Quarterly Report Jan – March 2016

1

The Illinois Department of Public Health has initiated action, as indicated, against the following facilities which have been determined to be in violation of the Nursing Home Care Act, or has recommended decertification to the Director of the Department of Healthcare and Family Service, or the Secretary of the United States Department of Health and Human Services for violations in relation to patient care, pursuant to Titles XVIII and XIX of the Federal Social Security Act. FACILITY NAME: Alden Des Plaines Rehab & HC FACILITY ADDRESS: 1221 East Golf Road FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016 DOCKET NUMBER: NH 16-C0023 LICENSEE INFO: Des Plaines Rehabilitation and Health Care Center, Inc LICENSEE ADDRESS: 4200 West Peterson Ave LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 12/22/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Alden Estates of Orland Park FACILITY ADDRESS: 16450 South 97th Avenue FACILITY CITY, STATE, ZIP: Orland Park, IL 60462 DOCKET NUMBER: NH 15-C0413 LICENSEE INFO: Alden-Orland Park Rehabilitation and Health Care Center, Inc. LICENSEE ADDRESS: 4200 W. Peterson Ave, Ste 140 LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 08/05/2015 FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn. FACILITY NAME: Alden Village Health Facility FACILITY ADDRESS: 267 East Lake Street FACILITY CITY, STATE, ZIP: Bloomingdale, IL 60108 DOCKET NUMBER: NH 16-S0040 LICENSEE INFO: Alden Village Health Facility for Children and Young Adults LICENSEE ADDRESS: 4200 W. Peterson Avenue, Ste 140 LICENSEE CITY, STATE, ZIP: Chicago, IL 60646 Survey Date – 11/20/2015 Type B violation for violating one or more sections: 350.3240. No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Aperion Care Colfax FACILITY ADDRESS: 402 South Harrison FACILITY CITY, STATE, ZIP: Colfax, IL 61728 DOCKET NUMBER: NH 16-C0056 LICENSEE INFO: Aperion Care Colfax, LLC LICENSEE ADDRESS: 801 Adlai Stevenson Drive LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 12/31/2015 Type B violation for violating one or more sections: 300.1230k). No fine FACILITY NAME: Aperion Care Colfax FACILITY ADDRESS: 402 South Harrison FACILITY CITY, STATE, ZIP: Colfax, IL 61728 DOCKET NUMBER: NH 16-S0129 LICENSEE INFO: Aperion Care Colfax, LLC LICENSEE ADDRESS: 801 Adlai Stevenson Drive LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 03/15/2016 Type B violation for violating one or more sections: 300.670k)1)2)3). No fine Type B violation for violating one or more sections: 300.696a)c)6). No fine Type B violation for violating one or more sections: 300.1210d)1). No fine Type B violation for violating one or more sections: 300.1220a)1)2). No fine Type B violation for violating one or more sections: 300.2210b)2). No fine Type B violation for violating one or more sections: 300.3260c). No fine FACILITY NAME: Aperion Care International FACILITY ADDRESS: 4815 South Western Avenue FACILITY CITY, STATE, ZIP: Chicago, IL 60609 DOCKET NUMBER: NH 16-C0109 LICENSEE INFO: International Nursing & Rehab Center, LLC LICENSEE ADDRESS: 8131 N. Monticello LICENSEE CITY, STATE, ZIP: Skokie, IL 60076 Survey Date – 01/26/2016 Type B violation for violating one or more sections: 300.690B). No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Arba Care Ctr of Bloomington FACILITY ADDRESS: 1509 N. Calhoun Street FACILITY CITY, STATE, ZIP: Bloomington, IL 61701 DOCKET NUMBER: NH 16-S0002 LICENSEE INFO: Arba Care Center of Bloomington, LLC LICENSEE ADDRESS: 134 N. McLean Blvd LICENSEE CITY, STATE, ZIP: Elgin, IL 60123 Survey Date – 11/30/2015 Type B violation for violating one or more sections: 300.3100d)2). No fine FACILITY NAME: Arden Courts of Glen Ellyn FACILITY ADDRESS: 2 South 706 Park Boulevard FACILITY CITY, STATE, ZIP: