable location within the area, and perform feasibility and due diligence on the property. Ron Rhode was present and gave an update. Motion: A motion was made by Mr. David Laffoon and seconded by Mr. David Norsworthy to grant the first sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. 4. Country Place Senior of Wynne Co., File #HSPA (1442) requested their first sixth month extension to obtain a construction contract. Attached is the executed Addendum to Purchase Agreement stating that feasibility has been extended from 1/16/2016 to 3/16/2016. The applicant states that the extra time is needed to work out details on roads, infrastructure and improvements to and on the property. Also, once that is completed a final plat needs to be submitted, finalized, and recorded with the city. Ron Rhode was present and gave an update. Motion: A motion was made by Mr. Reagor and seconded by Dr. Robertson to grant their first sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. / \ 5. Country Place Senior Living of Mountain Home, Baxter Co., File #HSP A (1444) requested their first sixth month extension to obtain a construction contract. Attached is the executed Addendum to Purchase Agreement stating that feasibility has been extended from 1/30/2016 to 2/29/2016 with closing being extended to 3/29/2016. Extra time is needed to clear title objections, finalize/record the plat, and finish closing. Ron Rhode was present and gave an update. Motion: A motion was made by Mr. Norsworthy and seconded by Mr. Laffoon to grant their first sixth month extension to obtain a Construction contract. A voice vote was taken. The motion carried. 6. Country Place Senior Living of Batesville, Independence Co., File #HSP A (1446) requested their first sixth month extension to obtain a construction contract. Applicant states that extra time is needed to locate a new desirable location due to budgeting concerns with infrastructure expense with the previous property that was under contract. Ron Rhode was present and gave an update. L Motion: A motion was made by Mr. Reagor and seconded by Mrs. Pugsley to grant the first sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. 4

8 HEALTH SERVICES PERMIT COMMISSION March 16, The Manor at Benton, Saline Co., File #HSPA (1453) requested their first sixth month extension to complete the foundation. The applicant states that they anticipate completion of their foundation prior to the end offebniary, but may not meet the March 4, 2016 deadline. Scott Kingsborough was present and gave an update. Motion: A motion was made by Mr. Reagor and seconded by Mrs. Pugsley to grant the first sixth month extension to complete the foundation. A voice vote was taken. The motion was carried. 8. Stoneybrook Health & Rehab Center, Saline Co., File #HSPA (1460) requested their first sixth month extension to obtain a construction contract. The Permit Holder has received several offers to purchase the original site selected.to build. The new development has lead the Permit Holder to consider if it is in the best interest of the project and the surrounding community to move forward with the sale and look into purchasing a site located closer to the hospital. David Norsworthy was recused. David Norsworthy and Amy Wilbourn gave an update. Motion: A motion was made by Mr. Reagor and seconded by Mr. Laffoon to grant the first sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. I l Clarity Pointe of Conway, Faulkner Co., File #HSPA (1456) requested their first sixth month extension to obtain a construction contract. The applicant states their site is under contract with Hendrix College at a location within a development they own next door to the college. The seller has recently obtained approval for the needed additional utilities (sewer) from the municipal provider. The seller is now in a position to have their total site engineered of which their site is a part of. With the new development engineering in hand, their engineer will be able to proceed with their site engineering, and conclude the engineering construction documents. Once those plans are finalized, they will then be able to conclude the construction contract with the contractor. Murry Reagor recused. No one was present to give update. Motion: A motion was made by Mr. Laffoon and seconded by Mrs. Pugsley to grant the first sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. The St. Scholstica, Sebastian Co., File #HPSA (1462) requested their first sixth month extension to obtain a construction contract. The applicant states that in preparing for construction, it has been necessary to conduct soil testing which revealed some unknown issues with the ground and could impact the overall cost of the project. As such, the facility has had an unavoidable delay in meeting the expected target date for obtaining a construction contract. Eric Bell was present and gave an update. 5

9 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 Motion: A motion was made. by Mrs. Pugsley and seconded by Mr. Petrus to grant the first sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried 11. Country Place Senior Living of El Dorado, Union Co., File #HSPA (1415) requested their third sixth month extension to obtain a construction contract. The applicant states that the extension is needed to find a new, desirable location for their facility that is within their budget and in close proximity to local infrastructure. Ron Rhode was present and gave an update. Motion: A motion was made by Mr. Laffoon and seconded by Mrs. Pugsley to deny the third sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. 12. Country Place Senior Living of Nashville, Howard Co., File #HSPA (1416) requested their third sixth month extension to obtain a construction contract. The applicant states that the extension is needed to finalize contract negotiations, perform their due diligence, close on the property, and initiate design work. Ron Rhode was present and gave an update. Motion:.A motion was made by Mr. Laffoon and seconded by Mr. Reagor to deny the third sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. 13. Mill Creek Health & Rehab, Washington Co., File #HSPA (1425) requested their third sixth month extension to obtain a construction contract. Applicant states this project, which includes Washington County Assisted Living File No. HSP A ( 1407) 14 and other health facilities, will be built as part of a large scale development project site. The Permit Holder has advised that financing has been approved; however, city planning approvals are still in their preliminary stages. In an effort to continue the progress of the projects, the Holder continues to collaborate and discuss with engineers and architects regarding road placement, traffic flow and best location of these buildings within the foot print of the site location. Discussions and negotiations with area health providers and a major hospital regarding use of portions of the location site to assist the providers with the health facilities are also being finalized. It is the Permit Holder's desire to have all these issues firmed up before a contract is executed. David Norsworthy recused. David Norsworthy and Amy Wilbourn were present and gave an update. Motion: A motion was made by Mr. Robertson and seconded by Mr. Pugsley to grant the third sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. L 14. Serenity Pointe Health & Rehab Nursing Home, Garland Co., File #HSP A(l385) requested their 1.) Fourth sixth month extension to obtain a construction contract and 2.) Movement of beds. The applicant states that the 6

