STATE OF NEBRASKA ROSTER LONG TERM CARE FACILITIES

Transcription

1 STATE OF NEBRASKA ROSTER LONG TERM CARE FACILITIES Nursing Facilities Skilled Nursing Facilities Intermediate Care Facilities Long Term Care Hospitals Department of Health and Human Division of Public Health, Licensure Unit 301 Centennial Mall South-Third Floor PO Box Lincoln, NE Long Term Care Licenses Expire March 31, each year

2 NEBRASKA LONG TERM CARE FACILITIES DEFINITIONS Skilled Nursing Facility means a facility where medical care, skilled nursing care, rehabilitation, or related services and associated treatment are provided for a period of more than twenty-four consecutive hours to persons residing at such facility who are ill, injured, or disabled. Intermediate Care Facility means a facility where shelter, food, and nursing care or related services are provided for a period of more than twenty-four consecutive hours to persons residing at such facility who are ill, injured, or disabled and do not require hospital or skilled nursing facility care. Nursing Facility means a facility where medical care, nursing care, rehabilitation, or related services and associated treatment are provided for a period of more than twenty-four consecutive hours to persons residing at such facility who are ill, injured, or disabled. Long-Term Care Hospital means a hospital or any distinct part of a hospital that provides the care and services of an intermediate care facility, a nursing facility, or a skilled nursing facility.

3 NEBRASKA NURSING HOMES/LONG TERM CARE FACILITIES Licensed Facilities Licensed NURSING FACILITY (LIC) 1 72 SKILLED NURSING FACILITY (LIC) NURSING FACILITY (19) SKILLED NURSING FACILITY (18) 1 42 SKILLED NSG/NSG FAC DISTINCT PART 16 1,779 DUAL CERT , ,756 SPECIAL CARE UNIT Alzheimer 29 LEGEND S/NF DP LTC LTCH SNF LIC LTC NF LTCH SNF LTCH NF NF LIC SNF/ICF S/NF DP SNF-LIC LIC Long Term Care Hospital / Distinct Part Long Term Care Hospital / Dual Long Term Care Hospital / License Only Long Term Care Hospital / Nursing Facility Long Term Care Hospital / Skilled Nursing Facility Nursing Facility (19) - Medicaid Certified Nursing Facility / License Only Skilled Nursing Facility / Intermediate Care Facility Skilled Nursing Facility / Distinct Part - Medicare/Medicaid Distinct Part Skilled Nursing Facility / License Only Skilled Nursing Facility / Nursing Facility - ALL BEDS Medicare/Medicaid Certified Medicare Certified Medicaid Certified License Only Please contact the Licensure Unit or the provider to determine current Medicare/Medicaid status

4 Page 2 of 48 ADAMS (GAGE) Gold Crest Retirement Center 200 LEVI LANE (402) FAX: (402) COFFMAN-LEVI CHARITABLE TRUST, INC JEFF FRITZEN, ADMINISTRATOR MICHELLE DENKER, Director of Nursing Medicare/Medicaid - 52 Total Lic - 52 AINSWORTH (BROWN) Ainsworth Care Center, LLC 143 NORTH FULLERTON STREET (402) FAX: (402) AINSWORTH CARE CENTER, LLC JOHN KLAASMEYER, ADMINISTRATOR KATIE AASE, Director of Nursing c/o: AINSWORTH CARE CENTER, LLC 190 S MAIN STREET, BOUNTIFUL UT Medicare/Medicaid - 46 Total Lic - 46 ALBION (BOONE) Good Samaritan Society - Albion P O BOX 271, 1222 SOUTH 7TH STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY KERRY DAVIDSON, ADMINISTRATOR CHERYL MUSIL, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60 ALLIANCE (BOX BUTTE) Good Samaritan Society - Alliance P O BOX 970, 1016 EAST 6TH STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY JOSEPH SHAFER, ADMINISTRATOR ANN LAJUNE BACON, Director of Nursing Medicare/Medicaid - 77 Total Lic - 77 ALLIANCE (BOX BUTTE) Highland Park Care Center P O BOX 950, 1633 SWEETWATER (308) FAX: (308) ALLIANCE HEALTH CARE, INC. ROBIN POWELL, ADMINISTRATOR TERESA MCFARLAND, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60

5 Page 3 of 48 ALMA (HARLAN) Good Samaritan Society - Colonial Villa 719 NORTH BROWN STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CYNTHIA THOMAS, ADMINISTRATOR STACY NEUBAUER, Director of Nursing Medicare/Medicaid - 53 Total Lic - 53 ARAPAHOE (FURNAS) Good Samaritan Society - Arapahoe P O BOX 448, 601 MAIN STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CYNTHIA THOMAS, ADMINISTRATOR SUE ROBERTS, Director of Nursing Medicare/Medicaid - 30 Total Lic - 30 ASHLAND (SAUNDERS) Ashland Care Center 1700 FURNAS STREET (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC GAY HARBERTS, PROVISIONAL ADM CARA NICHOLSON, Director of Nursing Medicare/Medicaid - 97 Total Lic - 97 c/o: ASHLAND CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA BEHAVIORAL NEEDS RESPIRATORY THERAPY ATKINSON (HOLT) Good Samaritan Society - Atkinson 409 NEELY STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY JESSICA EBY, ADMINISTRATOR LINDA PRICE, Director of Nursing Medicare/Medicaid - 61 Total Lic - 61

6 Page 4 of 48 AUBURN (NEMAHA) Good Samaritan Society - Auburn 1322 U STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY JEFFREY HARVEY, ADMINISTRATOR AMANDA HARRIFELD, Director of Nursing Medicare/Medicaid Total Lic AURORA (HAMILTON) Hamilton Manor TH STREET (402) FAX: (402) HAMILTON COUNTY HOME FOR THE AGED MARGARET WILLIAMS, ADMINISTRATOR DEBRA MCKINNON, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60 AURORA (HAMILTON) Memorial Community Care 1423 SEVENTH STREET (402) FAX: (402) MEMORIAL COMMUNITY HEALTH, INC. DIANE KELLER, ADMINISTRATOR JULIE PICEK, Director of Nursing NF LTCH 28E191 LTCH001 Medicaid - 48 Medicare/ Total Lic - 48 BASSETT (ROCK) Rock County Hospital LTC 100 EAST SOUTH STREET (402) FAX: (402) ROCK COUNTY STACEY KNOX, ADMINISTRATOR BRITTANY DEVALL-HEYDEN, Director of Nursing NF LTCH 28E278 LTCH002 Medicaid - 30 Medicare/ Total Lic - 30 BATTLE CREEK (MADISON) Community Pride Care Center 901 SOUTH 4TH STREET (402) FAX: (402) CITY OF BATTLE CREEK STEVEN FREESE, ADMINISTRATOR NATALITE YONAMINE, Director of Nursing Medicare/Medicaid - 47 Total Lic - 47

7 Page 5 of 48 BAYARD (MORRILL) Chimney Rock Villa P O BOX A, 106 EAST 13TH STREET (308) FAX: (308) CITY OF BAYARD PEGGY RATZLAFF, PROVISIONAL ADM CYNTHIA CRAMER, Director of Nursing Medicare/Medicaid - 49 Total Lic - 49 BEATRICE (GAGE) Beatrice Health and Rehabilitaion 1800 IRVING STREET (402) FAX: (402) MONROE HEALTHCARE, INC SPENCER MORRIS, ADMINISTRATOR LORI PORTER, Director of Nursing Medicare/Medicaid - 87 Total Lic - 87 BEATRICE (GAGE) Good Samaritan Society - Beatrice 401 S 22ND STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CORRENE ADAMS, ADMINISTRATOR CERICE CORNELIUS, Director of Nursing NH0015 Medicare/Medicaid - 80 Total Lic - 80 BEAVER CITY (FURNAS) Beaver City Manor P O BOX 70, 905 FLOYD STREET (308) FAX: (308) CITY OF BEAVER CITY MEGAN MAPES, PROVISIONAL ADM NICOLE BOSE, Director of Nursing Medicare/Medicaid - 28 Total Lic - 28 BEEMER (CUMING) Colonial Haven 424 HARRISON (402) FAX: (402) VILLAGE OF BEEMER LAUREN LIERMAN, ADMINISTRATOR SHAYLA RISCH, Director of Nursing Medicare/Medicaid - 34 Total Lic - 34 RESPIRATORY THERAPY

8 Page 6 of 48 BELLEVUE (SARPY) Eastern Nebraska Veterans Home SOUTH 40TH STREET (402) FAX: (402) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM TROY SCHULZ, ADMINISTRATOR TARYN STRUTHERS, Director of Nursing SNF-LIC NH0005 Medicare/ Total Lic BELLEVUE (SARPY) S/NF DP Hillcrest Health & Rehab HILLCREST DRIVE (402) FAX: (402) RED OAK HEALTH SERVICES, INC. KEVIN SAUBERZWEIG, ADMINISTRATOR TAMMIE KNIGHT, Director of Nursing 1902 HARLAN DRIVE, SUITE A, BELLEVUE NE Medicare - 91 Medicare/Medicaid - 23 Total Lic BENKELMAN (DUNDY) Sarah Ann Hester Memorial Home P O BOX 646, 407 DAKOTA STREET (308) FAX: (308) SARAH ANN HESTER MEMORIAL HOME JANICE EDWARDS, ADMINISTRATOR KELLIE SIMEON, Director of Nursing Medicare/Medicaid - 56 Total Lic - 56 BERTRAND (PHELPS) Bertrand Nursing Home PO BOX 97, 100 MINOR AVENUE (308) FAX: (308) VILLAGE OF BERTRAND AMY GRUBE, ADMINISTRATOR TERESA STADLER, Director of Nursing Medicare/Medicaid - 26 Total Lic - 26 BLAIR (WASHINGTON) Crowell Memorial Home 245 SOUTH 22ND STREET (402) FAX: (402) CROWELL MEMORIAL HOME WILLIAM WILLIARD, ADMINISTRATOR PRUDENCE CEMER, Director of Nursing Medicare/Medicaid - 88 Total Lic - 88