Glen Ellyn, IL 60137 DOCKET NUMBER: NH 16-S0043 LICENSEE INFO: Arden Courts of Glen Ellyn IL, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 12/08/2015 Type B violation for violating one or more sections: 330.7103)F). No fine Type B violation for violating one or more sections: 330.780a), 330.780b), and 330.780c). No fine Type B violation for violating one or more sections: 330.4240f). No fine Type B violation for violating one or more sections:330.1155b), 330.1155c), and 330.1155e)1)2)3). No fine Type B violation for violating one or more sections: 330.765a), 330.765b), and 330.765c). No fine Type B violation for violating one or more sections: 330.1710f)1). No fine Type B violation for violating one or more sections: 330.911. No fine Administrative Warning for violating the following section of the Code: 330.720e)1)2)3). No fine Administrative Warning for violating the following section of the Code: 330.1950c), 330.19501)A)B)C), 330.19502)A), 330.1950i), 330.1950g), and 330.19501)A). No fine Administrative Warning for violating the following section of the Code:330.1510a)4). No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Aria Post Acute Care FACILITY ADDRESS: 4600 North Frontage Road FACILITY CITY, STATE, ZIP: Hillside, IL 60162 DOCKET NUMBER: NH 16-C0074 LICENSEE INFO: Symphony Aria, LLC LICENSEE ADDRESS: 801 Adlia Stevenson Drive LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 01/04/2016 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00. FACILITY NAME: Asbury Gardens Nrsg & Rehab FACILITY ADDRESS: 212 Airport Road FACILITY CITY, STATE, ZIP: North Aurora, IL 60542 DOCKET NUMBER: NH 16-C0004 LICENSEE INFO: Asbury Pavilion Nursing & Rehabilitation Center, LLC LICENSEE ADDRESS: 8170 McCormick Blvd, Ste 104 LICENSEE CITY, STATE, ZIP: Skokie, IL 60076 Survey Date – 12/03/2015 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.610c)4), 300.1210a), 300.1210b)3), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)6) and 300.3240a). A fine of $25,000.00. FACILITY NAME: Auburn Rehab & HCC FACILITY ADDRESS: 304 Maple Avenue FACILITY CITY, STATE, ZIP: Auburn, IL 62615 DOCKET NUMBER: NH 16-S0076 LICENSEE INFO: Auburn Nursing and Rehabilitation Center. L.L.C. LICENSEE ADDRESS: 412 E. Lawrence LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 01/22/2016 Type B violation for violating one or more sections: 300.610a), 300.1010h), 300.1210a), 300.1210d)5), and 300.3240a). No fine Type B violation for violating one or more sections: 300.610a), 300.1210d)6), 300.3240a) No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Ballard Respiratory and Rehab FACILITY ADDRESS: 9300 Ballard Road FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016 DOCKET NUMBER: NH 16-S0008 LICENSEE INFO: Ballard Respiratory and Rehabilitation Center, LLC LICENSEE ADDRESS: 55 W. Monroe Street, Ste 2400 LICENSEE CITY, STATE, ZIP: Chicago, IL 60603 Survey Date – 10/26/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Ballard Respiratory and Rehab FACILITY ADDRESS: 9300 Ballard Road FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016 DOCKET NUMBER: NH 16-C0009 LICENSEE INFO: Ballard Respiratory and Rehabilitation Center, LLC LICENSEE ADDRESS: 55 W. Monroe St., Ste 2400 LICENSEE CITY, STATE, ZIP: Chicago, IL 60603 Survey Date – 11/25/2015 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210c), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00. FACILITY NAME: Ballard Respiratory and Rehab FACILITY ADDRESS: 9300 Ballard Road FACILITY CITY, STATE, ZIP: Des Plaines, IL 60016 DOCKET NUMBER: NH 16-C0093 LICENSEE INFO: Ballard Respiratory and Rehabilitation Center, LLC LICENSEE ADDRESS: 55 W. Monroe Street. Ste 2400 LICENSEE CITY, STATE, ZIP: Chicago, IL 60603 Survey Date – 01/07/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