10 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 extension request is based on the decision to reduce the project from the original application of a 115 beds facility to a 95 bed facility. This decision required the architectural firm to redraw the original plans to the reduced bed size plans. The plans are being completed and will be submitted for construction pricing in the next 6 months. The remaining 20 beds will go back to Heritage of Hot Springs Health and Rehab. Randy Wyatt was present and gave and update. Motion: A motion was made by Mr. Laffoon and seconded by Mr. Norsworthy to grant the fourth sixth month extension to obtain a construction contract and grant the movement of beds. A voice vote was taken. The motion carried. ( 15. Washington County Assisted Living, Washington Co., File #HSPA (1407) requested their fourth six month extension to obtain a construction contract. Applicant states this project, which includes Mill Creek Health and Rehab File No. HSP A (1425) and other health facilities, will be built as part of a large scale development project site. The Permit Holder has advised that financing has been approved; however, city planning approvals are still in their preliminary stages. In an effort to continue the progress of the projects, the Holder continues to collaborate and discuss with engineers and architects regarding road placement, traffic flow and best location of these buildings within the foot print of the site location. Discussions and negotiations with area health providers and a major hospital regarding use of portions of the location site to assist the providers with the health facilities are also being finalized. It is the Permit Holder's desire to have all these issues firmed up before a contract is executed. David Norsworthy recused. David Norsworthy and Amy Wilbourn were present and gave an update. Motion: A motion was made by Mr. Reagor and seconded by Dr. Robertson to grant the fourth sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. 16. NEA Village, Craighead Co., File #HSPA (1310) requested their fifth sixth month extension to obtain licensure. The applicant states that they have made substantial progress with the construction of the project. There was a delay in the progress when the Landlord discovered that the fire systems and sprinkler systems would have to be upgraded and reworked. With such finalization, the construction is now nearing completion and they anticipate filing for licensure in late March or April. Jenny Teeter and Rick Williams were present and gave an update. Motion: A motion was made by Mr. Laffoon and seconded by Mr. Petrus to grant their fifth sixth month extension to obtain licensure. A voice vote was taken. The motion carried. 17. Auburn Hills Therapy & Living Center, Baxter Co., File #HSP A (1387) requested their 1.) Fifth sixth month extension to obtain a construction contract 2.) Site location change 3.) Movement of beds. The Permit Holder believes that 7

11 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 this facility will better serve the community and be more cost efficient if it was transferred to the Pine Lane Therapy and Living Center location which is located at 1100 Pine Tree Lane, Mountain Home, AR, Baxter County. The Holder plans on tearing down the Pine Lane building and replacing it with the Auburn Hills facility. The new proposed building will house one hundred and forty (140) beds. The additional twenty-six (26) beds needed will come from the Pine Lane facility. [ Auburn Hills 114 beds + 26 licensed beds from Pine Lane = 140] [Pine Lane 105 licensed beds - 26 licensed beds = 79 beds] Amy Wilbourn was present and gave an update. Motion: A motion was made by Mr. Norsworthy and seconded by Mr. Laffoon to grant the fifth sixth month extension to obtain a construction contract and site location change. A voice vote was taken. The motion carried. ( 18. Pinecrest, Little River Co., File #HSP A (1360) requested their sixth, sixth month extension to obtain a construction contract. The Permit Holder have analyzed and assessed the communities in the rural locations where these facilities will be located. The reality is that only a handful of residents are financially able to pay for assisted living. Therefore, the Waiver program is absolutely essential if these assisted living programs are going to be viable. The contract for renewal of the program is currently under review by the State and Federal Government. It has not been completed at this point and renewal is not guaranteed. An extension of these contract dates would assure the developer that sufficient time is available for the State and Federal government to either renew the program or discontinue it. Amy Wilbourn and Steve Marinick were present and gave an update. Motion: A motion was made by Mr. Petrus and seconded by Mr. Laffoon to grant the sixth, sixth month extension to obtain a construction contract. A voice vote was taken. The motion was carried. L 19. Saline Nursing Rehab Center, Saline Co., File #HSPA (1321) requested their seventh sixth month extension. to complete the foundation. The applicant states, since the September of 2015 Commission Meeting, they have adjusted the final. site plans, purchased the land, revised the construction contract to reflect the additional size and dimensions, obtained all of the necessary permits (see enclosed Building Permit), closed on the bank loan, cleared the site and begun the initial stages of the dirt-work. In fact, considering land acquisition costs, they have already spent well over $IM on this project to date and very much need it to be completed as quickly as possible. However, as you will see from the enclosed letter from their contractor, Smithers Merchant Builders, LP, and from the enclosed photos, the soil is simply too wet at present and is going to require a little bit of time, without rain, to dry before continuing on with the dirt-work. However, with the spring rains being upon them, applicant hopes you will consider granting them a six-month extension with the commitment from them 8