9 Page 7 of 48 BLAIR (WASHINGTON) Good Shepherd Lutheran Home 2242 WRIGHT STREET (402) FAX: (402) GOOD SHEPHERD LUTHERAN COMMUNITY AMIE CLAUSEN, ADMINISTRATOR NANCY PEDERSEN, Director of Nursing Medicare/Medicaid - 84 Total Lic - 84 BLOOMFIELD (KNOX) Good Samaritan Society - Bloomfield P O BOX 307, 300 NORTH SECOND ST (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY GAIL BLOCKER, ADMINISTRATOR PATRICIA DOERING, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70 PEDIATRIC BLUE HILL (WEBSTER) Blue Hill Care Center 414 NORTH WILSON (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC SHERRILL ACTON, ADMINISTRATOR KELLY BOOM, Director of Nursing Medicare/Medicaid - 62 Total Lic - 62 c/o: BLUE HILL CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA BRIDGEPORT (MORRILL) Skyview at Bridgeport 505 O STREET (308) FAX: (308) CITY OF BRIDGEPORT VIRGINIA CLARKE, ADMINISTRATOR JAMA OENNING, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 BROKEN BOW (CUSTER) Golden LivingCenter - Broken Bow 224 EAST SOUTH E STREET (308) FAX: (308) GGNSC BROKEN BOW LLC KELLY ALDERMAN, ADMINISTRATOR PAMELA TAYLOR, Director of Nursing Medicare/Medicaid - 79 Total Lic - 79

10 Page 8 of 48 BROKEN BOW (CUSTER) Jennie M Melham Medical Center LTC P O BOX 250, 145 MEMORIAL DRIVE (308) FAX: (308) JENNIE M. MELHAM MEMORIAL MEDICAL CENTER, INC. MICHAEL STECKLER, ADMINISTRATOR BEVERLY TREW, Director of Nursing NF LTCH 28A056 LTCH004 Medicaid - 50 Medicare/ Total Lic - 50 BURWELL (GARFIELD) Community Memorial Health Center LTC P O BOX 340, 295 NORTH 8TH STREET (308) FAX: (308) COMMUNITY MEMORIAL HOSPITAL, INC. TIMOTHY GROSHANS, ADMINISTRATOR JENNIFER LARSON, Director of Nursing LTCH LTCH005 Medicare/Medicaid - 55 Total Lic - 55 BUTTE (BOYD) Butte Senior Living 210 BROADWAY (402) FAX: (402) TEALWOOD CARE CENTERS SUE CONNOT, ADMINISTRATOR DESSI BOETTCHER, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 CALLAWAY (CUSTER) Callaway Good Life Center, Inc PO BOX 250, 600 WEST KIMBALL STREET (308) FAX: (308) CALLAWAY GOOD LIFE CENTER, INC VICKY HENDRICKS, ADMINISTRATOR JANICE BARNES, Director of Nursing c/o: CALLAWAY GOOD LIFE CENTER, INC PO BOX 250, CALLAWAY NE Medicare/Medicaid - 35 Total Lic - 35 CAMBRIDGE (FURNAS) Cambridge Manor P O BOX 488, WEST HWY 6 & 34 (308) FAX: (308) TRI VALLEY HEALTH SYSTEM JOYCE DEAVER, ADMINISTRATOR BARBARA HELBERG, Director of Nursing NF 28E Medicaid - 34 Medicare/ Total Lic - 34

11 Page 9 of 48 CENTRAL CITY (MERRICK) Central City Care Center 2720 SOUTH 17TH AVENUE (308) FAX: (308) FIVE STAR QUALITY CARE NE, INC KATHERINE KLINGSPORN, ADMINISTRATOR STEVEN ROY, Director of Nursing Medicare/Medicaid - 63 Total Lic - 64 c/o: CENTRA CITY CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA BEHAVIORAL NEEDS CENTRAL CITY (MERRICK) Litzenberg Memorial County Hospital TH STREET (308) FAX: (308) LITZENBERG MEMORIAL MERRICK COUNTY JULIE MURRAY, ADMINISTRATOR LAURIE JOHNSON, Director of Nursing LTCH LTCH006 Medicare/Medicaid - 46 Total Lic - 46 CHADRON (DAWES) Crest View Healthcare Community 420 GORDON AVENUE (308) FAX: (308) CHADRON HEALTHCARE, LLC CATHY SNYDER, ADMINISTRATOR KELLI SCHERBARTH, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70 CHAPPELL (DEUEL) Miller Memorial Care Center, LLC P O BOX 428, 589 VINCENT AVENUE (308) FAX: (308) MILLER MEMORIAL CARE CENTER, LLC AMBER DICKINSON, ADMINISTRATOR MARY HINNEGAN, Director of Nursing NF 28E Medicaid - 24 Medicare/ Total Lic - 24 CLARKSON (COLFAX) Golden LivingCenter - Clarkson 212 SUNRISE DRIVE (402) FAX: (402) COMMERCIAL MANAGEMENT, INC. KIM DVORAK, ADMINISTRATOR MEGAN NIEWOHNER, Director of Nursing Medicare/Medicaid - 51 Total Lic - 52

12 Page 10 of 48 COLERIDGE (CEDAR) Park View Haven Nursing Home 309 NORTH MADISON STREET (402) FAX: (402) VILLAGE TRUSTEES OF COLERIDGE SHERYL KALIN, ADMINISTRATOR KRISTINE KARNES-SNYDER, Director of Nursing Medicare/Medicaid - 34 Total Lic - 34 COLUMBUS (PLATTE) Brookestone Acres TH STREET (402) FAX: (402) COLUMBUS HEALTH CARE, INC TANYA BABEL, ADMINISTRATOR DAN SMITH, Director of Nursing NH0018 Medicare/Medicaid - 80 Total Lic - 80 COLUMBUS (PLATTE) Columbus Community Hospital LTC TH STREET (402) FAX: (402) COLUMBUS COMMUNITY HOSPITAL, INC. MICHAEL HANSEN, ADMINISTRATOR GINA OLSON, Director of Nursing SNF-LIC LTC LTCH007 Medicare/ Total Lic - 4 COLUMBUS (PLATTE) Golden LivingCenter - Columbus P O BOX 625, TH AVENUE (402) FAX: (402) GGNSC COLUMBUS LLC ROBERT SHECKLER, ADMINISTRATOR MELINDA MOLT, Director of Nursing Medicare/Medicaid Total Lic COLUMBUS (PLATTE) Morys Haven TH STREET (402) FAX: (402) FIVE STAR QUALITY CARE NE, INC TERRI GROTELUSCHEN, ADMINISTRATOR KRISTIN RASMUSSEN, Director of Nursing Medicare/Medicaid - 48 Total Lic - 48 c/o: MORYS HAVEN FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA 02458

13 Page 11 of 48 COZAD (DAWSON) Golden LivingCenter - Cozad 318 WEST 18TH STREET (308) FAX: (308) GGNSC COZAD LLC BARRY EMERSON, ADMINISTRATOR CAROLYN GRIESE, Director of Nursing Medicare/Medicaid - 67 Total Lic - 67 CRAWFORD (DAWES) Ponderosa Villa P O BOX 526, FIRST & PADDOCK STREET (308) FAX: (308) CITY OF CRAWFORD STEPHANIE HUFFMAN, ADMINISTRATOR TRACI DIDIER, Director of Nursing Medicare/Medicaid - 35 Total Lic - 35 CREIGHTON (KNOX) Avera Creighton Care Centre P O BOX 289, 1603 MAIN STREET (402) FAX: (402) AVERA SACRED HEART HEALTH SERVICES JENNIFER POPPEN, ADMINISTRATOR TANYA CURTIS, Director of Nursing LTCH LTCH008 Medicare/Medicaid - 47 Total Lic - 47 CRETE (SALINE) Premier Estates of Crete, LLC 830 EAST 1ST STREET (402) FAX: (402) PREMIER ESTATES OF CRETE, LLC DANIEL STACKIS, PROVISIONAL ADM MARLENE WALENTA, Director of Nursing Medicare/Medicaid Total Lic c/o: PREMIER ESTATES OF CRETE, LLC TRILLIUM HEALTHCARE CONSULTING, 5265 OFFICE PARK BLVD, SUITE 101, BRADENTON FL CRETE (SALINE) Tabitha Nursing Center at Crete P O BOX 9, 1540 GROVE STREET (402) FAX: (402) TABITHA INC. SHERRI DUE, ADMINISTRATOR MICHELLE HUNTER, Director of Nursing NH0003 c/o: TABITHA, INC. ATTENTION: CFO, 4720 RANDOLPH STREET, LINCOLN NE Medicare/Medicaid - 44 Total Lic - 44

14 Page 12 of 48 DAVID CITY (BUTLER) David Place 260 SOUTH 10TH STREET (402) FAX: (402) HERITAGE OF DAVID CITY, INC. BARBARA ALDRICH, ADMINISTRATOR TRUDY SVOBODA, Director of Nursing Medicare/Medicaid - 86 Total Lic - 86 DAVID CITY (BUTLER) St. Joseph's Villa, Inc. 927 SEVENTH STREET (402) FAX: (402) ST. JOSEPH'S VILLA, INC. SANDRA PALMER, ADMINISTRATOR RUTH HEULE, Director of Nursing Medicare/Medicaid - 58 Total Lic - 58 DESHLER (THAYER) Parkview Haven Nursing Home P O BOX 667, TH STREET (402) FAX: (402) CITY OF DESHLER MARY MILLER, ADMINISTRATOR JUDY KUJATH, Director of Nursing Medicare/Medicaid - 49 Total Lic - 49 DODGE (DODGE) Parkview Home, Inc 930 2ND STREET (402) FAX: (402) PARKVIEW HOME, INC. KELLEY SEITZ, ADMINISTRATOR CARA GUNTER, Director of Nursing Medicare/Medicaid - 62 Total Lic - 64 EDGAR (CLAY) Rose Brook Care Center 106 5TH STREET (402) FAX: (402) ROSE BROOK CARE CENTER, LLC BRAD HONL, PROVISIONAL ADM KARA EDWARDS, Director of Nursing c/o: ROSE BROOK CARE CENTER 190 S MAIN STREET, BOUNTIFUL UT Medicare/Medicaid - 47 Total Lic - 47