Quarterly Report Jan – March 2016

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FACILITY NAME: Bement Health Care Center FACILITY ADDRESS: 601 North Morgan FACILITY CITY, STATE, ZIP: Bement, IL 61813 DOCKET NUMBER: NH 16-S0128 LICENSEE INFO: Petersen Health Quality, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 03/10/2016 Type B violation for violating one or more sections: 300.615a)e). No fine Type B violation for violating one or more sections: 300.626c). No fine FACILITY NAME: Bridgeway Senior Living FACILITY ADDRESS: 111 East Washington Street FACILITY CITY, STATE, ZIP: Bensenville, IL 60106 DOCKET NUMBER: NH 16-S0032 LICENSEE INFO: Bridgeway Senior Living, LLC LICENSEE ADDRESS: 5750 Old Orchard Rd, Ste 420 LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 11/20/2015 Type B violation for violating one or more sections 300.625. No fine FACILITY NAME: Bryan Manor FACILITY ADDRESS: 2150 East McCord FACILITY CITY, STATE, ZIP: Centralia, IL 62801 DOCKET NUMBER: NH 16-S0073 LICENSEE INFO: Penta Group, Inc. LICENSEE ADDRESS: 623 E. Broadway LICENSEE CITY, STATE, ZIP: Centralia, IL 62801 Survey Date – 01/21/2016 Type B violation for violating one or more sections: 350.620a), and 350.1210. No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Casey Health Care Center FACILITY ADDRESS: 100 North East 15th FACILITY CITY, STATE, ZIP: Casey, IL 62420 DOCKET NUMBER: NH 16-S0046 LICENSEE INFO: Petersen Management Company, LLC LICENSEE ADDRESS: 830 West Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 01/08/2016 Type B violation for violating one or more sections: 300.163a)b)c)d)e)f)g)h)i), and 300.7000a)b). No fine FACILITY NAME: Christian Nursing Home FACILITY ADDRESS: 1507 7th Street FACILITY CITY, STATE, ZIP: Lincoln, IL 62656 DOCKET NUMBER: NH 16-S0078 LICENSEE INFO: Christian Homes, Inc. LICENSEE ADDRESS: 200 N. Postville Drive LICENSEE CITY, STATE, ZIP: Lincoln, IL 62656 Survey Date – 01/28/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Clark-Lindsey Village FACILITY ADDRESS: 101 West Windsor Road FACILITY CITY, STATE, ZIP: Urbana, IL 61801 DOCKET NUMBER: NH 16-S0031 LICENSEE INFO: Clark-Lindsey Village, Inc. LICENSEE ADDRESS: 1729 Georgetown Drive LICENSEE CITY, STATE, ZIP: Champaign, IL 61821 Survey Date – 12/18/2015 Type B violation for violating one or more sections: 300.840. No fine. Type B violation for violating one or more sections: 300.2100. No fine. Type B violation for violating one or more sections:330.2000. No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Clayberg, The FACILITY ADDRESS: East Monroe Street FACILITY CITY, STATE, ZIP: Cuba, IL 61427 DOCKET NUMBER: NH 16-C0138 LICENSEE INFO: Fulton County LICENSEE ADDRESS: 100 N. Main Street LICENSEE CITY, STATE, ZIP: Lewistown, IL 61542 Survey Date – 02/23/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3240a), and 300.3240e). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.3240a) and 300.3240e). A fine of $2,200.00. FACILITY NAME: Concordia Village Care Center FACILITY ADDRESS: 4101 West Iles Avenue FACILITY CITY, STATE, ZIP: Springfield, IL 62711 DOCKET NUMBER: NH 16-C0079 LICENSEE INFO: Lutheran Senior Services LICENSEE ADDRESS: 208 So. LaSalle Street, Ste 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 01/19/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Danville Care Center FACILITY ADDRESS: 1700 North Bowman FACILITY CITY, STATE, ZIP: Danville, IL 61832 DOCKET NUMBER: NH 16-C0108 LICENSEE INFO: Danville Care Center, LTD LICENSEE ADDRESS: 5750 Old Orchard Road, Ste 420 LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 02/25/2016 Type B violation for violating one or more sections: 300.690b)c). No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Daystar Nursing & Rehab Center FACILITY ADDRESS: 2001 Cedar Street FACILITY CITY, STATE, ZIP: Cairo, IL 62914 DOCKET NUMBER: NH 16-C0007 LICENSEE INFO: Daystar Nursing and Rehabilitation Center, LLC LICENSEE ADDRESS: 8170 McCormick Blvd, Ste 219 LICENSEE CITY, STATE, ZIP: Skokie, IL 60078 Survey Date – 12/11/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00 FACILITY NAME: Decatur Rehab & Health Care Ct. FACILITY ADDRESS: 136 South Dipper Lane FACILITY CITY, STATE, ZIP: Decatur, IL 62522 DOCKET NUMBER: NH 16-C0077 LICENSEE INFO: Petersen Health & Wellness, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 01/21/2016 Type B violation for violating one or more sections: 300.610, 300.1010h), 300.1210b), 300.1210d)5), 300.3240a). No fine FACILITY NAME: Elm Brook Healthcare & Rehab FACILITY ADDRESS: 127 West Diversey Avenue FACILITY CITY, STATE, ZIP: Elmhurst, IL 60126 DOCKET NUMBER: NH 16-S0117 LICENSEE INFO: Elmbrook Skilled Nursing Facility, LLC LICENSEE ADDRESS: 7040 North Ridgeway Avenue LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 02/24/2016 Type B violation for violating one or more sections: 300.2040b). No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Elmwood Care FACILITY ADDRESS: 7733 West Grand Avenue FACILITY CITY, STATE, ZIP: Elmwood Park. O: 60707 DOCKET NUMBER: NH 16-S0069 LICENSEE INFO: Elmwood Care, Inc. LICENSEE ADDRESS: 6840 N. Lincoln Avenue LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 01/21/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210a), 300.1210b), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Forest City Rehab & Nrsg Ctr. FACILITY ADDRESS: 321 Arnold Avenue FACILITY CITY, STATE, ZIP: Rockford, IL 61108 DOCKET NUMBER: NH 16-C0020 LICENSEE INFO: Forest City Rehab and Nursing Center, LLC LICENSEE ADDRESS: 4711 Golf Rd, Ste 200 LICENSEE CITY, STATE, ZIP: Skokie, IL 60076 Survey Date – 12/16/2015

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2, 200.00. Administrative Warning for violating the following section of the Code: 300.690b) and 300.690c). FACILITY NAME: Genesis Senior Living FACILITY ADDRESS: 309 NW 9th Avenue FACILITY CITY, STATE, ZIP: Aledo, IL 61231 DOCKET NUMBER: NH 16-S0110 LICENSEE INFO: Genesis Senior Living, Aledo LICENSEE ADDRESS: 801 Illini Drive LICENSEE CITY, STATE, ZIP: Silvis, IL 61282 Survey Date – 02/18/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation 300.1210b), 300.1210d)6), and 300.3240a). A fine of $2,200.00. Administrative Warning for violating the following section of the Code: 300.1230k). No fine.

Quarterly Report Jan – March 2016

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FACILITY NAME: Good Samaritan - Flanagan FACILITY ADDRESS: 205 North Adams Street FACILITY CITY, STATE, ZIP: Flanagan, IL 61740 DOCKET NUMBER: NH 16-S0082 LICENSEE INFO: Good Samaritan Home of Flanagan Illinois LICENSEE ADDRESS: 205 North Adams Street LICENSEE CITY, STATE, ZIP: Flanagan, IL 61740 Survey Date – 01/21/2016

Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00. FACILITY NAME: Greek American Rehab & Care Ct. FACILITY ADDRESS: 220th First Street FACILITY CITY, STATE, ZIP: Wheeling, IL 60090 DOCKET NUMBER: NH 16-C0005 LICENSEE INFO: The Greek American Rehabilitation and Care Centre, Inc LICENSEE ADDRESS: 220 North First Street LICENSEE CITY, STATE, ZIP: Wheeling, IL 60090 Survey Date – 12/09/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)5), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b)5), 300.1210d)6) and 300.3240a). A fine of $2.200.00 FACILITY NAME: Grove at the Lake, The FACILITY ADDRESS: 2534 Elim Avenue FACILITY CITY, STATE, ZIP: Zion, IL 60099 DOCKET NUMBER: NH 16-S0122 LICENSEE INFO: Grove at the Lake Skilled Nursing Facility, LLC LICENSEE ADDRESS: 7040 North Ridgeway Avenue LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 02/18/2016 Type B violation for violating one or more sections: 300.1210b)3). No fine

Quarterly Report Jan – March 2016

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FACILITY NAME: Grove of LaGrange Park, The FACILITY ADDRESS: 701 North LaGrange Park FACILITY CITY, STATE, ZIP: LaGrange Park, IL 60526 DOCKET NUMBER: NH 16-S0086 LICENSEE INFO: LaGrange Skilled Nursing Facility, LLC LICENSEE ADDRESS: 7040 North Ridgeway Avenue LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 02/18/2016 Type B violation for violating one or more sections: 300.1210a), 300.1210d)(a)2), 300.1810c)2), 300.1810c)3), and 300.1820c)3). No fine Administrative Warning for violating the following section of the Code: 300.2100. No fine FACILITY NAME: Grove of Northbrook, The FACILITY ADDRESS: 263 Skokie Boulevard FACILITY CITY, STATE, ZIP: Northbrook, IL 60062 DOCKET NUMBER: NH 16-S0096 LICENSEE INFO: Northbrook Skilled Nursing Facility, LLC LICENSEE ADDRESS: 7040 North Ridgeway Avenue LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 02/18/2016 Type B violation for violating one or more sections: 300.1620a. No fine Type B violation for violating one or more sections: 300.3220f) and 300.696a). No fine Type C violation for violating one or more sections: 300.2040b and 300.2090a)b). No fine Type C violation for violating one or more sections: 300.2210b)1)3)9 and 300.2930c)4). No fine Type C violation for violating one or more sections: 300.1210d)4). No fine FACILITY NAME: Heartland of Decatur FACILITY ADDRESS: 444 West Harrison Street FACILITY CITY, STATE, ZIP: Decatur, IL 62526 DOCKET NUMBER: NH 16-C0123 LICENSEE INFO: Heartland of Decatur IL, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 01/30/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1010h), 300.1210b), 300.1210d)1), 300.1210d)2), 300.1210d)3), 300.1610a)1), 300.1610d) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200.00

Quarterly Report Jan – March 2016

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FACILITY NAME: Helia Healthcare of Champaign FACILITY ADDRESS: 1915 S. Mattis Street FACILITY CITY, STATE, ZIP: Champaign, IL 61821 DOCKET NUMBER: NH 16-S0131 LICENSEE INFO: Helia Healthcare of Champaign, LLC LICENSEE ADDRESS: 118 W. Edwards Street, Ste 200 LICENSEE CITY, STATE, ZIP: Springfield, IL 62704 Survey Date – 02/19/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)4), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Helia Healthcare of Energy-DD FACILITY ADDRESS: 210 East College FACILITY CITY, STATE, ZIP: Energy, IL 62933 DOCKET NUMBER: NH 16-C0107 LICENSEE INFO: Helia Healthcare of Energy, L.L.C. LICENSEE ADDRESS: 600 South 2nd Street LICENSEE CITY, STATE, ZIP: Springfield, IL 62704 Survey Date – 02/02/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.2040b), 300.2040g), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation 300.1210b), and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Heritage Health – Mt. Zion FACILITY ADDRESS: 1225 Woodland Drive FACILITY CITY, STATE, ZIP: Mt. Zion, IL 62549 DOCKET NUMBER: NH 16-S0072 LICENSEE INFO: Heritage Manor – Mt. Zion, LLC LICENSEE ADDRESS: 115 W. Jefferson Street, Ste 400 LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701 Survey Date – 01/22/2016 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)5), 300.1210d)6), 300.1220b)2), 300.1220b)7) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b)5), 300.1210d)6) and 300.3240a). A fine of $25,000.00.

Quarterly Report Jan – March 2016

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FACILITY NAME: Heritage Health – Normal FACILITY ADDRESS: 509 N. Adelaide FACILITY CITY, STATE, ZIP: Normal, IL 61761 DOCKET NUMBER: NH 16-S0047 LICENSEE INFO: Heritage Manor – Normal, LLC LICENSEE ADDRESS: 115 W. Jefferson Street, Ste 401 LICENSEE CITY, STATE, ZIP: Bloomington, IL 61701 Survey Date – 01/07/2016 Type B violation for violating one or more sections: 300.615e) and 300.615f). No fine Type B violation for violating one or more sections:300.626c) and 300.627c). No fine Type B violation for violating one or more sections: 300.7040e). No fine Administrative Warning for violating the following section of the Code: 300.7050e)f). No fine Administrative Warning for violating the following section of the Code: 300.7020b)1)8). No fine FACILITY NAME: Hillsboro Rehab & HCC FACILITY ADDRESS: 1300 East Tremont Street FACILITY CITY, STATE, ZIP: Hillsboro, IL 62049 DOCKET NUMBER: NH 15-S0397 LICENSEE INFO: Hillsboro Rehabilitation and Health Care Center, LLC LICENSEE ADDRESS: 412 E. Lawrence LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 08/19/2015 FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn. FACILITY NAME: Holland Terrace FACILITY ADDRESS: 15175 State Street FACILITY CITY, STATE, ZIP: South Holland, IL 60473 DOCKET NUMBER: NH 16-S0081 LICENSEE INFO: Pioneer Concepts, Inc. LICENSEE ADDRESS: 285 South Farnham Street LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401 Survey Date – 01/26/2016 Type B violation for violating one or more of the following sections of the Code: 350.620a), 350.1010e), 350.1060a), 350.1210, and 350.3240a). A fine of $550.00