12 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 that they will get back to work as soon as the soil is dry enough. Mike Hathorn was present and gave an update. Motion: A motion was made by Mr. Petrus and seconded by Mrs. Pugsley to grant the seventh sixth month extension to complete the foundation. A voice vote was taken. The motion carried. 20. DeQueen Assisted Living, Sevier Co., File #HSP A (1332) requested their seventh sixth month extension to obtain a construction contract. The applicant states the POA Holder has new management and it has decided that it is in the best interest of the project to move the location of the facility to a more suitable and community friendly site. Several land options are currently being evaluated and considered for implementation of the above stated POA. Once a site is selected the project will be bid out and steps towards securing a contract will be on its way. It is anticipated that a decision regarding the purchase will be made in the near future. Amy Wilbourn and Josh Kilgore were present and gave an update. Motion: A motion was made by Mr. Petrus and seconded by Mr. Norsworthy to grant the seventh sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. (~ ( \ Hope Haven, Hempstead Co., File #HSP A (1351) requested their seventh sixth month extension to obtain a construction contract. The Permit Holder have analyzed and assessed the communities in the rural locations where these facilities will be located. The reality is that only a handful of residents are financially able to pay for assisted living. Therefore, the Waiver program is absolutely essential if these assisted living programs are going to be viable. The contract for renewal of the program is currently under review by the State and Federal Government. It has not been completed at this point and renewal is not guaranteed. An extension of these contract dates would assure the developer that sufficient time is available for the State and Federal government to either renew the program or discontinue it. Amy Wilbourn and Steve Mayrick were present and gave an update. Motion: A motion was made by Mr. Petrus and seconded by Mrs. Pugsley to grant the seventh sixth month extension to obtain a construction contract. A voice vote was taken. The motion carried. Howard County Health & Rehab, Benton Co., File #HSPA (1221) requested their ninth sixth month extension to obtain licensure. The Permit of Approval Holder continues to diligently work on this project. The exterior of the building is fully constructed. However, there is still interior work which needs to be completed. Due to the large scaled nature of the project it is anticipated that the facility will not be finished this spring. Once everything is finalized the POA Holder will proceed with the licensing process. David Norsworthy recused. Amy Wilbourn, Rick Williams and David Norsworthy were present and gave an update. 9

13 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 Motion: A motion was made by Mr. Reagor and seconded by Dr. Robertson to grant the ninth sixth month extension to obtain licensure. A voice vote was taken. A motion carried. 23. The Gardens Health & Rehab, Pulaski Co., File #HSPA (1281) requested their ninth sixth month extension to obtain licensure. The applicant states that the building is fully constructed. In addition, most large equipment has been installed. The Permit Holder is in the process of completing the landscaping and having a cleaning crew prepares the building prior to the implementation of the interior design components. Once this is completed, the POA Holder will proceed with the licensing process. It is believed that this could be finalized by March 19th but we believe this is unlikely. David Norsworthy recused. Amy Wilbourn and David Norsworthy wer_e present and gave an update. ( 24. Motion: A motion was made by Mr. Laffoon and seconded by Mrs. Pugsley to grant a ninth sixth month extension to obtain licensure. A voice vote was taken. A motion carried. Spring Valley Health & Rehab, Garland Co., File #HSP A (1188) requested their tenth sixth month extension to complete the foundation. The Permit of Approval Holder is building both the above stated Skilled Nursing Facility and Belvedere Assisted Living, #HSPA (1375)13, on the same campus. In an attempt to be efficient and cost effective, the POA Holder is coordinating the implementation of these projects. All permits required to proceed with dirt work on the campus have been acquired and extensive dirt work continues to be done on site. In addition, a necessary retaining wall is being constructed and is nearly complete. The POA Holder believes that all the remaining dirt work will be complete and a foundation lay within the next couple of months. It is anticipated that an update for additional progress made during the next month will be available by the March 2016 Commission meeting. David Norsworthy recused. Amy Wilbourn and David Norsworthy were present and gave an update. Motion: A motion was made _by Mr. Petrus and seconded by Dr. Robertson to grant the tenth sixth month extension to complete the foundation. A voice vote was taken. A motion carried. III. SITE LOCATION CHANGE 1. Auburn Hills Therapy & Living Center, Baxter Co., File #HSP A (1387) requested to move from 3545 Hwy 5 North to the Pine Lane Therapy & Living Center location, 1100 Pine Tree Lane, Mtn. Home. Amy Wilbourn was present and gave an update. l Motion: A motion was made by Mr. Norsworthy and seconded by Mr. 10

14 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 Laffoon to grant the site location change. A voice vote was taken. The motion carried. 2. Johnson County Health & Rehab, Johnson Co., File #HSPA (1450) requested to move from 1451 East Poplar Street, Clarksville to 300 South Thompson Road, Lamar. Both locations are in Johnson County. David Norsworthy recused. David Norsworthy and Amy Wilbourn were present and gave an update. Motion: A motion was made by Mr. Petrus and seconded by Dr. Robertson to grant the facility to move from 1451 East Poplar Street, Clarksville to 300 South Thompson Road, Lamar both located in Johnson County. A voice vote was taken. The motion carried. IV. MOVEMENT OF BEDS 1. Woodridge Behavioral Care LLC and Ozark Guidance Center, Inc. had reached an agreement to transfer five (5) of the PRTF beds currently owned by Ozark Guidance to Woodridge. Woodridge is requesting to move five (5) beds from their Springdale facility to their location in Forrest City and West Memphis. The request is to move three (3) beds to Forrest City and two (2) beds to West Memphis. Neal Campbell was present and gave an update. ( Motion: A motion was made by Mr. Laffoon and seconded by Dr. Robertson to transfer five (5) of the PRTF beds currently owned by Ozark Guidance to Woodridge. Woodridge is requesting to move (5) beds from their Springdale facility to their location in Forrest City and West Memphis. The request is to move (3) beds to Forrest City and two (2) beds to West Memphis. 2. Serenity Pointe Health & Rehab Nursing Home, Garland County, File #HSP A(1385) requested to return twenty (20) beds to Heritage of Hot Springs Health and Rehab. Randall Wyatt was present and gave an update. Motion: A motion was made by Mr. Laffoon and seconded by Mr. Norsworthy 1.) Grant their request for the fourth six month extension to obtain a construction contract and 2.) Movement of beds the applicant states that the extension request is based on the decision to reduce the project from the original application of a 115 beds facility to a 95 bed facility. This decision required the architectural firm to redraw the original plans to the reduced bed size plans. The plans are being completed and will be submitted for construction pricing in the next 6 months. The remaining 20 beds will go back to Heritage of Hot Springs Health and Rehab. L 11