15 Page 13 of 48 ELKHORN (DOUGLAS) Brookestone Meadows Rehabilitation And Care Center 600 BROOKESTONE MEADOWS PLAZA (402) FAX: (402) BROOKESTONE MEADOWS, INC REVONNA WHITE, ADMINISTRATOR DAWN TRUCKENBROD, Director of Nursing S/NF DP NH0006 Medicare - 74 Medicare/Medicaid - 66 Total Lic c/o: BROOKESTONE MEADOWS C/O VETTER HOLDING INC, 5020 S 118TH ST, OMAHA NE ELKHORN (DOUGLAS) Life Care Center of Elkhorn HOPPER STREET (402) FAX: (402) CONSOLIDATED RESOURCES HEALTH CARE FUND I, L.P. PAUL MORRIS, ADMINISTRATOR PEGGY MART, Director of Nursing Medicare/Medicaid Total Lic ELWOOD (GOSPER) Elwood Care Center P O BOX 315, 607 SMITH AVENUE (308) FAX: (308) VILLAGE OF ELWOOD KATE REINERS, ADMINISTRATOR AMANDA KLEIN, Director of Nursing Medicare/Medicaid - 43 Total Lic - 47 EMERSON (DAKOTA) Heritage of Emerson, Inc. 607 NEBRASKA STREET (402) FAX: (402) HERITAGE OF EMERSON, INC. SHELLEE HUGGENBERGER, ADMINISTRATOR DANIEL SCHOCK, Director of Nursing Medicare/Medicaid - 38 Total Lic - 38 EXETER (FILLMORE) Exeter Care Center P O BOX 59, 425 SOUTH EMPIRE AVENUE (402) FAX: (402) EXETER CARE CENTER, LLC MIRIAM WALL, ADMINISTRATOR SHARON LOCKWOOD, Director of Nursing Medicare/Medicaid - 56 Total Lic - 56 c/o: EXETER CARE CENTER 500 NORTH MARKET PLACE DRIVE, SUITE 203, CENTERVILLE UT 84014

16 Page 14 of 48 FAIRBURY (JEFFERSON) Gardenside LTC-JCHC P O BOX 277, 2200 NORTH H STREET (402) FAX: (402) JEFFERSON COMMUNITY HEALTH CENTER, INC. DEBRA SUTTON, ADMINISTRATOR LINDA COLLINS, Director of Nursing LTCH LTCH010 Medicare/Medicaid - 39 Total Lic - 40 FAIRBURY (JEFFERSON) Heritage Care Center P O BOX 667, TH STREET (402) FAX: (402) HERITAGE OF FAIRBURY/ST. EDWARD, INC. BETH BLOCK, ADMINISTRATOR MARGARET SPILKER, Director of Nursing Medicare/Medicaid Total Lic FAIRMONT (FILLMORE) Fairview Manor 255 F STREET (402) FAX: (402) VILLAGE OF FAIRMONT TAMARA SCHEIL, ADMINISTRATOR JOAN RIEL, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 FALLS CITY (RICHARDSON) Falls City Healthcare Community 2800 TOWLE STREET (402) FAX: (402) FALLS CITY HEALTHCARE, LLC VALERIE BUCKMINSTER, ADMINISTRATOR CLAUDIA GEIER, Director of Nursing Medicare/Medicaid Total Lic FALLS CITY (RICHARDSON) Falls City Nursing and Rehabilitation Center 1720 BURTON DRIVE (402) FAX: (402) STANTON LAKE HEALTHCARE, INC DAVID YOUNG, ADMINISTRATOR MICHELE FREDERICK, Director of Nursing Medicare/Medicaid - 63 Total Lic - 65

17 Page 15 of 48 FRANKLIN (FRANKLIN) Golden LivingCenter - Franklin 1006 M STREET (308) FAX: (308) GGNSC FRANKLIN III LLC CANDACE GIBSON, ADMINISTRATOR MARY GOESSLING, Director of Nursing Medicare/Medicaid - 42 Total Lic - 42 FREMONT (DODGE) Dunklau Gardens 450 EAST 23RD STREET (402) FAX: (402) FREMONT HEALTH RACHEL REIMAN, ADMINISTRATOR JOANN STROUF, Director of Nursing S/NF DP LTC LTCH011 Medicare - 16 Medicare/Medicaid - 96 Total Lic FREMONT (DODGE) Nye Legacy Health & Rehabilitation Center 3210 N CLARKSON (402) FAX: (402) FREMONT CARE CENTER, INC. KRISTIN HARRIS, ADMINISTRATOR DEBRA FILTER, Director of Nursing S/NF DP NH0008 Medicare - 34 Medicare/Medicaid - 66 Total Lic c/o: NYE LEGACY HEALTH & REHABILITATION CENTER C/O FREMONT CARE CENTER INC, 2230 N SOMERS, FREMONT NE RESPIRATORY THERAPY FREMONT (DODGE) Nye Pointe Health & Rehab Ctr 2700 LAVERNA STREET (402) FAX: (402) FREMONT CARE CENTER, INC. MARK HOYLE, ADMINISTRATOR LISA FERRILL, Director of Nursing Medicare/Medicaid - 43 Total Lic - 43 FREMONT (DODGE) Premier Estates of Fremont, LLC 2550 NORTH NYE AVENUE (402) FAX: (402) PREMIER ESTATES OF FREMONT, LLC MARIA GETZSCHMAN, ADMINISTRATOR SUSAN DEVEREAUX, Director of Nursing Medicare/Medicaid Total Lic c/o: PREMIER ESTATES OF FREMONT, LLC TRILLIUM HEALTHCARE CONSULTING, 5265 OFFICE PARK BLVD, SUITE 101, BRADENTON FL 34203

18 Page 16 of 48 FRIEND (SALINE) Warren Memorial Hospital LTC 905 SECOND STREET (402) FAX: (402) CITY OF FRIEND CHRISTOPHER BJORNBERG, ADMINISTRATOR KIM PIETZYK, Director of Nursing NF 28E Medicaid - 51 Medicare/ Total Lic - 51 FULLERTON (NANCE) Golden LivingCenter - Fullerton P O BOX 648, 202 NORTH ESTHER (308) FAX: (308) GGNSC FULLERTON LLC MELISSA VANDEWALLE, ADMINISTRATOR BETH BOWMAN, Director of Nursing Medicare/Medicaid - 75 Total Lic - 75 BEHAVIORAL NEEDS GENEVA (FILLMORE) Heritage Crossings 501 NORTH 13TH STREET (402) FAX: (402) MANOR OF GENEVA, INC. STEPHANIE WITT, ADMINISTRATOR LAURA LEA, Director of Nursing Medicare/Medicaid - 68 Total Lic - 68 GENOA (NANCE) Genoa Community Hospital/LTC P O BOX 310, 606/706 EWING AVENUE (402) FAX: (402) CITY OF GENOA MICHAEL HARRIS, PROVISIONAL ADM FAITH WEAVER, Director of Nursing NF 28E Medicaid - 39 Medicare/ Total Lic - 39 GERING (SCOTTS BLUFF) The Lodge at Heritage Estates 2325 LODGE DRIVE (308) FAX: (308) HERITAGE OF GERING, INC. KENNETH BRUCKNER, ADMINISTRATOR KRISTIN FOX, Director of Nursing NH0002 Medicare/Medicaid Total Lic - 102

19 Page 17 of 48 GORDON (SHERIDAN) Gordon Countryside Care 500 EAST 10TH STREET (308) FAX: (308) GORDON MEMORIAL HOSPITAL DISTRICT JULIE SCHNELL, ADMINISTRATOR JENNIFER COMBS, Director of Nursing NF 28E Medicaid - 32 Medicare/ Total Lic - 32 GOTHENBURG (DAWSON) Hilltop Estates P O BOX 429, 2520 AVENUE M (308) FAX: (308) K. C. HEALTH CARE ENTERPRISES, INC. SCOTT BAHE, ADMINISTRATOR SERINA SLADKY, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64 GRAND ISLAND (HALL) CHI Health St. Francis 2116 WEST FAIDLEY AVENUE (308) FAX: (308) CATHOLIC HEALTH INITIATIVES DAN MCELLIGOTT, ADMINISTRATOR LTCH LTCH014 Medicare/Medicaid - 36 Total Lic - 36 GRAND ISLAND (HALL) Golden LivingCenter - Grand Island Lakeview 1405 WEST HWY 34 (308) FAX: (308) GGNSC GRAND ISLAND LAKEVIEW LLC SALLY BERNEY, ADMINISTRATOR JACKI CONNERY, Director of Nursing Medicare/Medicaid - 95 Total Lic - 95 GRAND ISLAND (HALL) Golden LivingCenter - Grand Island Park Place 610 NORTH DARR AVENUE (308) FAX: (308) GGNSC GRAND ISLAND PARK PLACE LLC LESLIE FENNELL, ADMINISTRATOR AMBER ROSNO, Director of Nursing Medicare/Medicaid - 85 Total Lic - 85

20 Page 18 of 48 GRAND ISLAND (HALL) Good Samaritan Society - Grand Island Village 4061 TIMBERLINE STREET & 4055 TIMBERLINE STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CHERI THEESEN, ADMINISTRATOR CHERYL CHRISTENSON, Director of Nursing NH0010 Medicare/Medicaid - 61 Total Lic - 61 c/o: GOOD SAMARITAN SOCIETY - GRAND ISLAND VILLAGE ATTN: ADMINISTRATOR, 4075 TIMBERLINE STREET, GRAND ISLAND NE GRAND ISLAND (HALL) Grand Island Veterans Home 2300 WEST CAPITAL AVE (308) FAX: (308) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM ALEXANDER WILLFORD, ADMINISTRATOR DANIELLE DEAVER, Director of Nursing SNF-LIC Medicare/ Total Lic GRAND ISLAND (HALL) Tiffany Square Care Center 3119 WEST FAIDLEY AVENUE (308) FAX: (308) GRAND ISLAND HEALTH CARE, INC. DUSTIN FREY, ADMINISTRATOR KEVIN VOGT, Director of Nursing Medicare/Medicaid Total Lic GRAND ISLAND (HALL) Wedgewood Care Center 800 STOEGER DRIVE (308) FAX: (308) FIVE STAR QUALITY CARE-NE, LLC CHERYL SCHULZ, ADMINISTRATOR ANGELA CORNELIUS, Director of Nursing Medicare/Medicaid - 76 Total Lic - 76 c/o: WEDGEWOOD CARE CENTER FIVE STAR QUALITY CARE ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA 02458