Quarterly Report Jan – March 2016

15

FACILITY NAME: Hope Creek Care Center FACILITY ADDRESS: 4343 Kennedy Drive FACILITY CITY, STATE, ZIP: East Moline, IL 61244 DOCKET NUMBER: NH 16-S0097 LICENSEE INFO: Rock Island County LICENSEE ADDRESS: 1504 Third Avenue LICENSEE CITY, STATE, ZIP: Rock Island, IL 61201 Survey Date – 01/27/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections if the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A total fine of $2,200.00 FACILITY NAME: Illini Heritage Rehab & HC FACILITY ADDRESS: 1315 Curt Drive FACILITY CITY, STATE, ZIP: Champaign, IL 61820 DOCKET NUMBER: NH 16-S0113 LICENSEE INFO: Petersen Health Care – Illini, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 02/25/2016 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210d)6, 300.1220b)2), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation 300.1210b), 300.1210d)6), and 300.3240a). A fine of $25,000.00.

FACILITY NAME: Integrity HC of Godfrey FACILITY ADDRESS: 1623-29 W. Delmar Avenue FACILITY CITY, STATE, ZIP: Godfrey, IL 62035 DOCKET NUMBER: NH 16-C0042 LICENSEE INFO: Godfrey Healthcare & Rehabilitation Center, LLC LICENSEE ADDRESS: 8170 N. McCormick Blvd, Ste 219 LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 12/30/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b), 300.1210d)2), 300.1210d)5), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00.

Quarterly Report Jan – March 2016

16

FACILITY NAME: Lexington of Orland Park FACILITY ADDRESS: 14601 South John Humphrey Dr. FACILITY CITY, STATE, ZIP: Orland Park, IL 60462 DOCKET NUMBER: NH 16-C0018 LICENSEE INFO: Lexington Health Care Center of Orland Park, Inc. LICENSEE ADDRESS: 665 West North Avenue LICENSEE CITY, STATE, ZIP: Lombard, IL 60148 Survey Date – 12/07/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210d)3), 300.1210d)5), 300.1220b)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)5) and 300.3240a). A fine of $2,200.00 FACILITY NAME: Lexington of Wheeling FACILITY ADDRESS: 730 West Hintz Road FACILITY CITY, STATE, ZIP: Wheeling, IL 60090 DOCKET NUMBER: NH 16-S0045 LICENSEE INFO: Lexington Health Care Center of Wheeling, Inc. LICENSEE ADDRESS: 665 W. North Avenue LICENSEE CITY, STATE, ZIP: Lombard, IL 60148 Survey Date – 01/14/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)5), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)5) and 300.3240a). A fine of $2,200.00. Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.615e). No fine FACILITY NAME: Life’s Journey Mattoon FACILITY ADDRESS: 300 Lerna Road South FACILITY CITY, STATE, ZIP: Mattoon, IL 61938 DOCKET NUMBER: NH 15-S0539 LICENSEE INFO: MAS Senior Living, LLC LICENSEE ADDRESS: 70 W. Madison St., Ste. 3500 LICENSEE CITY, STATE, ZIP: Chicago, IL 60602 Survey Date – 12/18/2015 Type B violation for violating one or more sections:330.710a), 330.780a), and 330.110a)f). No fine Type B violation for violating one or more sections: 330.1930, 330.2000, 750.160a), 750.800e) and 330.3970f). No fine Administrative Warning for violating the following section of the Code:330.1120a). No fine

Quarterly Report Jan – March 2016

17

FACILITY NAME: Lutheran Home, The FACILITY ADDRESS: 6901 North Galena Road FACILITY CITY, STATE, ZIP: Peoria, IL 61614 DOCKET NUMBER: NH 16-C0067 LICENSEE INFO: Lutheran Hillside Village, Inc. LICENSEE ADDRESS: 6901 N. Galena Road LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 12/23/2015 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00. FACILITY NAME: Lutheran Home, The FACILITY ADDRESS: 6901 North Galena Road FACILITY CITY, STATE, ZIP: Peoria, IL 61614 DOCKET NUMBER: NH 16-C0102 LICENSEE INFO: Lutheran Hillside Village, Inc. LICENSEE ADDRESS: 6901 N. Galena Road LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 01/25/2016 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.3240a), 300.3240b), 300.3240d), and 300.3240e). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation 300.3240a), 300.3240d), 300.3240e). A fine of $25,000.00. FACILITY NAME: Magnolia Manor Shelter Care H FACILITY ADDRESS: 1100 Grant FACILITY CITY, STATE, ZIP: Eldorado, IL 62930 DOCKET NUMBER: NH 16-C0090 LICENSEE INFO: John Zink LICENSEE ADDRESS: 150 South Route 45, P. O. Box 250 LICENSEE CITY, STATE, ZIP: Louisville, IL 62858 Survey Date – 02/18/2016 Type B violation for violating one or more sections: 330.780a), 330.780b), 330.780c), 330.4240d) and 330.4240f). No fine