15 HEALTH SERVICES PERMIT COMMISSION March 16, Auburn Hills Therapy & Living Center, Baxter Co., File #HSPA (1387) requested to transfer twenty-six (26) beds from the Pine Lane facility. Amy Wilbourn was present and gave an update. Motion: A motion was made by Mr. Norsworthy and seconded by Mr. Laffoon to transfer twenty-six (26) beds from the Pine Lane facility. A voice vote was taken. The motion carried Johnson County Health & Rehab, Johnson Co., File #HSPA(1450) requested to move from 1451 East Poplar Street, Clarksville to 300 South Thompson Road, Lamar. Both locations are in Johnson County. David Norsworthy recused. David Norsworthy gave an update. Motion: A motion was made by Mr. Reagor and seconded by Mr. Petrus to to transfer eight (8) beds from 1451 East Poplar Street, to 300 South Thompson Road both locations are in Johnson County. A voice vote was taken. The motion carried V. DISCUSSION FOR COMMISSION ( Mr. Steele informed the Commission that the Agency had received a request to be placed on the agenda to discuss the following: 1. PRTFs Beds - Discuss Authorization of Beds for Victims of Trafficking Program Lisa McGee with the Department of Human Services and Attorney Debbie Nye were present. Motion: A motion was made by Mr. Laffoon and seconded by Ms. Pugsley to create a new sub category in reference to the PRTF beds. A voice vote was taken. The motion carried 2. PRTFs Beds- Discuss to lift Moratorium on PRTFs beds for Victims of Sex Trafficking Motion: A motion was made by Mr. Reagor and seconded by Mr. Norsworthy to explore lifting moratorium on PRTFs beds for sex trafficking. A voice vote was taken. The motion carried. 3. Rulebook- requested new changes are included in the proposed changes and put back out for public comment L Mr. Steele stated that the last Commission meeting the Agency informed the Commission that the Agency was reviewing the Rulebook and there are proposed changes that the Agency would like to be considered and asked the Rulebook be put out for public comment. He stated that the Rulebook was 12

16 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 ~) put out for public comments and the Agency received comments. The comments are attached for the Commission to review. Motion: A motion was made by Mr. Norsworthy and seconded by Mr. Reagor to request new changes are in the proposed changes and put back out for public comment. A voice vote was taken. The motion carried. 4. Applications- Nancy Elphingstone suggested putting committee together with Home Health providers who know the application process, especially to new owners for recommendations on applications reviewed by the agency. Motion: A motion was made by Mr~ Laffoon and seconded by Mr. Norsworthy to create an Advisory Committee to review applications and help the agency staff with questions and the applicants with changing the form of their application. A voice vote was taken. The motion carried. VI. APPEALS Peggy Johnson, Hearing Officer, called the hearing to order at 1:17 P.M. with the following Commission members present: ( Representing Thrive Pediatric Nursing, Inc., of Jefferson and Benton were Michelle Mantuano, Attorney Debbie Nye, Angie Turner and Amy Hudson, and representing the Agency was Sara Farris, attorney of the Arkansas Attorney General's office. Witnesses announced for both parties were sworn in, the introduction of exhibits, the arguments of counsel, and discussion among the members of the Commission, the following motion was made: 1. Thrive Pediatric Nursing, Inc., Jefferson Co., File #HSPA(1474) appealing the Agency's decision of denial to provide Home Health Services to Jefferson County from an office in Pine Bluff, AR (Jefferson Co.) Michelle Mantuano, Attorney Debbie Nye and Amy Hudson were present and gave an update. 2. Thrive Pediatric Nursing, Inc., Benton Co., File #HSP A(1475) appealing the Agency's decision of denial to provide Home Health Services to Benton County from an office in Bentonville, AR (Benton Co.) Michelle Mantuano, Attorney Debbie Nye, Angie Turner and Amy Hudson were present and gave an update. The hearing was closed at 4:30 p.m. The Chair reopened the meeting at 4:39 p.m. for discussion from the commission. After discussion, the following motions were made: L Motion: A motion was made by Mr. Reagor and seconded by Ms. Pugsley to deny the appeal and uphold the agency decision to deny the 13

17 HEALTH SERVICES PERMIT COMMISSION March 16, 2016 permit of approval to Thrive Pediatric Nursing, Inc., Jefferson Co., File #HSPA (1474). A voice vote was taken. The motion carried. Motion: A motion was made Mr. Petrus and seconded by Mr. Laffoon to deny the appeal and uphold the agency decision to deny the permit of approval to Thrive Pediatric Nursing, Inc., Benton Co., File #HSPA (1475). A voice vote was taken. The motion carried. 3. Arkansas Home Hospice, LLC, (Crowley's Ridge Hospice House) Craighead Co., File #HSPA(1476) is appealing the Agency's decision of denial of the applicant to provide hospice services to Craighead Co. WITHDRAWN 4. Arkansas Home Hospice, LLC, (Crowley's Ridge Hospice House) Craighead Co., File #HSPA(1476) is appealing the Agency's decision of approval to Home Health Professionals & Hospice, Inc, File #HSP A(l 4 73) to provide hospice services to Craighead Co. WITHDRAWN ( 5. Arkansas Home Hospice, LLC, (Crowley's Ridge Hospice House) Craighead Co., File #HSPA(1476) is appealing the Agency's decision of approval to Lester Dierksen Memorial, File #HSPA(l477) to provide hospice services to Craighead Co. WITHDRAWN VII. Other Each Commissioner was mailed a questionnaire along with their March 16th 2016 information packets regarding how they would prefer to receive information in the future regarding Commission meeting appeals, applications and etc. After further consideration Health Services, feels that it would be economical feasible to provide each Commissioner with flash drives with information loaded, to use as a guide at each meeting. The flash drives will be mailed a week prior and returned back to the Agency after each commission meeting. There being no further business the meeting adjourned at 4:47 p.m. L 14