21 Page 19 of 48 GRANT (PERKINS) Golden Ours Convalescent Home 902 CENTRAL AVENUE (308) FAX: (308) PERKINS COUNTY HOSPITAL DISTRICT MARGARET ROGERS, ADMINISTRATOR MICHELLE WOJCZYNSKI, Director of Nursing NF LTCH 28E199 LTCH015 Medicaid - 50 Medicare/ Total Lic - 50 GREELEY (GREELEY) Greeley Care Home 201 E O'CONNOR AVENUE (308) FAX: (308) VILLAGE OF GREELEY LORA MOUSEL, ADMINISTRATOR PAUL SULLIVAN, Director of Nursing Medicare/Medicaid - 26 Total Lic - 26 GRETNA (SARPY) Gretna Care Center 700 HIGHWAY 6 (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC WILLIAM GERKEN, ADMINISTRATOR ELIZABETH BUCKINGHAM, Director of Nursing Medicare/Medicaid - 63 Total Lic - 63 c/o: GRETNA CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA HARTINGTON (CEDAR) Golden LivingCenter - Hartington P O BOX 107, 401 DARLENE STREET (402) FAX: (402) GGNSC HARTINGTON LLC LEIGH BLOOMQUIST, ADMINISTRATOR STEPHANIE MORTEN, Director of Nursing Medicare/Medicaid - 47 Total Lic - 47 HARVARD (CLAY) Harvard Rest Haven 400 EAST 7TH STREET (402) FAX: (402) CITY OF HARVARD RUTH SANDS-JERKE, ADMINISTRATOR CHRISTINA BUCKHALTER, Director of Nursing Medicare/Medicaid - 37 Total Lic - 37

22 Page 20 of 48 HASTINGS (ADAMS) Good Samaritan Society - Hastings Village P O BOX 2149, 926 EAST E STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY DORIN VAIPAN, ADMINISTRATOR JERI WICHMAN, Director of Nursing Medicare/Medicaid Total Lic HASTINGS (ADAMS) Mary Lanning Memorial Healthcare Long Term Care 715 NORTH ST. JOSEPH AVENUE (402) FAX: (402) MARY LANNING HEALTHCARE MARK CALLAHAN, ADMINISTRATOR LTCH016 Medicare/Medicaid - 9 Total Lic - 9 HAY SPRINGS (SHERIDAN) Pioneer Manor Nursing Home P O BOX 310, 318 N 3RD STREET (308) FAX: (308) CITY OF HAY SPRINGS KRYSTYN TURMAN, PROVISIONAL ADM BRENDA JOHNSON, Director of Nursing Medicare/Medicaid - 57 Total Lic - 57 HEBRON (THAYER) Blue Valley Lutheran Care Home P O BOX 166, 755 SOUTH 3RD STREET (402) FAX: (402) BLUE VALLEY LUTHERAN HOMES SOCIETY, INC. KATHY RETZLAFF, ADMINISTRATOR CAROL MUEHLING, Director of Nursing NF 28E Medicaid - 64 Medicare/ Total Lic - 64 HEBRON (THAYER) Blue Valley Lutheran Nursing Home P O BOX 166, 220 PARK AVENUE (402) FAX: (402) BLUE VALLEY LUTHERAN HOMES SOCIETY, INC. ALAN JARECKI, PROVISIONAL ADM KERREY MILLER, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64

23 Page 21 of 48 HEMINGFORD (BOX BUTTE) Hemingford Community Care Center P O BOX 307, 605 DONALD AVENUE (308) FAX: (308) HEMINGFORD COMMUNITY CARE CENTER KRISTY BOLEK, ADMINISTRATOR ANGELA MCKEE, Director of Nursing Medicaid - 33 Medicare/ Total Lic - 33 BEHAVIORAL NEEDS HENDERSON (YORK) Henderson Care Center 1621 FRONT STREET (402) FAX: (402) HENDERSON HEALTH CARE SERVICES, INC CHERYL BROWN, ADMINISTRATOR MICHELE GEORGE, Director of Nursing NF LTCH 28E173 LTCH017 Medicaid - 42 Medicare/ Total Lic - 42 HOLDREGE (PHELPS) Christian Homes Health Care Center 1923 WEST 4TH AVENUE (308) FAX: (308) CHRISTIAN HOMES, INC. DON BAKKE, ADMINISTRATOR CINDY PETERSON, Director of Nursing Medicare/Medicaid - 86 Total Lic - 86 BEHAVIORAL NEEDS HOLDREGE (PHELPS) Holdrege Memorial Homes, Inc TH AVENUE (308) FAX: (308) HOLDREGE MEMORIAL HOMES KEVIN MORIARTY, ADMINISTRATOR LINDA CARPENTER, Director of Nursing Medicare/Medicaid - 94 Total Lic - 94 HOOPER (DODGE) Hooper Care Center 400 EAST BIRCHWOOD DRIVE (402) FAX: (402) HOOPER HEALTH CARE, INC. DIANE VILLWOK, ADMINISTRATOR MICHELE WENDT, Director of Nursing Medicare/Medicaid - 48 Total Lic - 48

24 Page 22 of 48 HUMBOLDT (RICHARDSON) Colonial Acres Nursing Home TH STREET (402) FAX: (402) CITY OF HUMBOLDT MARY KENT, ADMINISTRATOR CAROL GIMESON, Director of Nursing Medicare/Medicaid - 49 Total Lic - 49 IMPERIAL (CHASE) Imperial Manor Nursing Home P O BOX 757, 933 GRANT STREET (308) FAX: (308) CITY OF IMPERIAL LYLE HIGHT, ADMINISTRATOR TAMMI SIMPSON, Director of Nursing Medicare/Medicaid - 53 Total Lic - 53 KEARNEY (BUFFALO) CHI Health Good Samaritan P O BOX 1990, 10 EAST 31ST STREET (308) FAX: (308) GOOD SAMARITAN HOSPITAL MICHAEL SCHNIEDERS, ADMINISTRATOR LTCH LTCH018 Medicare/Medicaid - 22 Total Lic - 22 KEARNEY (BUFFALO) Good Samaritan Society - St John's 3410 CENTRAL AVENUE (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CHERLYN HUNT, ADMINISTRATOR DEBRA WADDELL, Director of Nursing Medicare/Medicaid - 77 Total Lic - 77 KEARNEY (BUFFALO) Good Samaritan Society - St Luke's Village 2201 EAST 32ND STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY RACY BAUER, ADMINISTRATOR SHAWN LEACH, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60

25 Page 23 of 48 KEARNEY (BUFFALO) Mother Hull Home 125 EAST 23RD STREET (308) FAX: (308) MOTHER HULL HOME CORP. STEPHANIE SIMMONS, ADMINISTRATOR RITA SAMUELSON, Director of Nursing Medicare/Medicaid - 58 Total Lic - 58 KEARNEY (BUFFALO) Mt Carmel Home - Keens Memorial 412 WEST 18TH STREET (308) FAX: (308) CORPUS CHRISTI CARMELITES, INC. MISTY SHOEMAKER, PROVISIONAL ADM KELINDA GILG, Director of Nursing Medicare/Medicaid - 75 Total Lic - 75 KENESAW (ADAMS) Premier Estates of Kenesaw, LLC P O BOX 10, 100 WEST ELM AVENUE (402) FAX: (402) PREMIER ESTATES OF KENESAW, LLC DIXIE JACKSON, ADMINISTRATOR ARATI MEERS, Director of Nursing Medicare/Medicaid - 76 Total Lic - 76 c/o: PREMIER ESTATES OF KENESAW, LLC TRILLIUM HEALTHCARE CONSULTING, 5265 OFFICE PARK BLVD, SUITE 101, BRADENTON FL KIMBALL (KIMBALL) Kimball County Manor 810 EAST 7TH STREET (308) FAX: (308) KIMBALL COUNTY MANOR BEVERLY SCHNELL, ADMINISTRATOR SHANNON MONHEISER, Director of Nursing Medicare/Medicaid - 49 Total Lic - 49 LAUREL (CEDAR) Hillcrest Care Center 702 CEDAR AVENUE (402) FAX: (402) CITY OF LAUREL HEATHER EAGLE, ADMINISTRATOR KATHLEEN KEIFER, Director of Nursing Medicare/Medicaid - 36 Total Lic - 36

26 Page 24 of 48 LEXINGTON (DAWSON) Plum Creek Healthcare Community 1505 NORTH ADAMS STREET (308) FAX: (308) LEXINGTON HEALTHCARE #1, LLC GAYLE ROGERS, ADMINISTRATOR JENNIFER CHANCELLOR, Director of Nursing Medicare/Medicaid - 66 Total Lic - 66 LINCOLN (LANCASTER) Diagnostic & Evaluation Center Hospital & Clinic 3220 WEST VAN DORN STREET (402) FAX: (402) NEBRASKA DEPARTMENT OF CORRECTIONAL SERVICES JOHN WILSON, ADMINISTRATOR TEENA LENGER, Director of Nursing SNF-LIC NH0013 Medicare/ Total Lic - 9 c/o: DEPT OF CORRECTIONAL SERVICES, CAMERON WHITE DIAGNOSTIC & EVALUATION CENTER HOSPITAL & CLINIC, PO BOX 94661, LINCOLN NE BEHAVIORAL NEEDS RESPIRATORY THERAPY LINCOLN (LANCASTER) Eastmont Towers 6315 O STREET (402) FAX: (402) CHRISTIAN RETIREMENT HOMES BETH NELSEN, ADMINISTRATOR MERRIT BEUNING, Director of Nursing SNF Medicare - 20 Medicare/ Total Lic - 42 LINCOLN (LANCASTER) Gateway Senior Living 225 NORTH 56TH STREET (402) FAX: (402) GATEWAY PROPERTIES, INC. MARK SROCZYNSKI, ADMINISTRATOR NICOLE WILSON, Director of Nursing S/NF DP Medicare - 68 Medicare/Medicaid - 12 Total Lic - 80 c/o: GATEWAY PROPERTIES, INC NORTH SOMERS STREET, FREMONT NE LINCOLN (LANCASTER) Holmes Lake Rehabilitation & Care Center 6101 NORMAL BLVD (402) FAX: (402) MID AMERICA CARE CENTERS, INC. LAVONNE HARROM, ADMINISTRATOR RUTH GAJARDO, Director of Nursing S/NF DP Medicare/Medicaid - 97 Total Lic - 97