Quarterly Report Jan – March 2016

18

FACILITY NAME: Manorcare of Palos Hts East FACILITY ADDRESS: 7850 W. College Drive FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463 DOCKET NUMBER: NH 16-S0003 LICENSEE INFO: Manor Care of Palos Heights, IL., LLC LICENSEE ADDRESS: 208 S. LaSalle St. Ste 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 11/17/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00. FACILITY NAME: Manorcare of Westmont FACILITY ADDRESS: 512 East Ogden Avenue FACILITY CITY, STATE, ZIP: Westmont, IL 60559 DOCKET NUMBER: NH 16-S0017 LICENSEE INFO: Manor Care of Westmont, IL, LLC LICENSEE ADDRESS: 208 S. LaSalle Street, Ste 814 LICENSEE CITY, STATE, ZIP: Chicago, IL 60604 Survey Date – 12/11/2015 Type B violation for violating one or more sections:300.625m)n). No fine FACILITY NAME: Marigold Rehabilitation HCC FACILITY ADDRESS: 275 East Carl Sandberg Drive FACILITY CITY, STATE, ZIP: Galesburg, IL 61401 DOCKET NUMBER: NH 16-C0030 LICENSEE INFO: Petersen Health Network, LLC LICENSEE ADDRESS: 830 W. Trailcreek Dr. LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 12/02/2015 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A total fine of $25,000.00.

Quarterly Report Jan – March 2016

19

FACILITY NAME: Mattoon Rehab & HCC FACILITY ADDRESS: 2121 South 9th Street FACILITY CITY, STATE, ZIP: Mattoon, IL 61938 DOCKET NUMBER: NH 16-C0053 LICENSEE INFO: Mattoon Manor, LLC LICENSEE ADDRESS: 412 E. Lawrence LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 12/29/2015 Type B violation for violating one or more sections: 300.610a), 300.1010h), 300.1210b), and 300.3240a). No fine FACILITY NAME: Mid America Care Center FACILITY ADDRESS: 4920 North Kenmore Avenue FACILITY CITY, STATE, ZIP: Chicago, IL 60640 DOCKET NUMBER: NH 16-S0026 LICENSEE INFO: Mid America Care Center, L.L.C. LICENSEE ADDRESS: 4600 W. Touhy Avenue, Ste 200 LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 12/10/2015 Type B violation for violating one or more sections: 300.610a), 300.1210a), 300.1210b), 300.1220b)3), 300.1620a), 300.1630d), and 300.3240a). No fines Type B violation for violating one or more sections: 300.625j), 300.625k), and 300.625l. No fine FACILITY NAME: Moweaqua Rehab & HCC FACILITY ADDRESS: 525 South Macon Street FACILITY CITY, STATE, ZIP: Moweaqua, IL 62550 DOCKET NUMBER: NH 16-S0088 LICENSEE INFO: Moweaqua Rehabilitation & Health Care Center, LLC LICENSEE ADDRESS: 412 E. Lawrence Avenue LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 02/11/2016 Type B violation for violating one or more sections: 300.615e). No fine

Quarterly Report Jan – March 2016

20

FACILITY NAME: Parkway Manor FACILITY ADDRESS: 3116 Williamson County PKWY FACILITY CITY, STATE, ZIP: Marion, IL 62959 DOCKET NUMBER: NH 16-S0124 LICENSEE INFO: UDI #1, LLC LICENSEE ADDRESS: 285 South Farnham Street LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401 Survey Date – 02/09/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.696a), 300.696c)2), 300.696c)7), 300.1210b), 300.1210c)3) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.696, 300.1210b) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Piper City Rehab & Living Ctr FACILITY ADDRESS: 600 South Maple Street FACILITY CITY, STATE, ZIP: Piper City, IL 60959 DOCKET NUMBER: NH 16-S0127 LICENSEE INFO: Midwest Health Operations, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 02/10/2016

Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00

FACILITY NAME: Pleasant View & HCC FACILITY ADDRESS: 500 North Jackson Street FACILITY CITY, STATE, ZIP: Morrison, IL 61270 DOCKET NUMBER: NH 16-S0083 LICENSEE INFO: Petersen Health Operations III, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 01/29/2016 Type B violation for violating one or more sections: 300.661 and 300.615e). No fine Administrative Warning for violating the following section of the Code: 300.3130C04) and 300.3130C05). No fine.

Quarterly Report Jan – March 2016

21

FACILITY NAME: Plymouth Place FACILITY ADDRESS: 315 North LaGrange Road FACILITY CITY, STATE, ZIP: LaGrange Park, IL 60526 DOCKET NUMBER: NH 16-C0034 LICENSEE INFO: Plymouth Place, Inc. LICENSEE ADDRESS: 315 N. LaGrange Rd. LICENSEE CITY, STATE, ZIP: LaGrange, IL 60526 Survey Date – 12/14/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b), 300.1210d)3), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $2,200. FACILITY NAME: Presence Cor Mariae Center FACILITY ADDRESS: 3330 Maria Linden Drive FACILITY CITY, STATE, ZIP: Rockford, IL 61114 DOCKET NUMBER: NH 16-S0011 LICENSEE INFO: Presence Life Connections LICENSEE ADDRESS: 9223 West Saint Francis Road LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423 Survey Date – 11/19/2015 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1010h), 300.1210b)4), 300.1210d)1), 300.1210d)2), 300.1610a), 300.1630b) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b)and 300.3240a). A fine of $25,000.00. FACILITY NAME: Presence Cor Mariae Center FACILITY ADDRESS: 3330 Maria Linden Drive FACILITY CITY, STATE, ZIP: Rockford, IL 61114 DOCKET NUMBER: NH 16-S0011 LICENSEE INFO: Presence Life Connections LICENSEE ADDRESS: 9223 West Saint Francis Road LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423 Survey Date – 11/19/2015 FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn.

