Additional pages attached. Attachment 4 to Consolidated Certifications Operator: – Listing of Other Business Concerns (Owned, Operated or Managed) (Note: Projects/facilities listed on Attachment 3 are not required to be listed again on Attachment 4) For <<enter operator's name here>> Entity (name & address) Participation Other Information (Attach a detailed explanation on a separate sheet for any box not checked) Role: Name of Business Entity No Pending bankruptcy claims % ownership (if No Pending judgments applicable) No Pending legal actions or suits No Open professional liability insurance claims Real Estate No Open State findings Non-Real Estate Additional explanation sheet attached. Healthcare Facility YES NO Role: Name of Business Entity No Pending bankruptcy claims % ownership (if No Pending judgments applicable) No Pending legal actions or suits No Open professional liability insurance claims Real Estate No Open State findings Non-Real Estate Additional explanation sheet attached. Healthcare Facility YES NO Name of Business Entity Role: No Pending bankruptcy claims % ownership (if No Pending judgments applicable) No Pending legal actions or suits No Open professional liability insurance claims Real Estate No Open State findings Non-Real Estate Additional explanation sheet attached. Healthcare Facility YES NO Name of Business Entity Role: No Pending bankruptcy claims % ownership (if No Pending judgments applicable) No Pending legal actions or suits Real Estate No Open professional liability insurance claims Non-Real Estate No Open State findings Healthcare Facility Additional explanation sheet attached. YES NO
Additional pages attached. Attachment 4 to Consolidated Certifications – Operator: Listing of Other Business Concerns (Owned, Operated or Managed) (Note: Projects/facilities listed on Attachment 3 are not required to be listed again on Attachment 4) For <<enter operator's name here>> Entity (name & address) Participation Other Information (Attach a detailed explanation on a separate sheet for any box not checked) Name of Business Entity Role: % ownership (if applicable) Real Estate Non-Real Estate Healthcare Facility YES NO No Pending bankruptcy claims No Pending judgments No Pending legal actions or suits No Open professional liability insurance claims No Open State findings Additional explanation sheet attached. Name of Business Entity Role: % ownership (if applicable) Real Estate Non-Real Estate Healthcare Facility YES NO No Pending bankruptcy claims No Pending judgments No Pending legal actions or suits No Open professional liability insurance claims No Open State findings Additional explanation sheet attached. Name of Business Entity Role: % ownership (if applicable) Real Estate Non-Real Estate Healthcare Facility YES NO No Pending bankruptcy claims No Pending judgments No Pending legal actions or suits No Open professional liability insurance claims No Open State findings Additional explanation sheet attached. Name of Business Entity Role: % ownership (if applicable) Real Estate Non-Real Estate Healthcare Facility YES NO No Pending bankruptcy claims No Pending judgments No Pending legal actions or suits No Open professional liability insurance claims No Open State findings Additional explanation sheet attached.
90015_orcf-Redline.docx