27 Page 25 of 48 LINCOLN (LANCASTER) Homestead Nursing & Rehabilitation Center 4735 SOUTH 54TH STREET (402) FAX: (402) HOMESTEAD NURSING & REHABILITATION CENTER, LLC MATT ROMSHEK, ADMINISTRATOR DEBORAH JOHNSON, Director of Nursing Medicare/Medicaid Total Lic c/o: HOMESTEAD NURSING & REHABILITATION CENTER, LLC 2201 W MAIN STREET, EVANSTON IL LINCOLN (LANCASTER) Lancaster Rehabilitation Center, LLC 1001 SOUTH STREET (402) FAX: (402) LANCASTER MANOR REHABILITATION CENTER, LLC AMY FISH, ADMINISTRATOR SANDRA HOVIS, Director of Nursing Medicare/Medicaid Total Lic c/o: LANCASTER REHABILITATION CENTER, LLC 2201 MAIN STREET, EVANSTON IL RESPIRATORY THERAPY LINCOLN (LANCASTER) Nebraska State Penitentiary Hospital & Clinic 4201 SOUTH 14TH STREET (402) FAX: (402) NEBRASKA DEPARTMENT OF CORRECTIONAL SERVICES JOHN WILSON, ADMINISTRATOR TERESA SMITH, Director of Nursing SNF-LIC NH0011 Medicare/ Total Lic - 12 c/o: DEPT OF CORRECTIONAL SERVICES, CAMERON WHITE NEBRASKA STATE PENITENTIARY HOSPITAL & CLINIC, PO BOX 94661, LINCOLN NE BEHAVIORAL NEEDS RESPIRATORY THERAPY LINCOLN (LANCASTER) Southlake Village Rehabilitation & Care Center 9401 ANDERMATT DRIVE (402) FAX: (402) MANOR OF LINCOLN, INC. AIMEE MIDDLETON, ADMINISTRATOR MICHELLE SANTISTEVAN, Director of Nursing S/NF DP NH00011 Medicare - 78 Medicare/Medicaid - 48 Total Lic - 126

28 Page 26 of 48 LINCOLN (LANCASTER) St. Jane de Chantal Long Term Care 2200 SOUTH 52ND STREET (402) FAX: (402) MADONNA REHABILITATION HOSPITAL MELODY GAGNER, PROVISIONAL ADM DONNA HANEY, Director of Nursing S/NF DP LTC LTCH022 Medicaid - 38 Medicare/Medicaid - 87 Total Lic c/o: ATTN: PAUL A. DONGILLI MADONNA REHABILITATION HOSPITAL, 5401 SOUTH STREET, LINCOLN NE LINCOLN (LANCASTER) SUMNER PLACE 1750 SOUTH 20TH STREET (402) FAX: (402) MILDER MANOR, INC. LARRY VAN HUNNIK, ADMINISTRATOR MINDY ZUHAIRI, Director of Nursing Medicare/Medicaid Total Lic LINCOLN (LANCASTER) Tabitha At The Landing 6120 SOUTH 34TH STREET (402) FAX: (402) TABITHA INC. IMOGENE WATTERS, ADMINISTRATOR JOSHUA PENCE, Director of Nursing NH0014 Medicare/Medicaid - 17 Total Lic - 17 LINCOLN (LANCASTER) Tabitha Nursing Home 4720 RANDOLPH STREET (402) FAX: (402) TABITHA HEALTH CARE SERVICES ANNE FERGUSON, PROVISIONAL ADM HEATHER JUREY, Director of Nursing Medicare/Medicaid Total Lic LINCOLN (LANCASTER) The Ambassador Lincoln 4405 NORMAL BLVD (402) FAX: (402) THE AMBASSADOR LINCOLN, INC. KENNETH DAVIS, ADMINISTRATOR MARJORIE HAIDER, Director of Nursing S/NF DP Medicare - 44 Medicare/Medicaid - 78 Total Lic RESPIRATORY THERAPY

29 Page 27 of 48 LOUISVILLE (CASS) Louisville Care Center 410 WEST 5TH STREET (402) FAX: (402) CITY OF LOUISVILLE/LOUISVILLE CARE CENTER KARI WOCKENFUSS, ADMINISTRATOR CYNTHIA SHERA, Director of Nursing S/NF DP Medicare - 6 Medicare/Medicaid - 55 Total Lic - 61 LOUP CITY (SHERMAN) Rose Lane Home RR 2 BOX 46, 1005 NORTH 8TH STREET (308) FAX: (308) LOUP CITY HEALTH CARE, INC. TAMI SMITH, ADMINISTRATOR JANELLE KRZYCKI, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64 LYONS (BURT) Logan Valley Manor DIAMOND STREET (402) FAX: (402) LOGAN VALLEY MANOR, LLC MARK NELSON, PROVISIONAL ADM DEBRA REHBEIN, Director of Nursing c/o: LOGAN VALLEY MANOR 190 S MAIN, BOUNTIFUL UT Medicare/Medicaid - 65 Total Lic - 65 MACY (THURSTON) Carl T Curtis Health Education Center Nursing Home P O BOX 250 (402) FAX: (402) OMAHA TRIBE OF NEBRASKA KOURTNEY WILLIAMS, ADMINISTRATOR CINDY PEDERSEN, Director of Nursing NF 28A Medicaid - 25 Medicare/ Total Lic - 25 MADISON (MADISON) Countryside Home 703 NORTH MAIN STREET (402) FAX: (402) CITY OF MADISON LINDA ANDERSON, ADMINISTRATOR STEPHANIE WEHRLE, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70

30 Page 28 of 48 MCCOOK (RED WILLOW) Hillcrest Nursing Home P O BOX 1087, 309 WEST 7TH STREET (308) FAX: (308) RED WILLOW COUNTY COLINDA NAPPA, ADMINISTRATOR REBECCA TATE, Director of Nursing Medicare/Medicaid Total Lic RESPIRATORY THERAPY MILFORD (SEWARD) Crestview Care Center 1100 WEST 1ST STREET (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC VICKI BLACKWELL, ADMINISTRATOR NICOLE FARLESS, Director of Nursing Medicare/Medicaid - 54 Total Lic - 54 c/o: CRESTVIEW CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA MILFORD (SEWARD) Sunrise Country Manor PO BOX A, TH STREET (402) FAX: (402) SUNRISE COUNTRY, INC. CHARLISS MARSHALL, ADMINISTRATOR CARI STUKENHOLTZ, Director of Nursing Medicare/Medicaid - 80 Total Lic - 80 MINDEN (KEARNEY) Bethany Home, Inc 515 WEST FIRST STREET (308) FAX: (308) BETHANY HOME, INC. ROBERT TANK, ADMINISTRATOR RHONDA THORELL, Director of Nursing Medicare/Medicaid - 58 Total Lic - 58 MINDEN (KEARNEY) Kearney County Health 727 EAST 1ST STREET (308) FAX: (308) KEARNEY COUNTY FRED MEIS, ADMINISTRATOR DINA SILVRANTS, Director of Nursing NF 28E297 LTCH034 Medicaid - 34 Medicare/ Total Lic - 34

31 Page 29 of 48 MITCHELL (SCOTTS BLUFF) Mitchell Care Center RD STREET (308) FAX: (308) CITY OF MITCHELL STEPHANIE HAHN, ADMINISTRATOR KRISTEN PALSER, Director of Nursing Medicare/Medicaid - 50 Total Lic - 50 MULLEN (HOOKER) Pioneer Memorial Community Hospital Association P O BOX 578, 206 NW 4TH STREET (308) FAX: (308) MULLEN HOSPITAL DISTRICT DAWN MALLORY, ADMINISTRATOR LAURI SWANSON, Director of Nursing NF LTCH 28E175 LTCH024 Medicaid - 30 Medicare/ Total Lic - 30 NEBRASKA CITY (OTOE) Duff Memorial Nursing Home 1104 THIRD AVENUE (402) FAX: (402) FRIENDSHIP VILLAS LTD, INC ROY SCHNEIDER, ADMINISTRATOR DOROTHY EASTER, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60 RESPIRATORY THERAPY NEBRASKA CITY (OTOE) Golden LivingCenter - Nebraska City 1420 NORTH 10TH STREET (402) FAX: (402) GGNSC NEBRASKA CITY LLC DOUG WILLIAMS, ADMINISTRATOR HEATHER WHITE, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64 NEBRASKA CITY (OTOE) The Ambassador Nebraska City, Inc TH AVENUE (402) FAX: (402) THE AMBASSADOR HOLDING COMPANY TYLER JUILFS, ADMINISTRATOR WENDY HAYS, Director of Nursing Medicare/Medicaid - 55 Total Lic - 55