18 AGENCY REPORT ON APPLICATION DECISIONS; MARCH 1, 2016 CYCLE r APPROVALS Nursing Home Willowbend at Marion Nursing and Rehabilitation, File #HSPA (1483)16, was granted a Permit of Approval (POA) for the purpose of replacing a 98 bed with a new 118 bed nursing home called Willowbend at Marion Nursing and Rehabilitation located at TBD Canal Street Extension, Marion, AR (Crittenden County). The projected capital expenditure for this project is $8,139,750. The Cottages_ at Angelo's Grove, File #HSPA (1480)16, was granted a Permit of Approval (POA) for the purpose of replacing a 155 (70 beds from the 155 and adding 14 beds to the new facility; the 85 beds remain at West Memphis Health and Rehabilitation f/k/a Health Care and Rehabilitation Center of West Memphis) bed with a new 84 bed nursing home called The Cottages at Angelo's Grove located at SW Comer of Interstate 55 and Highway 64 in a development called Angelo's Grove, Marion, AR (Crittenden County). The projected capital expenditure for this project is $10,334,500. Trinity Health and Rehab, File #HSPA (148\)16, w~ gr~tec(t/p~~tq(appr6;~rcroayf.6ftliy:1)~6~~ :.o(' replacing a 86 bed with a new 104 bed nursing home caliedtnru.ty'i-i~aith ~ci: Rehab: locatefai22lriles Road; Hot Springs, AR (Garland County). The projected capital expenditure for this project is $10,000, :.. : '... :. ;-~,; -. _.; '.' / :... : :. ' -< '... ~:.. l. -.i ~ ;..... ~....

19 Health Services Permit Commission Legal Update June 2016 {1) Thrive Pediatric Nursing, Inc. v Tracy Steele, Director; Arkansas Health Services Permit Agency; Arkansas Health Services Permit Commission Pulaski County Circuit Court No. 60CV Thrive filed a judicial appeal chall~nging the decision to deny it a POA to operate as a pediatric home health agency in Benton County and Jefferson County. Sara Farris filed the Response and administrative record with the Court on May 19, The next step is for the Court to set a briefing schedule. (2) Twin Rivers Health and Rehab LLC v. Health Services Permit Comm'n, et al. Pulaski County Circuit Court No. GOCV Twin Rivers filed a complaint for judicial review and declaratory judgment challenging the decision to grant a POA to Gracewood Nursing. Sara Farris filed the administrative record on March 4th and filed the Response on March 6th. The parties submitted briefs on the merits and a hearing was held on March 4th, All agreed that the parties will submit additional briefs on a procedural issue before the Court hears oral arguments on the merits. Update: Sara filed a Motion to Dismiss on March 18, Twin Rivers ed a response to Farris but failed to file it in the correct case. On May 11, Sara wrote the judge and asked that he grant the Motion to Dismiss. The Court has not responded as of May 25, (3) Genesis Pediatric Home Health v. Health Services Permit Comm'n Miller County Circuit Court No. 46CV Genesis filed a judicial appeal challenging the decision to deny it a POA to operate as a pediatric home health agency in Miller County. Sara Farris filed the Response and administrative record with the Court on March 4th. The parties filed briefs on the merits. The Court heard in Texarkana on April 7. Update: The Court ruled in the Commission's favor. Sara is awaiting the final signed Order from the judge. (4) RCR Health Care d/b/a Premiere Homecare v. Health Services Permit Commission Miller County Circuit Court No. CIV l Premiere filed a petition for judicial review challenging the decision to deny a permit of approval for a home health agency in Miller County. I filed the administrative record on May 21, Heritage Home Health's motion to intervene was denied on 12/31/09. Premiere Homecare filed a brief in support of its petition on 2/16/10. Counsel filed the

20 Commission's brief on 3/09/10. We are waiting for a hearing to be scheduled or a decision. Update: Update: Sara filed a Motion on Feb. 24th, 2016, to dismiss the case for lack of prosecution and this Motion is pending before the Court. (5) RCR Health Care d/b/a Premier Homecare v. Health Services Permit Commission Lafayette County Circuit Court No. CIV Premiere filed a petition for judicial review challenging the decision to deny a permit of approval for a home health agency in Lafayette County. Counsel filed the administrative record on 5/21/08. Heritage Home Health's motion to intervene was denied on 12/31/09. Premiere Homecare filed a brief in support of its petition on 2/16/10. Counsel filed the Commission's brief on 3/09/10. We are waiting for a hearing to be scheduled or a decision. Update: Sara filed a Motion on Feb. 24th, 2016, to dismiss the case for lack of prosecution and this Motion is pending before the Court. (6) Clifford Flowers d/b/a Jefferson County Southeast Arkansas Hospice - Pulaski County v. Arkansas Health Services Permit Commission Pulaski County Circuit Court No. 60-CV Clifford Flowers d/b/a Jefferson County Southeast Arkansas Hospice - Pulaski County filed a petition for judicial review challenging the denial of its permit of approval application. The petition for judicial review was filed on 11/15/13. Counsel filed a response to the petition on 12/05/13 and filed the administrative record on 12/12/13. We are waiting for a briefing schedule. NO CHANGE L

21 SUMMARY FOR UNITED METHODIST CHILDREN'S HOME PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY EXTENSION REQUEST SUMMARY (1062)-06 C Date April 11, 2006 July 9, 2015 December 16, 2015 April 25, 2016 Event POA granted for moving adding ten (10) beds to an existing twenty-seven (27) bed Psychiatric Residential Care Facility for a total of thirty-seven (37) beds at 2002 S. Fillmore St., Little Rock, Pulaski County. Transfer of Beds Request Received. The applicant is requesting to transfer twentyfour (24) beds from Little Rock (Pulaski Co.) to their facility in Magnolia, (Columbia Co.). Request to trans,er 24 beds granted. Licensure due 12/16/16. First Extension Request and Discussion of New Construction Received. 1.) The applicant is requesting their first six month extension to obtain a construction contract. Applicant states that they were asked by the Department of Family Service's Director at that time to free up space on their Fillmore Campus for special programming for children of human trafficking and contracted secure care. The DCFS Director has since resigned her position, as well as, the Department of Human Service's Director. Based on these two events, they have intentionally slowed their work toward moving beds until the new directors are in place and have time to assess if this effort is even needed. 2.) The applicant also states that The Methodist Children's Home Board of Directors are exploring to build a secure facility on the Fillmore Campus. If they give approval, this could result in not having to move any beds to an over bedded area,. Also, they have made contact with three separate construction companies to answer pricing around the design and build that each of them offer for their Fillmore Campus.

