Other Facilities Owned, Operated or Managed Key Questions Yes No . Does the parent of the operator own, operate, or manage any other facilities? Do any of the other facilities have pending judgments; legal actions or suits; or, N/A bankruptcy claims? Do any of the other facilities have any open professional liability insurance N/A claims? Do any of the other facilities have any open state findings related to instances N/A of actual harm and/or immediate jeopardy (G or higher)? <<For each answer above, provide a narrative discussion on the topic describing the risk “yes” and how it will be mitigated. Example: Other Facilities: XXXXX identified XX other facilities it owns, operates, or manages in addition to the subject facility.>> Program Guidance: For other projects/facilities owned, operated, or managed, the lender must submit copies of inspection reports for the facilities that have open level or higher citations/deficiencies. The “G” lender must address any issues/risks associated with the reports and show how they would be mitigated. If no open/unresolved level G or higher deficiencies, this should be stated. Note: If any facility has recent (within last 2 years) resolved or higher citations/deficiencies, the “G” lender must address this in the narrative; however, a copy of the report is not required. Financial Statements The application includes the following parent of the operator financial statements: Year-to-date: <<dates for start and end of period>> Fiscal year ending: <<date end of period>> – Fiscal year ending: <<date end of period>> – Fiscal year ending: <<date end of period>> – Key Questions Yes No Are less than 3-years of historical financial data available for the parent of the operator? . Are the financial statements missing any required information or schedules? Do the Aging of Accounts Payable schedules show any material accounts payables (amounts in excess of 5% of effective gross income) over 90 days? Did your review and analysis of the financial statements indicate any other
Other Facilities Owned, Operated or Managed Key Questions Yes No Does the parent of the operator own, operate, or manage any other facilities? . Do any of the other facilities have pending judgments; legal actions or suits; or, bankruptcy claims? N/A Do any of the other facilities have any open professional liability insurance claims? N/A Do any of the other facilities have any open state findings related to instances of actual harm and/or immediate jeopardy (G or higher)? N/A <<For each “yes” answer above, provide a narrative discussion on the topic describing the risk and how it will be mitigated. Example: Other Facilities: XXXXX identified XX other facilities it owns, operates, or manages in addition to the subject facility.>> Program Guidance: For other projects/facilities owned, operated, or managed, the lender must submit copies of inspection reports for the facilities that have open level “G” or higher citations/deficiencies. The lender must address any issues/risks associated with the reports and show how they would be mitigated. If no open/unresolved level G or higher deficiencies, this should be stated. Note: If any facility has recent (within last 2 years) resolved “G” or higher citations/deficiencies, the lender must address this in the narrative; however, a copy of the report is not required. Financial Statements The application includes the following parent of the operator financial statements: Year-to-date: <<dates for start and end of period>> Fiscal year ending: <<date – end of period>> Fiscal year ending: <<date – end of period>> Fiscal year ending: <<date – end of period>> Key Questions Yes No Are less than 3-years of historical financial data available for the parent of the operator? . Are the financial statements missing any required information or schedules? Do the Aging of Accounts Payable schedules show any material accounts payables (amounts in excess of 5% of effective gross income) over 90 days? Did your review and analysis of the financial statements indicate any other