32 Page 30 of 48 NELIGH (ANTELOPE) Golden LivingCenter - Neligh P O BOX 66, 1100 NORTH T STREET (402) FAX: (402) GGNSC NELIGH LLC GWEN KOINZAN, ADMINISTRATOR SHELLY SANDS, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70 NEWMAN GROVE (MADISON) Mid-Nebraska Lutheran Home 109 NORTH 2ND STREET (402) FAX: (402) MID-NEBRASKA LUTHERAN HOME LINDSI LUEKEN, ADMINISTRATOR SUE STEVENSON, Director of Nursing Medicare/Medicaid - 45 Total Lic - 45 NORFOLK (MADISON) Golden LivingCenter - Norfolk 1900 VICKI LANE (402) FAX: (402) GGNSC NORFOLK VALLEY VIEW LLC KAY VANNESS, ADMINISTRATOR LACEY MOELLER, Director of Nursing Medicare/Medicaid - 67 Total Lic - 67 NORFOLK (MADISON) Heritage of Bel Air P O BOX 429, 1203 NORTH 13TH STREET (402) FAX: (402) HERITAGE OF NORFOLK, INC. KATIE FREDERICK, ADMINISTRATOR STACI KOLM, Director of Nursing Medicare/Medicaid Total Lic NORFOLK (MADISON) Norfolk Veterans Home 600 E BENJAMIN AVENUE (402) FAX: (402) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM JERRY EISENHAUER, ADMINISTRATOR STACIE STEELE, Director of Nursing SNF-LIC NH0001 Medicare/ Total Lic - 159

33 Page 31 of 48 NORFOLK (MADISON) St. Joseph's Rehabilitation and Care Center 401 NORTH 18TH STREET (402) FAX: (402) FAITH REGIONAL HEALTH SERVICES KENNETH KLAASMEYER, ADMINISTRATOR LORA OTTEN, Director of Nursing Medicare/Medicaid - 83 Total Lic - 83 NORTH BEND (DODGE) Birchwood Manor 1120 WALNUT ST (402) FAX: (402) CELEBRATE LIFE, INC. SHANNON BORER, ADMINISTRATOR JASON KEENAN, Director of Nursing Medicare/Medicaid - 53 Total Lic - 53 NORTH PLATTE (LINCOLN) Centennial Park Retirement Village 510 CENTENNIAL CIRCLE (308) FAX: (308) FIVE STAR QUALITY CARE-NE, LLC SAZA LEE, ADMINISTRATOR CAROL UECKER, Director of Nursing Medicare/Medicaid - 68 Total Lic - 68 c/o: CENTENNIAL PARK RETIREMENT VILLAGE FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA NORTH PLATTE (LINCOLN) Linden Court 4000 WEST PHILIP AVENUE (308) FAX: (308) HERITAGE OF NORTH PLATTE, INC. JULIE SKALA, ADMINISTRATOR LYNN SANER, Director of Nursing Medicare/Medicaid Total Lic NORTH PLATTE (LINCOLN) North Platte Care Center, LLC 2900 WEST E STREET (308) FAX: (308) IANE PROPERTIES I, LLC HAROLD MCELDERRY, ADMINISTRATOR VERA HENDER, Director of Nursing Medicare/Medicaid - 71 Total Lic - 71 c/o: NORTH PLATTE CARE CENTER, LLC TRILLIUM HEALTHCARE CONSULTING LLC, PALM BRUSH TRAIL, SUITE 331, LAKEWOOD RANCH FL 34202

34 Page 32 of 48 O' NEILL (HOLT) Golden LivingCenter - O'Neill PO BOX 756, 1102 NORTH HARRISON (402) FAX: (402) GGNSC O'NEILL LLC STEPHANIE CLIFTON, PROVISIONAL ADM DANIKA HANSEN, Director of Nursing Medicare/Medicaid - 84 Total Lic - 84 OAKLAND (BURT) Oakland Heights 207 SOUTH ENGDAHL AVENUE (402) FAX: (402) CITY OF OAKLAND DAVID DEEMER, ADMINISTRATOR CHRISTINA ARNOLD, Director of Nursing Medicare/Medicaid - 45 Total Lic - 45 OGALLALA (KEITH) Indian Hills Heatlhcare Community 1720 NORTH SPRUCE (308) FAX: (308) OGALLALA HEALTHCARE #1, LLC SHEILA HUSKEY, ADMINISTRATOR NICOLE GAONA, Director of Nursing Medicare/Medicaid - 82 Total Lic - 82 OMAHA (DOUGLAS) Brighton Gardens of Omaha 9220 WESTERN AVENUE (402) FAX: (402) SOLOMON HOLDINGS I - THE TRIANGLE LLC WENDY GROSSE, ADMINISTRATOR YASMINE KAISER, Director of Nursing S/NF DP Medicare - 39 Medicare/Medicaid - 6 Total Lic - 45 OMAHA (DOUGLAS) Brookestone Village Rehabilitation and Care Center 4330 SOUTH 144TH STREET (402) FAX: (402) BROOKESTONE VILLAGE, INC. KRISTIN MILLIKEN, ADMINISTRATOR HARMONY WIDMAN, Director of Nursing S/NF DP Medicare Medicare/Medicaid - 14 Total Lic - 140

35 Page 33 of 48 OMAHA (DOUGLAS) Douglas County Health Center 4102 WOOLWORTH AVENUE (402) FAX: (402) DOUGLAS COUNTY JAMES TOURVILLE, ADMINISTRATOR MARY POWELL, Director of Nursing Medicare/Medicaid Total Lic BEHAVIORAL NEEDS OMAHA (DOUGLAS) Florence Home 7915 NORTH 30TH STREET (402) FAX: (402) FLORENCE HOME ANN ERICKSON, ADMINISTRATOR DEB NESBITT, Director of Nursing Medicare/Medicaid Total Lic OMAHA (DOUGLAS) Golden LivingCenter - Omaha 5505 GROVER STREET (402) FAX: (402) GGNSC OMAHA HALLMARK LLC JUDY SEALER, ADMINISTRATOR TERESA LAWSON, Director of Nursing Medicare/Medicaid Total Lic OMAHA (DOUGLAS) Golden LivingCenter - Sorensen 4809 REDMAN AVENUE (402) FAX: (402) GGNSC OMAHA OAK GROVE LLC DOUG WILLIAMS, ADMINISTRATOR TREVOR JONES, Director of Nursing Medicare/Medicaid - 74 Total Lic - 74 OMAHA (DOUGLAS) Good Samaritan Society - Millard DEAUVILLE DRIVE (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY BRANDI PETRIK, ADMINISTRATOR MICHELLE TORDOFF, Director of Nursing Medicare/Medicaid Total Lic - 106

36 Page 34 of 48 OMAHA (DOUGLAS) Immanuel Fontenelle 6809 N 68TH PLAZA (402) FAX: (402) IMMANUEL LONG TERM CARE JOHN TURNER, ADMINISTRATOR CYNTHIA LEO GOFTA, Director of Nursing c/o: IMMANUEL FONTENELLE 6809 NORTH 68TH PLAZA, OMAHA NE Medicare/Medicaid Total Lic OMAHA (DOUGLAS) Life Care Center of Omaha 6032 VILLE DE SANTE DRIVE (402) FAX: (402) CONSOLIDATED RESOURCES HEALTH CARE FUND I, L.P. SARA DELAHOYDE, ADMINISTRATOR MELISA MONICAL, Director of Nursing Medicare/Medicaid Total Lic OMAHA (DOUGLAS) Maple Crest Health Center 2824 NORTH 66TH AVENUE (402) FAX: (402) AMERICAN BAPTIST HOMES OF THE MIDWEST JOHN TANNER, ADMINISTRATOR EUGENIE AHOUNOU, Director of Nursing Medicare/Medicaid Total Lic OMAHA (DOUGLAS) Montclair Nursing and Rehabilitation Center 2525 SOUTH 135TH AVENUE (402) FAX: (402) MONTCLAIR HEALTHCARE, LLC ROSALYN BURKE, ADMINISTRATOR LINDA THIEDE, Director of Nursing Medicare/Medicaid Total Lic BEHAVIORAL NEEDS RESPIRATORY THERAPY OMAHA (DOUGLAS) Nebraska Skilled Nursing & Rehab 7410 MERCY ROAD (402) FAX: (402) COVENANT CARE MIDWEST, INC. TAMMY WESTON, ADMINISTRATOR KIM NICHOLS, Director of Nursing Medicare/Medicaid Total Lic RESPIRATORY THERAPY

37 Page 35 of 48 OMAHA (DOUGLAS) Old Mill Rehabilitation (Omaha TCU) 1131 PAPILLION PARKWAY (402) FAX: (402) SNF OMAHA OPERATING COMPANY, LLC DAVID WILLIAMSON, ADMINISTRATOR KRISTI KELLOGG, Director of Nursing NH0017 Medicare/Medicaid - 44 Total Lic - 44 OMAHA (DOUGLAS) Omaha Nursing and Rehabilitation Center 4835 SOUTH 49TH STREET (402) FAX: (402) SOUTHSIDE HEALTHCARE, INC JENNIFER HARRISON, ADMINISTRATOR MARLENA HARRIS, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70 OMAHA (DOUGLAS) Quality Living, Inc NORTH 70TH PLAZA (402) FAX: (402) QUALITY LIVING, INC. ALICIA ELSON, ADMINISTRATOR JENNIFER CLARK, Director of Nursing NF 28A Medicaid Medicare/ Total Lic OMAHA (DOUGLAS) Ridgecrest Rehabilitation Center, LLC 3110 SCOTT CIRCLE (402) FAX: (402) RIDGECREST REHABILITATION CENTER, LLC JOSEPH KEZAR, ADMINISTRATOR LAURRIE STEELE, Director of Nursing Medicare/Medicaid Total Lic c/o: RIDGECREST REHABILITATION CENTER, LLC 2201 MAIN STREET, EVANSTON IL OMAHA (DOUGLAS) Rose Blumkin Jewish Home 323 SOUTH 132ND STREET (402) FAX: (402) JEWISH FEDERATION OF OMAHA, INC. MICHAEL SILVERMAN, ADMINISTRATOR ROCHELLE CASH, Director of Nursing Medicare/Medicaid Total Lic - 105