22 RECEIVED Methodist... AP~~. IFAIVIILY HEALTM BY. ~l Methodist Children's Home April 22, 2016 Methodist Behavioral Hospital Arkansas CARES Residential Treatment Centers Therapeutic Group Homes Therapeutic Foster Care ( :,.. ~Jncy Shelter Therapeutic Day Treatment Programs Methodist Counseling Clinics Kaleidoscope Grief Center 1600 Aldersgate Road Suite 200 Little Rock, AR Health Services Permit Commission Attn: Mr. Tracy Steel Freeway Medical Tower 5800 West 10th, Suite 805 Little Rock, AR RE: United Methodist Children's Home Transfer of Beds Dear Commissioners: Pursuant to the Arkansas Permit of Approval Rulebook, we are obligated to have a construction contract for this project signed by June 16, However, we would like to request a three month extension period in which we have to sign a construction contract. We were asked by the Department of Family Service's Director at that time to free up space on our Fillmore Campus for special programming for children of human trafficking and contracted secure care. The DCFS Director has since resigned her position, as well as, the Department of Human Service's Director. Based on these two events, we have intentionally slowed our work toward moving beds until the new directors are in place and have time to assess if this effort is even needed. The Methodist Children's Home Board of Directors are exploring to build a secure facility on the Fillmore Campus. If they give approval, this could result in not having to move any beds to an over bedded area. Also, we have made contact with three separate construction companies to answer pricing around the design and build that each of them offer for our Fillmore Campus. If you have any questions regarding this request, please give me a call at ZA- Andy Altom, MBA PresidenUCEO P.O. Box Lil"- "~ck. AR '.i Fax: methodisttamily.org

23 SUMMARY FOR HAPPY VALLEY ALF HSPA (1457)15 EXTENSION REQUEST Date July 24, 2015 May 10, 2016 Event POA granted to construct a new forty ( 40) bed assisted living level II facili located at Division Street, Malvern, AR ot S rin Coun. First Extension Request Received. The applicant is requesting their first six month extension to obtain a construction contract. The applicant states that The opening of Happy Valley Health & Rehab 83 bed facility. Awaiting architect to provide final design for Happy Valley Assisted Living. Awaiting contractors to submit final bids for Happy Valley Assisted Livin. Li tin strike to new facili causin electrical dama e. l

24 HAPPY VALLEY HEALTH & REHABILITATION 955 DIVISION STREET MALVERN, ARKANSAS 72104,-.:_ :j~ceived I! MAY I 4" /.I~ i-;:-{"l.l. " "..;y, " ~S.- :e: - ~~;:::;== / FAX Mrs. Roxann Walker Arkansas Health Services Permit Agency Freeway Medical Tower, 5800 West 10th, suite 805 Little Rock, Arkansas 72204* 501/ Dear Mrs. Walker: I respectfully request an extension of time for submitting a signed construction contract for Happy Valley Assisted Living in Malvern, Arkansas. Rationale for ( extension is as follows: The opening of Happy Valley Health & Rehab 83 bed facility Awaiting architect to provide final design for Happy Valley Assisted Living Awaiting contractors to submit final bids for Happy Valley Assisted Living Lightning strike to new facility causing electrical damage I appreciate your assistance in this matter Thank You Sin' ~~ ~r-' :.:'.\; Jackie Kilgore (~

25 SUMMARYFORHAPPYVALLEY ALF HSP A (1458)15 EXTENSION REQUEST Date July 24, 2015 May 10, 2016 Event POA granted to construct a new forty ( 40) bed assisted living level II facili located at Al ha Drive, Camden, AR Ouachita Coun First Extension Request Received. The applicant is requesting their first six month extension to obtain a construction contract. The applicant states that The opening of Happy Valley Health & Rehab 83 bed facility. Awaiting architect to provide final design for Happy Valley Assisted Living. Awaiting contractors to submit final bids for Happy Valley Assisted Livin. Li tin strike to new facili causin electrical dam e. / L

26 RECEIVED HAPPY VALLEY HEALTH & REHABILITATION 955 DIVISION STREET MAY BY:!i.K MALVERN, ARKANSAS / FAX Mrs. Roxann Walker Arkansas Health Services Permit Agency Freeway Medical Tower, 5800 West 10th, suite 805 Little Rock, Arkansas 72204* 501/ Dear Mrs. Walker: \ I respectfully request an extension of time for submitting a signed construction contract for Happy Valley Assisted Living in Camden, Arkansas. Rationale for extension is as follows: The opening of Happy Valley Health & Rehab 83 bed facility Awaiting architect to provide final design for Happy Valley Assisted Living Awaiting contractors to submit final bids for Happy Valley Assisted Living Lightning strike to new facility causing electrical damage I appreciate your assistance in this matter ThankYou Sincerely, fjad(d. ~~ Jackie Kilgore l

27 SUMMARY FOR RIDGECREST HEAL TH AND REHABILITATION NURSING HOME FACILITY EXTENSION REQUEST SUMMARY (1426)-14 Date July 14, 2014 February 13, 2015 April 28, 2016 Event POA granted purpose of replacing an eighty three (83) bed nursing home called Ridgec:rest Health and Rehabilitation with a new one hundred (100) bed Nursing Home facility to be called PJdgecrest Health and Rehabilitation located at 5504 E. Johnson Ave., Jonesboro, AR (Craighead County). FIRST EXTENSION REQUEST RECEIVED. The applicant is requesting their first six month extension to complete the foundation. The applicant states that unfortunately, due to approximately twenty days of inclement weather delays since construction began, the foundation is, as of this date, not yet complete. Nonetheless, work is progressing at a good pace. The buildings foundation footings have been dug and work continues to complete underground utilities and finish the foundation. SECOND EXTENSION REQUEST AND MOVEMENT OF BEDS RECEIVED. The applicant is requesting their second six month extension 1.) to obtain licensure and 2.) movement of beds. The applicant states that Ridgecrest has experienced some unforeseen delays with completing construction due to weather which have delayed issuance of the facility's Certificate of Occupancy and Life Safety Code Approval. Also, the applicant is requesting to move thirty-five (35) beds from Lexington Place Health and Rehabilitation to Ridgecrest an inter-county movement of beds.