Quarterly Report Jan – March 2016

22

FACILITY NAME: Presence Pine View Care Center FACILITY ADDRESS: 611 Allen Lane FACILITY CITY, STATE, ZIP: St. Charles, IL 60174 DOCKET NUMBER: NH 15-S0415 LICENSEE INFO: Presence Life Connections LICENSEE ADDRESS: 9223 West Saint Francis Road LICENSEE CITY, STATE, ZIP: Frankfort, IL 60423 Survey Date – 08/21/2015 FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn. FACILITY NAME: Providence Palos Heights FACILITY ADDRESS: 13259 South Central Avenue FACILITY CITY, STATE, ZIP: Palos Heights, IL 60463 DOCKET NUMBER: NH 16-C0070 LICENSEE INFO: Providence Operations, LLC LICENSEE ADDRESS: 18601 N. Creek Drive, Ste A LICENSEE CITY, STATE, ZIP: Tinley Park, IL 60477 Survey Date – 01/08/2016 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $25,000.00. FACILITY NAME: Regency Rehabilitation Center FACILITY ADDRESS: 6631 Milwaukee Avenue FACILITY CITY, STATE, ZIP: Niles, IL 60714 DOCKET NUMBER: NH 16-C0035 LICENSEE INFO: Regency Rehabilitation Center, LLC LICENSEE ADDRESS: 6840 N. Lincoln Avenue LICENSEE CITY, STATE, ZIP: Lincolnwood, IL 60712 Survey Date – 12/16/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.

Quarterly Report Jan – March 2016

23

FACILITY NAME: Rosewood Care Ctr of Rockford FACILITY ADDRESS: 1660 S. Mulford Road FACILITY CITY, STATE, ZIP: Rockford, IL 61108 DOCKET NUMBER: NH 16-S0055 LICENSEE INFO: Bravo Care of Rockford, Inc. LICENSEE ADDRESS: 412 E. Lawrence LICENSEE CITY, STATE, ZIP: Springfield, IL 62703 Survey Date – 01/06/2016 Type B violation for violating one or more sections: 300.615e), and 300.1030d). No fine FACILITY NAME: Sandwich Rehab & HCC FACILITY ADDRESS: 902 East Arnold Street FACILITY CITY, STATE, ZIP: Sandwich, IL 60548 DOCKET NUMBER: NH 16-S0104 LICENSEE INFO: Petersen Health Business, LLC LICENSEE ADDRESS: 830 W. Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 01/22/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.2040b), 300.2040g), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation 300.1210b), and 300.3240a). A fine of $2,200.00. FACILITY NAME: Sharon Health Care Elms FACILITY ADDRESS: 3611 North Rochelle FACILITY CITY, STATE, ZIP: Peoria, IL 61604 DOCKET NUMBER: NH 16-C0021 LICENSEE INFO: Sharon Health Care Elms, Inc. LICENSEE ADDRESS: 465 Central Avenue, Ste 100 LICENSEE CITY, STATE, ZIP: Northfield, IL 60093 Survey Date – 12/17/2015 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), 300.1210d)6) and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b) and 300.3240a). A fine of $25,000.00.

Quarterly Report Jan – March 2016

24

FACILITY NAME: South Lawn Sheltered Care FACILITY ADDRESS: 512 South Franklin FACILITY CITY, STATE, ZIP: Bunker Hill, IL 62014 DOCKET NUMBER: NH 16-S0012 LICENSEE INFO: South Lawn Sheltered Care, Inc. LICENSEE ADDRESS: R.R. #1 Route 159, P.O. Box H LICENSEE CITY, STATE, ZIP: Bunker Hill, IL 62014 Survey Date – 12/09/2015 Type B violation for violating one or more sections: 330.725. No fine Type B violation for violating one or more sections: 330.920. No fine FACILITY NAME: South Lawn Sheltered Care FACILITY ADDRESS: 512 South Franklin FACILITY CITY, STATE, ZIP: Bunker Hill, IL 62014 DOCKET NUMBER: NH 16-C0133 LICENSEE INFO: South Lawn Sheltered Care, Inc. LICENSEE ADDRESS: R.R. 1 Route 159 LICENSEE CITY, STATE, ZIP: Bunker Hill, IL 62014 Survey Date – 01/24/2016

Type B violation for violating one or more sections: 330.3060g). No fine FACILITY NAME: Southview Manor Nursing Center FACILITY ADDRESS: 3311 South Michigan FACILITY CITY, STATE, ZIP: Chicago, IL 60616 DOCKET NUMBER: NH 16-C0075 LICENSEE INFO: SV Care, LLC LICENSEE ADDRESS: 1S433 Summitt Avenue, Ste 204 LICENSEE CITY, STATE, ZIP: Oakbrook Terrace, IL 60181 Survey Date – 01/14/2016 Type B violation for violating one or more sections: 300.625a), 300.625b), 300.625c)2), 300.625j), and 300.625n). No fine. Type B violation for violating one or more sections: 300.626c), and 300.626e). No fine