38 Page 36 of 48 OMAHA (DOUGLAS) Skyline Nursing and Rehabilitation 7350 GRACELAND DRIVE (402) FAX: (402) GOOD HOPE HEALTHCARE, INC DAVID MAGUIRE, PROVISIONAL ADM JAMIE SHANKS, Director of Nursing Medicare/Medicaid Total Lic c/o: SKYLINE NURSING AND REHABILITATION PUERTA REAL, SUITE 450, MISSION VIEJO CA BEHAVIORAL NEEDS OMAHA (DOUGLAS) St. Joseph Villa Nursing Center 2305 SOUTH 10TH STREET (402) FAX: (402) DELMAR GARDENS OF OMAHA, LLC HECTOR LEGUILLOW, ADMINISTRATOR MARY SMITH, Director of Nursing S/NF DP Medicaid Medicare/Medicaid - 32 Total Lic OMAHA (DOUGLAS) The Ambassador Omaha 1540 NORTH 72ND STREET (402) FAX: (402) THE AMBASSADOR OMAHA, INC. MITCH JEVNE, ADMINISTRATOR POLLY STERN, Director of Nursing S/NF DP Medicare - 41 Medicaid - 48 Medicare/Medicaid - 67 Total Lic PEDIATRIC RESPIRATORY THERAPY OMAHA (DOUGLAS) The Lighthouse at Lakeside Village ARBOR STREET (402) FAX: (402) IMMANUEL LONG TERM CARE JACOB SCHULTZ, ADMINISTRATOR ERIN CAHILL-CHRISTENSEN, Director of Nursing NH0009 Medicare/Medicaid - 36 Total Lic - 36 OMAHA (DOUGLAS) The Rehabilitation Center of Omaha 910 SOUTH 40TH STREET (402) FAX: (402) THE REHABILITATION CENTER OF OMAHA, LLC D. KIRK SWEENEY, ADMINISTRATOR HEAVENLEE BROWN, Director of Nursing Medicare/Medicaid - 61 Total Lic - 65

39 Page 37 of 48 ORD (VALLEY) Valley View Senior Village 220 SOUTH 26TH STREET (308) FAX: (308) VALLEY VIEW SENIOR VILLAGE, LLC RANDY KOZEAL, ADMINISTRATOR SARAH HON, Director of Nursing NF LTCH 28E286 NH0021 Medicaid - 53 Medicare/ Total Lic - 60 OSCEOLA (POLK) Good Samaritan Society - Osceola 600 CENTER DRIVE (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY SKYLER SCHMITT, ADMINISTRATOR MICHELLE MICEK, Director of Nursing Medicare/Medicaid - 47 Total Lic - 47 OSHKOSH (GARDEN) Regional West Garden County Nursing Home 1100 WEST 2ND (308) FAX: (308) REGIONAL WEST GARDEN COUNTY JIMMIE HANSEL, ADMINISTRATOR JOLENE LOBNER, Director of Nursing NF LTCH 28E180 LTCH036 Medicaid - 40 Medicare/ Total Lic - 40 PAPILLION (SARPY) Hillcrest Country Estates 6082 GRAND LODGE AVENUE (402) FAX: (402) HILLCREST DEVELOPMENT COMPANY, LLC CYNTHIA KLEIN, ADMINISTRATOR JOE DIMINICO, Director of Nursing NH0007 Medicaid - 39 Medicare/Medicaid - 22 Total Lic PAPILLION (SARPY) Huntington Park Care Center 1507 GOLD COAST ROAD (402) FAX: (402) HUNTINGTON PARK CARE CENTER, INC. SUSAN NEWELL, ADMINISTRATOR HARMONY WIDMAN, Director of Nursing Medicare/Medicaid Total Lic - 115

40 Page 38 of 48 PAPILLION (SARPY) Papillion Manor 610 SOUTH POLK STREET (402) FAX: (402) PAPILLION MANOR, INC. SARA BUNTING, ADMINISTRATOR MAUREEN BLAYLOCK, Director of Nursing S/NF DP Medicare - 99 Medicare/Medicaid - 11 Total Lic PAWNEE CITY (PAWNEE) Premier Estates of Pawnee, LLC P O BOX 513, TH STREET (402) FAX: (402) PREMIER ESTATES OF PAWNEE, LLC DANIEL STACKIS, PROVISIONAL ADM SUSAN DEVEREAUX, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64 PENDER (THURSTON) Legacy Garden Rehabilitation & Living Center 200 VALLEY VIEW DRIVE (402) FAX: (402) PENDER CARE CENTRE DISTRICT, INC. SHARI DORSEY, ADMINISTRATOR SARAH BAIER, Director of Nursing Medicare/Medicaid - 42 Total Lic - 42 PIERCE (PIERCE) Premier Estates of Pierce, LLC P O BOX 189, 515 EAST MAIN STREET (402) FAX: (402) PREMIER ESTATES OF PIERCE, LLC PAMELA ALBIN, ADMINISTRATOR CHIRSTANNA DALE, Director of Nursing Medicare/Medicaid - 75 Total Lic - 75 c/o: PREMIER ESTATES OF PIERCE, LLC TRILLIUM HEALCARE CONSULTING, 5265 OFFICE PARK BLVD, SUITE 101, BRADENTON NE PLAINVIEW (PIERCE) Plainview Manor P O BOX 219, 101 HARPER STREET (402) FAX: (402) CITY OF PLAINVIEW JULEEN JOHNSON, ADMINISTRATOR TAMI ANDERSON, Director of Nursing Medicare/Medicaid - 39 Total Lic - 39

41 Page 39 of 48 PLATTSMOUTH (CASS) Golden LivingCenter - Plattsmouth 602 SOUTH 18TH STREET (402) FAX: (402) GGNSC PLATTSMOUTH LLC CASSANDRA PUTNAM, ADMINISTRATOR JENNIFER NICHOLS, Director of Nursing Medicare/Medicaid Total Lic PLATTSMOUTH (CASS) The Nebraska Masonic Home 1300 AVENUE D (402) FAX: (402) THE NEBRASKA MASONIC HOME MARY VRBKA, ADMINISTRATOR SHELLY MULLINS, Director of Nursing NF LIC NH0004 Medicare/ Total Lic - 72 PONCA (DIXON) Elms Health Care Center P O BOX 628, 410 BALL PARK ROAD (402) FAX: (402) ELMS HEALTH CARE CENTER, INC. JACQUELINE HATCHER, ADMINISTRATOR REBECCA FOWLER, Director of Nursing Medicare/Medicaid - 42 Total Lic - 42 BEHAVIORAL NEEDS RANDOLPH (CEDAR) Colonial Manor of Randolph P O BOX 67, 811 SOUTH MAIN STREET (402) FAX: (402) RANDOLPH HEALTHCARE, INC ROBERT PYPER, ADMINISTRATOR DOLORITA RAUCH, Director of Nursing Medicare/Medicaid - 45 Total Lic - 45 RAVENNA (BUFFALO) Good Samaritan Society - Ravenna 411 WEST GENOA (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY JEFF ACHTENBERG, ADMINISTRATOR JANET CAMPBELL, Director of Nursing Medicare/Medicaid - 61 Total Lic - 61

42 Page 40 of 48 RED CLOUD (WEBSTER) Heritage of Red Cloud 636 NORTH LOCUST STREET (402) FAX: (402) HERITAGE OF RED CLOUD, INC. KIM GRAMS, ADMINISTRATOR JACKIE MILLER, Director of Nursing Medicare/Medicaid - 43 Total Lic - 43 SCHUYLER (COLFAX) Golden LivingCenter - Schuyler 2023 COLFAX STREET (402) FAX: (402) GGNSC SCHUYLER LLC SHARAN STOLTENBERG, ADMINISTRATOR COREY STULL, Director of Nursing Medicare/Medicaid - 53 Total Lic - 53 SCOTTSBLUFF (SCOTTS BLUFF) Golden LivingCenter - Scottsbluff 111 WEST 36TH STREET (308) FAX: (308) GGNSC SCOTTSBLUFF LLC DAWN JACOBS, ADMINISTRATOR DARLENE ELLIS, Director of Nursing Medicare/Medicaid Total Lic SCOTTSBLUFF (SCOTTS BLUFF) Northfield Retirement Communities Care Center 2100 CIRCLE DRIVE (308) FAX: (308) NORTHFIELD RETIREMENT COMMUNITIES MARK LUGER, ADMINISTRATOR SARA CHITWOOD, Director of Nursing Medicare/Medicaid - 66 Total Lic - 66 SCOTTSBLUFF (SCOTTS BLUFF) Western Nebraska Veterans Home 1102 WEST 42ND STREET (308) FAX: (308) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM LONNIE STARKE, ADMINISTRATOR SHIRLEY BARLOW, Director of Nursing SNF-LIC Medicare/ Total Lic - 50 BEHAVIORAL NEEDS RESPIRATORY THERAPY

43 Page 41 of 48 SCRIBNER (DODGE) Good Samaritan Society - Scribner 815 LOGAN STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY SHERRY OWINGS-MASON, ADMINISTRATOR SALLY SIMS, Director of Nursing Medicare/Medicaid - 73 Total Lic - 75 SEWARD (SEWARD) Ridgewood Rehabilitation & Care Center 624 PINEWOOD AVENUE (402) FAX: (402) SEWARD LIVING CENTER, INC JOSEPH CALDWELL, ADMINISTRATOR STACY QUAKENBUSH, Director of Nursing Medicare/Medicaid - 87 Total Lic - 87 SIDNEY (CHEYENNE) Golden LivingCenter - Sidney 1435 TOLEDO STREET (308) FAX: (308) GGNSC SIDNEY LLC KELLY ANDERSON, ADMINISTRATOR Medicare/Medicaid - 41 Total Lic - 41 RESPIRATORY THERAPY SIDNEY (CHEYENNE) Sidney Regional Medical Center-Extended Care 645 OSAGE STREET (308) FAX: (308) CHEYENNE COUNTY HOSPITAL ASSOCIATION, INC. JUDY FRERICHS, ADMINISTRATOR SUE RICE, Director of Nursing Medicare/Medicaid - 61 Total Lic - 63 SOUTH SIOUX CITY (DAKOTA) Matneys Colonial Manor 3200 G STREET (402) FAX: (402) MATNEY'S COLONIAL MANOR, INC LISA VERSCHOOR-MATNEY, INTERIM ADMINIS TAMMY PALMERSHEIM, Director of Nursing Medicare/Medicaid - 77 Total Lic - 77