28 RECEIVED Dawn D. Bicker Ridgecrest Health and Rehab, Inc. 824 Salem Rd., Suite 210., Conway, AR (501) (ph) (501) (fax) BY: April 28, 2016 SENT VIA FACIMILIE AND US MAIL POSTAGE PREPAID Ms. Roxann Walker Planning Specialist Arkansas Health Services Permit Agency Freeway Medical Tower 5800 West 10th, Suite 805 Little Rock, AR RE: Ridgecrest Health and Rehabilitation Center Request for Placement on the June 2016 Commission Agenda Dear Ms. Walker: On or about, July 14, 2014, the Health Services Permit Commission granted CHC RE, LLC d/b/a Ridgecrest Health and Rehabilitation Center ("Ridgecrest") a Permit of Approval for an Eighty-Three (83) Bed replacement facility. As you discussed in your April 14, 2016 letter to Mr. Bell, the POA requires licensure of the beds on or before July 14, 2016 While my client is hopeful that such licensure will be obtained by the required date, please accept this letter as their formal request for a brief extension to obtain such licensure. Ridgecrest has experienced some unforeseen delays with completing construction due to weather which have delayed the required issuance of the facility's Certificate of Occupancy and Life Safety Code Approval. CHC RE, LLC respectfully asks that the Commission grant an extension in which to allow the issuance of the required Certificate of Occupancy and Life Safety Code approval; the last step needed to obtain licensure of the beds pursuant to the above discussed permit of approval. Please place this issue on the June 2016 Commission agenda. Thank you for your continued time and attention to this matter. Should you have any questions or concerns, please contact me at or by mail at 824 Salem Rd. Conway, AR R-n;:;;b~~d, B ichn) l Dawn Bicker General Counsel Ridgecrest Health and Rehabilitation

29 r \. Dawn D. Bicker Ridgecrest Health and Rehab, Inc. 824 Salem Rd., Suite 210., Conway, AR (501) (ph) (501) (fax) April 25, 2016 SENT VIA FACIMILIE AND US MAIL POSTAGE PREP AID Ms. Roxann Walker Planning Specialist Arkansas Health Services Permit Agency Freeway Medical Tower 5800 West I 0th, Suite 805 Little Rock, AR RE: JBNC, INC., Jonesboro, AR Request for Placement on the June 2016 Commission Agenda Dear Ms. Walker: As counsel for JBNC, INC. d/b/a Ridgecrest Health and Rehabilitation Center ("Ridgecrest"), please accept this letter as a formal request to be placed on the June 2016 agenda for the Commission's consideration of an inter-county movement of thirty-five (35) beds from Lexington Place Health and Rehabilitation ("Lexington") to Ridgecrest. Lexington is currently a one hundred, fifty-two bed skilled nursing facility located in Craighead County, Arkansas. Pursuant to a Consent to Sublease Agreement entered into between Ridgecrest and the owners of Lexington on or about March 1, 2014, Ridgecrest was given an Option to transfer thirty-five beds from Lexington to Ridgecrest. As you know, Ridgecrest is soon to open a new facility and is exercising their option to obtain the thirty-five beds. Ridgecrest and Lexington have agreed on the transfer of these beds and following the transfer, Lexington will retain its POA for 117 licensed and approved beds. This is an inter-county movement of beds, thus it requires approval by the Arkansas Health Services Permit Commission, but will not affect the bed count for Craighead County. Further, the implementation of these beds at the Ridgecrest facility will incur no construction costs. All of the space that Ridgecrest will utilize in the transfer of these beds will have been properly reviewed by the OL TC for compliance with the Life Safety Code. Thank you for putting this issue on the agenda for the June 2016 regular meeting and for your favorable recommendation to the Commission. Respectfully submitted, fjawn <u. B1cbw Dawn Bicker General Counsel Ridgecrest Health and Rehabilitation

30 ( Date September 19, 2014 May 13, 2015 June 17, 2015 "N"ovember13,20I5 December 16, 2015 May 10, 2016 SUMMARY FOR MEMORY LANE (1413)14 EXTENSION REQUEST Event POA granted for.the purpose of transferring the POA for 75 ALF beds held by Ashleigh Crossing to Memory Lane to construct a new 125 ALF facility to be known as Memory Lane located at 1012 Fayetteville Road, AR (Crawford County). First Extension Request Received. The applicant is requesting their first six month extension to obtain licensure for the remaining fifty-one (51) beds. The applicant states that with their existing set up, they have number options that they are considering. In addition, they are currently researching the option to obtain licensure for the Medicaid Waiver Pro1rram. Request granted for si."! months to obtain Iicensure. Licensure due 12/19/15. Second Extension Request Received. The applicant is requesting their second six month extension to obtain licensure for the remaining fifty-one (51) beds. Applicant states that they received approval for the Medicaid Wavier program the last week of October. Their staff is currently undergoing training and they want to gain experience in documentation and billing before they move forward. They were unable to receive training without obtaining approval (Medicaid Number). Extension request granted. Licensure due June 19, Third Extension Request Received. The applicant is requesting their third six month extension to obtain licensure for the remaining fifty-one (51) beds. The Applicant states that they have completed construction and opened their ALF 11 facility in January They received Medicaid Waiver Approval in November Their 1st 20-bed unit is now full. They opened their last 20-bed unit May 2, 2016, and are currently admitting several residents. As you may know, Van Buren First Assembly of God (VBF A) is the owner of Memory Lane. In August 2015, the Pastor, Reverend Bobby L. Johnson, passed away suddenly. He was the Pastor of this church for 35 years. As you can imagine, the magnitude of bis loss has been tremendous for not only the church and the company, but for the community as well. In January 2016 VBF A elected a new Pastor, and this transition is still very much in process. In light of these events, the company Board is still evaluating the best course of action for Memory Lane in regard to the additional beds. l.