Quarterly Report Jan – March 2016

25

FACILITY NAME: St. Paul’s Home FACILITY ADDRESS: 1021 West E. Street FACILITY CITY, STATE, ZIP: Belleville, IL 62220 DOCKET NUMBER: NH 16-S0060 LICENSEE INFO: St. Paul’s Home LICENSEE ADDRESS: 23 Public Square # 300 LICENSEE CITY, STATE, ZIP: Belleville, IL 62220 Survey Date – 12/22/2015 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210b), 300.1210c), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00

FACILITY NAME: St. Paul’s Home FACILITY ADDRESS: 1021 West E. Street FACILITY CITY, STATE, ZIP: Belleville, IL 62220 DOCKET NUMBER: NH 16-S0060 LICENSEE INFO: St. Paul’s Home LICENSEE ADDRESS: 23 Public Square #300 LICENSEE CITY, STATE, ZIP: Belleville, IL 62220 Survey Date – 12/22/2015 FINAL ORDER – Violation Amended/Affirmed, Fine Assessment Reduced and/or Notice of Conditional License Withdrawn. FACILITY NAME: Stevens House FACILITY ADDRESS: 2182 Windish Drive FACILITY CITY, STATE, ZIP: Galesburg, IL 61401 DOCKET NUMBER: NH 16-S0054 LICENSEE INFO: Community Living Options, Inc. LICENSEE ADDRESS: 285 South Farnharm Street LICENSEE CITY, STATE, ZIP: Galesburg, IL 61401 Survey Date – 12/15/2015 Type A violation of an occurrence for violating one or more of the following sections of the Code: 350.620a), 350.1060e), 350.1210 and 350.3240a). A fine of $6250.00.

Quarterly Report Jan – March 2016

26

FACILITY NAME: The Elms FACILITY ADDRESS: 1212 Madelyn Avenue FACILITY CITY, STATE, ZIP: Macomb, IL 61455 DOCKET NUMBER: NH 16-S0066 LICENSEE INFO: McDonough County LICENSEE ADDRESS: One Courthouse Square, No. 7 LICENSEE CITY, STATE, ZIP: Macomb, IL 61455 Survey Date – 01/12/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210a), 300.1210b), 300.1210c), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b), 300.1210d)6) and 300.3240a). A fine of $2,200.00.

FACILITY NAME: Tower Hill Healthcare Center FACILITY ADDRESS: 759 Kane Street FACILITY CITY, STATE, ZIP: South Elgin, IL 60177 DOCKET NUMBER: NH 16-C0089 LICENSEE INFO: Tower Hill Rehabilitation, LLC LICENSEE ADDRESS: 7434 Skokie Blvd LICENSEE CITY, STATE, ZIP: Skokie, IL 60077 Survey Date – 01/13/2016 Type B violation of an occurrence for violating one or more of the following sections of the Code: 300.1210b)5), 300.1210d)6), and 300.3240a). The fine was doubled in this instance in accordance with 300.282i) and j)of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210d)6) and 300.3240a)/ A total fine of $2,200.00. FACILITY NAME: Tuscola Health Care Center FACILITY ADDRESS: 1203 Egyptian Trail FACILITY CITY, STATE, ZIP: Tuscola, IL 61953 DOCKET NUMBER: NH 16-S0100 LICENSEE INFO: Petersen Health Enterprises, L.L.C. LICENSEE ADDRESS: 830 West Trailcreek Drive LICENSEE CITY, STATE, ZIP: Peoria, IL 61614 Survey Date – 02/18/2016 Type B violation for violating one or more sections: 300.670a), 300.670c)1), and 300.670c)3). No fine Administrative Warning for violating the following section of the Code: 300.1230. No fine

Quarterly Report Jan – March 2016

27

FACILITY NAME: Waverly Place of Stockton FACILITY ADDRESS: 501 Front Street FACILITY CITY, STATE, ZIP: Stockton, IL 61085 DOCKET NUMBER: NH 16-S0058 LICENSEE INFO: Waverly Place of Stockton, LLC LICENSEE ADDRESS: 2711 W. Howard Street LICENSEE CITY, STATE, ZIP: Chicago, IL 60645 Survey Date – 01/20/2016 Type B violation for violating one or more sections: 300.2900d)2). No fine FACILITY NAME: Wesley Village FACILITY ADDRESS: 1200 East Grant Street FACILITY CITY, STATE, ZIP: Macomb, IL 61455 DOCKET NUMBER: NH 16-S0071 LICENSEE INFO: Wesley Village, Incorporated LICENSEE ADDRESS: 1200 East Grant Street LICENSEE CITY, STATE, ZIP: Macomb, IL 61455 Survey Date – 01/19/2016 Type A violation of an occurrence for violating one or more of the following sections of the Code: 300.610a), 300.1210a), 300.1210b), 300.1210c), and 300.1220b)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high risk designation: 300.1210b). A fine of $25, 000.00. Type B violation of an occurrence for violating the following section of the Code: 300.670). No fine. Administrative Warning for violating the following section of the Code: 300.615). No fine