44 Page 42 of 48 SOUTH SIOUX CITY (DAKOTA) Regency Square Care Center 3501 DAKOTA AVENUE (402) FAX: (402) RVP ENTERPRISES JANE WESSEL-STREIT, ADMINISTRATOR HEATHER LOGUE, Director of Nursing Medicare/Medicaid - 72 Total Lic - 72 ST EDWARD (BOONE) Cloverlodge Care Center 301 NORTH 13TH STREET (402) FAX: (402) HERITAGE OF FAIRBURY/ST. EDWARD, INC. SAMANTHA TILSON, ADMINISTRATOR EYDIE SCHRAD, Director of Nursing Medicare/Medicaid - 55 Total Lic - 55 ST PAUL (HOWARD) Brookefield Park 1405 HERITAGE DRIVE (308) FAX: (308) HERITAGE OF ST. PAUL, INC. BRENDA EWERS-NORDHUES, ADMINISTRATOR SARAH RASMUSSEN, Director of Nursing NH0016 Medicare/Medicaid - 70 Total Lic - 70 STANTON (STANTON) Stanton Health Center P O BOX 407, TH STREET (402) FAX: (402) CITY OF STANTON CHAYANN INDRA, PROVISIONAL ADM LISA RUMSEY, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70 STROMSBURG (POLK) Midwest Covenant Home P O BOX 367, 615 EAST 9TH STREET (402) FAX: (402) MIDWEST COVENANT HOME, INC CINDY TAPPHORN, ADMINISTRATOR HELEN WERTH, Director of Nursing Medicare/Medicaid - 58 Total Lic - 58

45 Page 43 of 48 STUART (HOLT) Parkside Manor P O BOX 350, 507 NORTH MAIN STREET (402) FAX: (402) STUART VILLAGE NURSING HOME BOARD PARKSIDE MANOR LUCAS KAUP, ADMINISTRATOR LISA KORINKO, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 SUPERIOR (NUCKOLLS) Good Samaritan Society - Superior 1710 IDAHO STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY MATTHEW BLUM, ADMINISTRATOR ANN HOBSON, Director of Nursing Medicare/Medicaid - 71 Total Lic - 71 SUTHERLAND (LINCOLN) Sutherland Care Center P O BOX 307, 333 MAPLE STREET (308) FAX: (308) FIVE STAR QUALITY CARE-NE, LLC SAZA LEE, ADMINISTRATOR COLLEEN WIGGERS, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60 c/o: SUTHERLAND CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA SUTTON (CLAY) Sutton Community Home, Inc NORTH SAUNDERS (402) FAX: (402) SUTTON COMMUNITY HOME, INC. HANNAH ELLIOTT, ADMINISTRATOR ERICA HUXOLL, Director of Nursing Medicare/Medicaid - 31 Total Lic - 31

46 Page 44 of 48 SYRACUSE (OTOE) Good Samaritan Society - Syracuse P O BOX F-1, 1622 WALNUT STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY DIANNA EPP, ADMINISTRATOR LORI ZAHN, Director of Nursing Medicare/Medicaid - 88 Total Lic - 88 TECUMSEH (JOHNSON) Belle Terrace 1133 NORTH THIRD ST (402) FAX: (402) BELLE HOLDINGS, INC. DIANA THIEMANN, ADMINISTRATOR CONNIE WALTERS, Director of Nursing S/NF DP Medicaid - 20 Medicare/Medicaid - 47 Total Lic - 67 TECUMSEH (JOHNSON) Tecumseh State Correctional Institution PO BOX 900, 2725 N HWY 50 (402) FAX: (402) NEBRASKA DEPARTMENT OF CORRECTIONAL SERVICES JOHN WILSON, ADMINISTRATOR KELLY BECK, Director of Nursing SNF-LIC NH0012 Medicare/ Total Lic - 10 BEHAVIORAL NEEDS RESPIRATORY THERAPY c/o: DEPT OF CORRECTIONAL SERVICES, CAMERON WHITE TECUMSEH STATE CORRECTIONAL INSTITUTION, PO BOX 94661, LINCOLN NE TEKAMAH (BURT) Golden LivingCenter - Tekamah 823 M STREET (402) FAX: (402) GGNSC TEKAMAH LLC TAMMY DEEMER, PROVISIONAL ADM CYNTHIA SENKBILE, Director of Nursing Medicare/Medicaid - 44 Total Lic - 46 TRENTON (HITCHCOCK) El Dorado Manor Nursing Home HWY 25, BOX 97 (308) FAX: (308) VILLAGE OF TRENTON SANDRA BRUNKHORST, ADMINISTRATOR ELAINE BERRY, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 BEHAVIORAL NEEDS RESPIRATORY THERAPY

47 Page 45 of 48 UTICA (SEWARD) Utica Community Care Center 1350 CENTENNIAL AVENUE (402) FAX: (402) FIVE STAR QUALITY CARE NE, INC MELANIE RUHL-SCHLUTER, ADMINISTRATOR JEANNE ENGEL, Director of Nursing Medicare/Medicaid - 41 Total Lic - 41 c/o: UTICA COMMUNITY CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA VALENTINE (CHERRY) Good Samaritan Society - Valentine P O BOX 180, 601 WEST 4TH STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY SHELLEY PIER, ADMINISTRATOR KRISS BOSWORTH, Director of Nursing Medicare/Medicaid - 58 Total Lic - 58 VALLEY (DOUGLAS) Golden LivingCenter - Valhaven 300 WEST MEIGS STREET (402) FAX: (402) BEVERLY ENTERPRISES - NEBRASKA, INC. LORETTA PAUL ALLEN, ADMINISTRATOR LISA CHURCH, Director of Nursing Medicare/Medicaid - 66 Total Lic - 66 VERDIGRE (KNOX) Alpine Village Retirement Center PO BOX 130, 706 JAMES STREET (402) FAX: (402) VILLAGE OF VERDIGRE BYRON SHAKESPAERE, ADMINISTRATOR KYLIE ZIMMERER, Director of Nursing Medicare/Medicaid - 58 Total Lic - 58 BEHAVIORAL NEEDS WAHOO (SAUNDERS) Saunders Medical Center 1760 COUNTY RD J (402) FAX: (402) SAUNDERS MEDICAL CENTER TYLER TOLINE, PROVISIONAL ADM NANCY HOLMGREN, Director of Nursing NF LTCH 28E223 LTCH035 Medicaid - 60 Medicare/ Total Lic - 60

48 Page 46 of 48 WAHOO (SAUNDERS) South Haven Living Center 1400 MARK DRIVE (402) FAX: (402) HERITAGE OF WAHOO, INC. JALENE CARPENTER, ADMINISTRATOR TAMMY COX, Director of Nursing Medicare/Medicaid - 84 Total Lic - 84 WAKEFIELD (DIXON) Wakefield Health Care Center 306 ASH STREET (402) FAX: (402) CITY OF WAKEFIELD TERRENCE HOFFMAN, ADMINISTRATOR MELIA TULLBERG, Director of Nursing Medicare/Medicaid - 49 Total Lic - 49 WAUNETA (CHASE) Sunrise Heights of Wauneta PO BOX 520, 427 LEGION STREET (308) FAX: (308) VILLAGE OF WAUNETA LISA KISINGER, ADMINISTRATOR DEBRA ANDREW, Director of Nursing Medicare/Medicaid - 36 Total Lic - 36 WAUSA (KNOX) Golden LivingCenter - Wausa 703 SOUTH VIVIAN (402) FAX: (402) GGNSC WAUSA LLC LEIGH BLOOMQUIST, ADMINISTRATOR RHEA LANGE, Director of Nursing Medicare/Medicaid - 42 Total Lic - 42 WAVERLY (LANCASTER) Waverly Care Center NORTH 137TH ST (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC DAVID BERGMANN, ADMINISTRATOR DEANNA QUALSET, Director of Nursing Medicare/Medicaid - 54 Total Lic - 54 c/o: WAVERLY CARE CENTER FIRVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA 02458

49 Page 47 of 48 WAYNE (WAYNE) Careage Campus of Care 811 EAST 14TH STREET (402) FAX: (402) LINDAHL HEALTHCARE, INC AMMON WOLFLEY, ADMINISTRATOR CONNIE VOGT, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60 WEST POINT (CUMING) Premier Estates of West Point, LLC 960 PROSPECT ROAD (402) FAX: (402) PREMIER ESTATES OF WEST POINT, LLC PAMELA ALBIN, ADMINISTRATOR DEBRA REHBEIN, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64 c/o: PREMIER ESTATES OF WEST POINT, LLC TRILLIUM HEALTHCARE CONSULTING, 5265 OFFICE PARK BLVD, SUITE 101, BRADENTON FL WILBER (SALINE) Wilber Care Center 611 NORTH MAIN (402) FAX: (402) CITY OF WILBER BARBARA DREYER, ADMINISTRATOR MICHELE VANA, Director of Nursing Medicare/Medicaid - 66 Total Lic - 66 WISNER (CUMING) Wisner Care Center TH STREET (402) FAX: (402) CITY OF WISNER HEATHER GEIS, PROVISIONAL ADM KELLY JOHNSON, Director of Nursing Medicare/Medicaid - 38 Total Lic - 38 WOOD RIVER (HALL) Good Samaritan Society - Wood River 1401 EAST STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY PEGGY SWANSON, ADMINISTRATOR JACKIE RIVERA, Director of Nursing Medicare/Medicaid - 61 Total Lic - 63

50 Page 48 of 48 WYMORE (GAGE) Good Samaritan Society - Wymore 105 EAST D STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY DANIEL GUENTHER, ADMINISTRATOR JEANNE MASCHMEIER, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 YORK (YORK) York General Hearthstone P O BOX 159, 2600 NORTH LINCOLN AVENUE (402) FAX: (402) YORK GENERAL HEALTH CARE SERVICES JOSEPH JAY COLBURN, ADMINISTRATOR TREVA JACOBSEN, Director of Nursing Medicare/Medicaid Total Lic Total Facilities: 228