31 (~ RECEIVED BY: MAY u 1 :.!,.11ayeuevu1e.1:<.oaa Van Buren, AR (479) memorylanevb.com May 10, 2016 RE: File #HSPA(1413)14 Dear Ms. Walker: I am writing this letter to request an extension. Our records reflect a total of he.ds _p.ending.li.c_ens_ur.e_for...m_e_mm:y: L_a_ne. _ --, _ To bring you up to date in regard to our status: We completed construction and opened our ALF II facility in January We received Medicaid Waiver Approval in November Our 1st 20-bed unit is now full. We opened our last 20-bed unit May 2, 2016, and are currently admitting several residents. ( As you may know, Van Buren First Assembly of God (VBFA) is the owner of Memory Lane. In August 2015, the Pastor, Reverend Bobby L. Johnson, passed away suddenly. He was the Pastor of this church for 35 years. As you can imagine, the magnitude of his loss has been tremendous for not only the church and the company, but for the community as well. In January 2016 VBFA elected a new Pastor, and this transition is still very much in process. In light of these events, the company Board is still evaluating the best course of action for Memory Lane in regard to the additional beds. Due to the multitude of factors that must be taken into account during this time, we respectfully ask that you consider granting us one more extension. We believe that Memory Lane as a company will have a more definite direction within the next 6 months. We completely understand if you are unable to do so, but would appreciate your consideration in these unexpected circumstances. Sincer DebraJo nso Landmark inistries Executive Director Memory Lane Administrator You don't have to walk this path alone

32 C "'ate 0ctober 8, 2013 May 15, 2014 June 24, 2014 April 24, 2015 June 17, 2015 October 27, 2015 SUMMARY FOR MT. CARMEL COMMUNITY AT BENTONVILLE HSPA (1391)14 EXTENSION REQUEST Event POA granted to construct anew 75 bed ALF II at 2407 SE Cottonwood, Bentonville, AR (Benton County). First Extension Request and Site Location Ch.ange Received. The applicant is requesting their I.) first six month extension to obtain a construction contract and 2.) site location change. Site location change requires Commission approval, the POA holder is asking for the site location change from 2407 SE Cottonwood, Bentonville, AR to 1843 SW Regional Airport Blvd, Bentonville, AR AND a six month extension to obtain a construction contract for the project at the new location. Commission granted sixth month extension to obtain a signed construction contract and a site iocation change. Construction contract due January 8, Second Extension Request Received. The applicant is requesting their second six month extension to complete the foundation. The applicant states that they are still negotiating with various financial institutions and have not settled on a bank at this time. They are also in the process of completing Mt. Carmel at Rogers. Applicant feels like it would be in everyone's best interest to complete this project (should be sometime in August 2015), before they begin their second Northwest Arkansas project. Commission granted sixth month extension to complete the foundation. Foundation 12/19/15. Third Extension Request Received. The applicant is requesting their third six month extension to complete the foundation. The applicant states that they have been working with their bank on the scheduling of their projects in NW Arkansas. They just recently opened Mt. Carmei Community in Rogers and the bank preferred the census at their location in Rogers be near 50% before they can begin construction in their Bentonville 'project. They anticipate being able to begin construction by Spring December 16, 2015 Extension request granted. Foundation due June 19, April 25, 2016 F_ourth Extension Request Received. The applicant is requesting their fourth six month extension to complete the foundation. The applicant states that they have been working with their bank on the scheduling of their project in NW Arkansas. Applicant just opened Mt. Carmel Community in Rogers and the bank preferred the census at that location in Rogers be near 50% before they begin construction on their Bentonville project. With deposits and commitments, they are over that percentage, but until the garden home phase is completed they are not there yet, as several of their commitments are within that level of care. The dirt work has been completed at the owner's expense, but until the loan is finalized (which should be within the next couple of weeks) they will not be in a position to continue working on the foundation. l

33 r April 19, 2016 r-"\... lvl.1.. ul\.k.lvl.tl / ~- CO M M U N IT Y at TH E VI L LAG E 540 Ponce de Leon Hot Springs Village, AR APR JJ3Y:==4:f~ Arkansas Health Services Permit Agency Freeway Medical Tower 5800 West 10th, Suite 805 Little Rock, Arkansas RE: Mt.Carmel Community in Bentonville File #HSPA (1391)14 To Whom It May Concern: It is necessary for Mt.Carmel Community in Bentonville to request an extension. It is very possible that we will have the foundation complete or near complete, but we wanted to file for the extension, just in case it wasn't completed by the June 19, 2016 deadline. ( It was shared that we have been working with our bank on the scheduling of our projects in NW Arkansas. We just recently opened Mt.Carmel Community in Rogers and the bank preferred the census at our location in Rogers be near 50% before we begin construction on our Bentonville project. With deposits and commitments, we are over that percentage, but until the garden home phase is complgtgd WQ are not there yet, as several of our commitments are within that level of care. The dirt work has been completed at the owner's expense, but until the loan is finalized (which should be within the next couple of weeks) we will not be in a position to continue working on the foundation. We formally request that an extension for the completion of our Bentonville foundation and this phase of our project be approved. If we see we are able to meet that June 19th deadline, we will withdraw our request and show proof of completion of Bentonville foundation../ l Respectfully, rt)~ Cl/u,d, ;(ff) ~j UM \JJi,mmy Elrod l). Managing Partner Mt.Carmel Community --- The Pinnacle of Senior Living ---

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